MMWR Morb Mortal Wkly Rep. 2019 Sep 6;68(35):766-770. doi: 10.15585/mmwr.mm6835a4.
Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water-associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971-2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water-associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971-2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency's (USEPA) public ground water system regulations. Individual water systems, which are not required to meet national drinking water standards, were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995-2009. No waterborne outbreaks were reported during 2009-2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.
甲型肝炎病毒（HAV）是一种 RNA 病毒，主要通过粪-口途径传播，在极少数情况下，会导致感染者肝衰竭和死亡。尽管美国很少报告与饮用水相关的甲型肝炎暴发（1），但 HAV 是在 1971 年至 2008 年期间与未经处理的地下水有关的暴发中报告的最常见病因（2），并且 HAV 在水中可保持数月的传染性（3）。本报告分析了 1971 年至 2017 年期间向水源性疾病和暴发监测系统（WBDOSS）报告的与饮用水相关的甲型肝炎暴发。在此期间，报告了 32 起暴发，导致 857 例病例，均发生在 2010 年之前。未经处理的地下水与 23 起（72%）暴发有关，导致报告的 585 例（68.3%）病例。在免疫实践咨询委员会（ACIP）甲肝疫苗接种建议*和美国环境保护署（USEPA）公共地下水系统法规出台后，报告的暴发显著减少。个体供水系统无需符合国家饮用水标准，是在 1995 年至 2009 年期间导致最后四起报告的甲型肝炎暴发的唯一受污染饮用水系统。在 2009 年至 2017 年期间未报告水传播暴发。水质检测和处理对于保护使用这些不受监管系统的人员免受 HAV 感染非常重要。
