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A hepatitis A virus (HAV) investigation in North Carolina demonstrated that wastewater monitoring detections preceded identification of 2 clinical cases by 12 days. State and local health officials used a preestablished decision tree to respond to wastewater detections of HAV and implement public health actions. The investigation determined that HAV detected in wastewater was likely from 2 people who had not yet developed symptoms or sought testing at the time of detection, providing early information for public health response, including vaccination of family members. Targeted outreach to hospitals as well as medically or socially vulnerable groups at high risk of HAV infection could be recommended in response to consistent HAV detections in wastewater.<\/jats:p>","DOI":"10.1177\/00333549251378101","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T10:02:06Z","timestamp":1762164126000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Public Health Response to Consecutive Hepatitis A Detections in Wastewater, North Carolina, 2024"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3925-1475","authenticated-orcid":false,"given":"Ariel","family":"Christensen","sequence":"first","affiliation":[{"name":"Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ty","family":"Lautenschlager","sequence":"additional","affiliation":[{"name":"Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Rimer","sequence":"additional","affiliation":[{"name":"Communicable Disease Team, Forsyth County Department of Public Health, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Doran","sequence":"additional","affiliation":[{"name":"Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Albertson","sequence":"additional","affiliation":[{"name":"Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura","family":"Trimble","sequence":"additional","affiliation":[{"name":"Communicable Disease Team, Forsyth County Department of Public Health, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Shanker","sequence":"additional","affiliation":[{"name":"Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Swift","sequence":"additional","affiliation":[{"name":"Communicable Disease Team, Forsyth County Department of Public Health, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"A.","sequence":"additional","affiliation":[{"name":"Section on Infectious Diseases, Wake Forest University School of Medicine, Winston Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"North Carolina Department of Health and Human Services COVID-19 Response. 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