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Early in 2025, the Florida Department of Health (FDOH) noticed that an unusually large share of the state's hepatitis A cases were in people who had just been in Cuba. Its investigation found that between June 1, 2024 and February 28, 2026, 76 of 249 confirmed cases (31%) followed recent travel to Cuba — and that most of the viruses it could sequence were the same strain.
Why Florida looked
- Since 2024, Cuban news media have reported hepatitis A outbreaks in several provinces, tied to drinking water contaminated when sanitation and utility systems broke down. Cuba has not published official national surveillance figures.
- In December 2024, Cuba's Ministry of Public Health issued a tourist alert about rising cases; in August 2025, the U.S. Embassy in Cuba issued a health alert about more cases in Havana.
- About 1.8 million Cuban Americans live in Florida — 8% of its population — and many visit family and friends in Cuba regularly.
How cases were counted
FDOH interviews every reported hepatitis A patient and reviews their records. For this outbreak it counted a Florida resident with confirmed hepatitis A and symptoms starting in the study window who met at least one of:
- travel to, or emigration from, Cuba 15–50 days before symptoms began — the hepatitis A exposure window;
- a virus matching genotype IA outbreak strain 1, which had never been seen in Florida, or in CDC's Global Hepatitis Outbreak Surveillance Technology (GHOST) platform, before this outbreak;
- a link to a confirmed outbreak case.
79 cases (32%) qualified: the 76 travelers (including four recent emigrants), two people who could not be interviewed but carried the outbreak strain, and one household contact of a traveler.
Who got sick
| Among the 79 outbreak cases | |
|---|---|
| Median age | 39 |
| Male | 70% |
| Hispanic or Latino | 92% |
| Visited an emergency department | 76% |
| Hospitalized | 72% |
| Deaths | none |
| Counties of residence | 13 of Florida's 67 |
| Living in Miami-Dade | 46 (58%) |
Outbreak-associated cases by county: Miami-Dade 46, Palm Beach 8, Lee 6, Broward 5, Hillsborough 3, Brevard, Collier and Flagler 2 each, and Duval, Hernando, Manatee, Osceola and St. Lucie 1 each. Image from CDC's report
Travel itself was the risk. The median stay in Cuba was 11 days. Seven travelers had been around a family member there who was diagnosed with hepatitis A. Only three patients had any other known risk factor, and apart from one household case there was no sign of spread within Florida.
What travelers told investigators
In Broward, Miami-Dade and Palm Beach — the three counties with the most cases (59 of 79) — FDOH phoned patients with a longer travel questionnaire; 29 answered.
| Of those who answered | |
|---|---|
| Stayed in Havana | 16 (55%) |
| Stayed in other provinces (eight in all) | 14 (48%) |
| Stayed only with family or friends | 26 of 28 (93%) |
| Drank tap water | 12 (41%) |
| Drank bottled water | 20 (69%) |
| Drank boiled or filtered water | 4 (14%) |
| Had ice | 4 (14%) |
| Heard of hepatitis A cases or outbreaks while there | 13 (45%) |
Many drank from more than one source.
One strain, from one place
Virus from 18 outbreak cases, in five counties, was sequenced at FDOH's Bureau of Public Health Laboratories:
| Strain | Cases |
|---|---|
| Genotype IA outbreak strain 1 | 15 (83%) |
| Genotype IB strain 1 | 2 (11%) |
| Genotype IA strain 2 | 1 (6%) |
Strain 1 was first identified in a Florida case in February 2025. None of these sequences matched any pattern seen in Florida before the outbreak; sequences from Cuba itself weren't available. The findings fit widespread transmission across several regions of Cuba.
Hepatitis A cases in Florida by month of symptom onset and strain. Image from CDC's report
How unusual this is
| Period | Share of Florida hepatitis A cases linked to international travel |
|---|---|
| 2010–2017 | 34% |
| 2018–2019 (a large person-to-person outbreak) | 3.3% — and those travel cases mostly carried unrelated strains |
| June 2024–February 2026 | 47% — 32% tied to Cuba alone |
The risk is continuing: Florida has identified more cases since March 2026, with exposures in Cuba as recent as August 2026.
What to do
Before a trip to Cuba
- Get the hepatitis A vaccine — see CDC's advice for travelers to Cuba.
- Leaving within 2 weeks and at higher risk — over 40, immunocompromised, or living with chronic liver disease? Ask about immune globulin as well.
- Take care with food and water and wash your hands.
For clinicians
- In a patient with hepatitis A–compatible symptoms, ask about recent travel, and think of hepatitis A in anyone just back from Cuba.
Limits of the study
- Only 23% of outbreak cases had sequencing data, all from five counties.
- The travel questionnaire covered only 37% of cases, from three counties, so neither set may represent every case.
- Some questionnaires came up to 18 months after the illness, so answers may suffer from recall bias.
- Most patients spent part of their exposure window in Florida, so not every infection can be proven to have come from Cuba.
Sources
Based on Natnari Natalie Linwong, Marie K. Etienne, Anthoni Llau, Scot Menke, Shannon Patelsky, Natalia Cano and Timothy J. Doyle, "Hepatitis A Outbreak Associated with Cuba — Florida, June 2024–February 2026," MMWR, volume 75, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licencia: CC0 1.0 (dominio público) · Adaptado de www.cdc.gov
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