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Despite the availability of a safe and effective vaccine against hepatitis B virus (HBV) infection in the United States, acute and chronic HBV cases continue to occur. Chronic HBV is associated with potential deadly complications, including cirrhosis and liver cancer. Because hepatitis C infection incidence has increased in some non-urban settings in this country, including Appalachia, and is associated with injection drug use, public health investigators conducted further investigation to determine the incidence of HBV infection in this region. They examined cases of acute HBV infection passively reported to the National Notifiable Diseases Surveillance System (NNDSS) from three Appalachian states (Kentucky, Tennessee, and West Virginia) b…