Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights Newly Reported Acute and Chronic Hepatitis C Cases—United States, 2009—2018, authored by Ryerson AB, Schillie S, Barker LK, Kupronis BA, Wester C., published in the Morbidity and Mortality Weekly Report on April 10, 2020.
What questions(s) does this study address?
- This study uses data from the National Notifiable Diseases Surveillance System (NNDSS) to study trends in acute and chronic Hepatitis C infection in the United States for the period 2009 through 2018. Data from the National Health and Nutrition Examination Survey (NHANES), 2015-2018, is used to estimate the proportion of adults aged 20 years and older with Hepatitis C who reported having ever been told that they were infected with Hepatitis C.
What are the major findings of this report/article?
- Historically, the highest prevalence of chronic Hepatitis C infection in the U.S. has been seen among baby boomers (persons born 1945 through 1965). However, in 2018 a bimodal age distribution of chronic Hepatitis C cases was observed with the largest proportion of cases among persons aged 20-39 years old (41.8%) and those aged 50-69 years (39.2%).
- In recent years, most new Hepatitis C infections have occurred among young adults, including persons of reproductive age. This trend is related to America’s ongoing opioid epidemic and associated with injection drug use. During 2009-2018, the number of reported acute Hepatitis C cases per 100,000 population increased threefold in the U.S. from 0.3 cases per 100,000 population in 2009 to 1.2 cases per 100,000 population in 2018. In 2018, the highest rates of acute Hepatitis C cases were seen among those aged 20-29 years (3.1 per 100,000) and 30-39 years (2.6 per 100,000).
- Among 2015-2018 NHANES participants (aged 20 years and older) who were confirmed Hepatitis C RNA positive, 61% reported having been told that they had Hepatitis C; 39% were unaware that they were infected.
What are the implications for the prevention and control of viral hepatitis?
- Diagnosing Hepatitis C infection is a necessary first step in eliminating viral hepatitis. People who are undiagnosed or unaware of their infection cannot take advantage of curative treatment and may continue to transmit the virus to others.
- Rapid increases in acute Hepatitis C infection among young adults, related to the nation’s ongoing opioid epidemic, have put multiple generations at risk for chronic Hepatitis C infection. As such, CDC is now recommending screening all adults (not just baby boomers) aged 18 years and older for Hepatitis C at least once in their lifetime and screening all pregnant women for Hepatitis C during each pregnancy. People with ongoing risk factors for Hepatitis C should be tested periodically, as long as the risk remains.
CDC’s new Hepatitis C testing recommendations can be found here.
