Vital Signs:Newly Reported Acute and Chronic Hepatitis C Cases ― United States, 2009–2018

Abstract

Introduction: Hepatitis C is a leading cause of death from liver disease in the United States. Acute hepatitis C infection is often asymptomatic, and >50% of cases will progress to chronic infection, which can be life-threatening. Hepatitis C can be diagnosed with a blood test and is curable, yet new cases of this preventable disease are increasing.Methods: National Notifiable Diseases Surveillance System data were analyzed to determine the rate of acute hepatitis C cases reported to CDC by age group and year during 2009-2018 and the number and rate of newly reported chronic cases in 2018 by sex and age. The proportion of adults aged ≥20 years with hepatitis C who reported having ever been told that they had hepatitis C was estimated with 2015-2018 National Health and Nutrition Examination Survey data.Results: During 2018, a total of 3,621 cases of acute hepatitis C were reported, representing an estimated 50,300 cases (95% confidence interval [CI] = 39,800-171,600). The annual rate of reported acute hepatitis C cases per 100,000 population increased threefold, from 0.3 in 2009 to 1.2 in 2018, and was highest among persons aged 20-29 (3.1) and 30-39 years (2.6) in 2018. A bimodal distribution of newly reported chronic hepatitis C cases in 2018 was observed, with the highest proportions among persons aged 20-39 years and 50-69 years. Only 60.6% (95% CI = 46.1%-73.9%) of adults with hepatitis C reported having been told that they were infected.

Hepatitis C treatment uptake among people who inject drugs in the oral direct‐acting antiviral era

“…Although our cohort of PWID had a median age of 49 years, these results have implications for the current opioid epidemic that has been disparately driven by younger PWID, who now also make up the majority of newly diagnosed HCV cases 10,61,62 . We observed PWID with a shorter duration of IDU were less likely to have started HCV treatment, which likely includes younger PWID who initiated IDU during the current opioid epidemic.…”

Utilizing public health data to geotarget hepatitis C virus elimination approaches in urban and rural Michigan

“…The CDC recently endorsed new screening recommendations that advises all adults and pregnant women be tested for HCV, expanding screening recommendations beyond persons born between 1945 and 1965 and those with risk factors 1 . This expanded scope was based on a CDC report that found the number of newly reported chronic infections was approximately equal among younger and older adults 2 . Although we did not find a correlation between the proportion of young adults and HCV rates in urban or rural areas, Michigan did see a bimodal distribution of chronic HCV cases overall, with the highest proportions among persons aged 18‐29 years and baby boomers in 2017 4 .…”

“…The result is a demographic shift in new HCV cases from baby boomers to younger adults with histories of injection drug use (IDU), and an increasing number of cases in rural areas. 1,2 However, few studies have evaluated potential differences in HCV burden, demographics and access to treatment between urban and rural areas.…”

Screening for Hepatitis C Virus: How Universal Is Universal?

“…These changes resulted in a bimodal distribution of HCV cases across the age spectrum with a peak in young adults and a peak in baby boomers (figure). 18 The 2012 screening strategy recommended universal screening for one age group peak ("baby boomers," black box) and risk-based screening for the other peak group in young adults (gray box). It is an important caveat that the figures for the young adults from these state surveys resulted from risk-based screening or from those with acute symptoms of hepatitis, and thus the alarmingly high rates are likely to be an underestimate of the true prevalence in this population.…”

“…The outer gray box shows that for those individuals in the young adult group, they would be captured by using a risk-based screening strategy. Adapted from Suryaprasad et al 18 strategies were highly cost-effective when coupled with DAA therapy to cure those patients identified with HCV infection. 35e40 These calls to action led to task forces and subgroups meeting to review how and when the shift in strategy would take place.…”