Screening for hepatitis C at the emergency department: Should babyboomers also be screened in Belgium?

Abstract

Background & Aims Patients are not screened adequately for hepatitis C virus infection in Belgium. In the USA, the Center for Disease Control recommends screening for patients born in the babyboom period (1945‐1965). In Europe, the babyboom cohort was born between 1955 and 1974, but no screening policy has been targeted to this group. We aimed to study the prevalence of hepatitis C virus in an emergency department population in Belgium and the risk factors associated with hepatitis C virus infection. Method We performed a monocentric, cross‐sectional seroprevalence study between January and November 2017 in a large Belgian non‐university hospital. Patients aged 18‐70 years presenting at the emergency department were eligible. Patients completed a risk assessment questionnaire and were screened for hepatitis C virus antibodies (Ab) with reflex hepatitis C virus ribonucleic acid testing. Results Of 2970 patients, 2366 (79.7%) agreed to participate. hepatitis C virus Ab prevalence was 1.31%. Twenty‐one (67.7%) hepatitis C virus Ab‐positive patients were born between 1955 and 1974. With a previous treatment uptake of 54.5%, the prevalence of viremia was 0.9% in retrospect; 0.2% were newly diagnosed. The weighted multiple logistic regression model identified males born in the 1955‐1974 cohort, intravenous drug use and high endemic birth country as significant risk factors for hepatitis C virus infection (P < 0.05). Conclusion Although the prevalence of hepatitis C virus Ab at the emergency department was higher than previously estimated for the general population in Belgium, the number of newly diagnosed patients with viremia was low. To optimize screening strategies, screening should be offered to males born in the 1955‐1974 cohort, but especially in drug users, the prison population and immigrants from high endemic countries.

Hepatitis C in two general practices in Flanders, Belgium: is there a need to reconsider current screening recommendations?

“…As expected patients of the baby boom cohort were more likely to have an HCV infection [15]. Although this was contested in other recent prevalence studies [5,16].…”

“…The other variables were binominal. In former studies the association between the baby boom generation and HCV infection varies among countries [5,18]; therefore, we created an extra variable by combining origin and birth cohort. Before 1990 transfused blood was not tested on HCV, which implies that baby boomers who had received a blood transfusion in that period are at higher risk for an HCV infection [15].…”

“…One of the main barriers to tackle HCV is that many patients are unaware of their infection status. The lack of reliable estimates of the undiagnosed population has become one of the main challenges to scale-up screening and prevention programs for HCV [5]. Correct prevalence information is important to install a feasible screening strategy and it can also help to estimate the global cost to cure infected patients [5].…”

“…The lack of reliable estimates of the undiagnosed population has become one of the main challenges to scale-up screening and prevention programs for HCV [5]. Correct prevalence information is important to install a feasible screening strategy and it can also help to estimate the global cost to cure infected patients [5]. In Belgium, until recently the seroprevalence of HCV antibodies, guided by the first Belgian nationwide HCV prevalence study from 1993 to 1994, was estimated 0.87% [6].…”

Identification and treatment of viral hepatitis C in persons who use drugs: a prospective, multicenter outreach study in Flanders, Belgium

“…The questionnaire was available in Dutch, French, and English and covered a total of 22 questions. Data from the questionnaire included birth gender, year of birth that was categorized into: < 1955, 1955–1974, and > 1974 based on the European baby-boom cohort [ 25 ], source of income, level of education, housing past 6 months, ever have been incarcerated, alcohol abuse (> 14 units women or > 21 units men per week), age of first drug use, kind of drugs (ever, past 6 months), manner of drug use, frequency of drug use (past 6 months), kind of intravenous (IV) drugs (ever, past 6 months), frequency of IV drug use (past 6 months), sharing IV-related paraphernalia (ever, past 6 months) receiving OAT, connected to an NSP.…”