Acute Hepatitis C Infections Triple from 2009-2018

The annual rate of acute hepatitis C infections reported to the US Centers for Disease Control and Prevention (CDC) tripled between 2009 and 2018. Health officials are calling upon all adults to be tested for the blood-borne disease.

An analysis of National Notifiable Diseases Surveillance System data found that 3621 cases of acute hepatitis C were reported in 2018, and acute cases per 100,000 population tripled from 0.3 in 2009 to 1.2 in 2018, according to a recent Morbidity and Mortality Weekly Report.

“To stop hepatitis C, we must radically transform the way we screen for this disease,” Carolyn Wester, MD, MPH, director of CDC’s Division of Viral Hepatitis told Contagion^®.

“We must expand testing to all adults, increase the proportion of hepatitis C diagnoses among people with the disease, and help people to access treatment—which can cure hepatitis C and ultimately prevent further transmission.”

The rate of hepatitis C infection increased most among people in their 20s, with 3.1 cases per 100,000 population reported in 2018 up from 0.7 in 2009, followed by people in their 30s, who saw 2.6 cases per 100,000 population, up from 0.5.

“These are dramatic increases in a relatively short timeframe,” Wester told Contagion^®. “These increases among reproductive-aged adults are additionally concerning given hepatitis C can be transmitted from mother to infant during pregnancy or childbirth.

“It’s also important to note that new hepatitis C virus infections reported to CDC have increased regardless of age since 2009. The opioid crisis has shifted the course of the hepatitis C epidemic, and no single generation is safe from the disease. Therefore, CDC is now recommending that all adults be tested for the disease at least once in their lifetime and that pregnant women be tested during every pregnancy.”

The CDC detailed these new recommendations for hepatitis C screening in a separate Morbidity and Mortality Weekly Report released this month.

The disease is primarily transmitted through blood exposure from injection drug use, sexual transmission or from mother to baby during pregnancy or childbirth. A paper published recently in Open Forum Infectious Diseases showed that injecting drugs and participating in receptive needle sharing was associated with a nearly 2-fold increase in the risk of hepatitis C infection.

The number of cases reported to the CDC underestimate actual incidence, and the CDC estimates there are 13.9 actual cases for every case reported. With 3621 cases of acute hepatitis C infection reported, the CDC estimates the actual incidence in 2018 was more than 50,000. According to the report, 137,713 new chronic hepatitis C cases were reported in 2018, with the largest portion among adults ages 20-39. About 2.4 million people were living with chronic hepatitis C infections between 2013 and 2016.

“While we’ve known for several years that new infections have been increasing in younger adults, seeing data showing that younger adults made up the majority of chronic diagnosis in 2018 is sobering,” Wester told Contagion^®.

Recommendations for screening began in 1991 and have been expanded to include people at risk and those born from 1945—1965.

More than 39% of adults with hepatitis C infection are unaware they are infected, according to the report. While hepatitis C is diagnosable and curable, more than half of cases progress to chronic infection, and the disease is a leading cause of morbidity and mortality from liver disease.

“Clinicians play a vital role in hepatitis C mitigation efforts,” Wester told Contagion^®. “Health care settings such as emergency departments, health clinics, and primary care settings can play a critical role in diagnosing, treating, and reducing transmission of this disease.

“Additionally, services for people at increased risk for hepatitis C (such as people who inject drugs) can play a critical role in diagnosing, treating, and reducing transmission of this disease. This includes syringe service programs, substance use disorder programs, and medication-assisted treatment programs; as well as health care settings.”

More research is needed to determine optimal frequency of testing for people at high risk and timing for testing during pregnancy along with treatment and prevention of transmission from pregnant mother to child.