CDC Underestimates Number of Acute HCV Infections

Lara C. Pullen, PhD

July 07, 2015

Formal surveillance by the Centers for Disease Control and Prevention (CDC) does a poor job of measuring the clinical diagnosis of acute hepatitis C virus (HCV) infection, according to a new report. Case ascertainment is negatively affected by incomplete clinician reporting, limitations of diagnostic testing, problematic case definitions, and imperfect data capture, and these problems persist despite automated electronic laboratory reporting.

Shauna Onofrey, MPH, from the Massachusetts Department of Public Health in Jamaica Plain, and colleagues published the results of their case series and chart review online June 30 in the Annals of Internal Medicine. The investigators reviewed medical records from two hospitals as well as a state correctional healthcare system in an effort to validate estimates of the incidence of acute HCV infection in their state.

Theirs was not a population-based survey of acute HCV infection, and thus they did not have an overall denominator with which to calculate incidence of disease.

The investigators identified 183 patients who were clinically diagnosed with acute HCV infection from 2001 to 2011. The majority (81.4%) of these patients were reported to the Massachusetts Department of Public Health for surveillance classification.

During that time, less than 1% of these cases were reported to the CDC, and the majority of the cases did not match the national case definition of acute infection. Reporting was also incomplete because of the requirements for negative hepatitis A and B laboratory results.

The authors had some suggestions to improve surveillance: "we agree with the decision to add seroconversion to the CDC's surveillance case definition of acute HCV infection in late 2012 to account for incident cases without need for an illness compatible with HCV infection, a criterion that is often absent, and to remove the requirement for negative test results for hepatitis A and B virus. Successful application of seroconversion as a criterion requires regular interval testing of high-risk patients. More detailed risk behavior history about specific injection practices and history of onset was extremely useful in a systematic screening for HCV infection in the Massachusetts state prison system, tripling the rate of identification."

In 2010, 850 acute HCV cases were reported to the CDC by local health authorities, and the CDC used this number to estimate a total of 17,000 cases annually. The current study suggests this is an underestimate.

Moreover, the lack of reported surveillance cases in Massachusetts stands in stark contrast to a growing HCV infection epidemic among adolescents and young adults in the state.

One coauthor reports receiving personal fees from AbbVie Pharmaceuticals outside the submitted work. Another coauthor reports receiving grants from the CDC during the conduct of the study. Dr. Kim reports receiving grants from the National Institutes of Health, personal fees from Bristol-Myers Squibb, and grants and personal fees from AbbVie Pharmaceuticals and Gilead Sciences during the conduct of the study. The other authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online June 30, 2015. Abstract


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