Vital Signs

Newly Reported Acute and Chronic Hepatitis C Cases — United States, 2009–2018

A. Blythe Ryerson, PhD; Sarah Schillie, MD; Laurie K. Barker, MSPH; Benjamin A. Kupronis, MPH; Carolyn Wester, MD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(14):399-404. 

In This Article

Abstract and Introduction

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.

Conclusions and Implications for Public Health Practice: Increasing rates of acute hepatitis C among young adults, including reproductive-aged persons, have put multiple generations at risk for chronic hepatitis C. The number of newly reported chronic infections was approximately equal among younger and older adults in 2018. The new CDC hepatitis C testing recommendations advise screening all adults and pregnant women, not just persons born during 1945–1965, and those with risk factors.

Introduction

Hepatitis C is a leading cause of morbidity and mortality from liver disease, costing the U.S. health care system billions of dollars annually.[1,2] Hepatitis C virus (HCV) is primarily transmitted through direct percutaneous exposure to blood through injection drug use, but can also be transmitted sexually or from an infected mother to her infant during pregnancy or childbirth. HCV can cause an acute infection (acute hepatitis C), followed in some cases by chronic infection (chronic hepatitis C). Persons with acute hepatitis C are typically asymptomatic or have only a mild clinical illness. Acute hepatitis C infection might clear completely without any treatment, but >50% of infections will progress to chronic hepatitis C, which is also typically asymptomatic until liver damage is severe enough to cause symptoms.[3,4] Left untreated, chronic hepatitis C can be life-threatening.

Despite availability of accurate diagnostic tests and highly effective curative treatment, approximately 2.4 million adults in the United States (i.e., approximately 1.0% of all U.S. adults) were living with hepatitis C during 2013–2016.[5] Because HCV infection is most often asymptomatic, only 55.6% of these adults reported having ever been told that they had hepatitis C during 2013–2016.[6] Being unaware of an HCV infection can have serious health consequences and increase risk for transmission to others. In 2018, ≥15,713 death certificates listed hepatitis C as the underlying or contributing cause of death.[7]

Historically, the highest prevalence of chronic hepatitis C in the United States has been among persons born during 1945–1965 (baby boomers).[8] Concurrent with the nation's opioid crisis, in more recent years, new HCV infections have occurred primarily among young adults, including persons of reproductive age. Compared with 2005 when reported acute hepatitis C cases were at a low point this century (0.2 per 100,000 population), by 2017 the rate had increased approximately fourfold, to 1.0 per 100,000, mostly among persons aged 20–39 years*.[9] Further, a recent study of the Healthcare Cost and Utilization Project showed that U.S. rates of maternal HCV infection at delivery increased from 0.8 per 1,000 live births in 2000 to 4.1 in 2015, with the highest increases among women with opioid use disorder.[10]

Because hepatitis C testing and curative treatment substantially reduces long-term risk for disease and death, in 2012 CDC augmented the risk-based testing guidelines to recommend screening all persons born during 1945–1965.[8] Because of the changing epidemiology of hepatitis C in the United States, CDC is now recommending screening of all adults at least once in their lifetime and screening of all pregnant women during every pregnancy.[11] The purpose of this report is to highlight the epidemic of hepatitis C among all adults in support of this new CDC screening recommendation.

*Historical CDC viral hepatitis surveillance data are available at https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htm.

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