Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 May 1;62(9):1059-65.
doi: 10.1093/cid/ciw074. Epub 2016 Feb 21.

Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department

Yu-Hsiang Hsieh  1 , Richard E Rothman  2 , Oliver B Laeyendecker  3 , Gabor D Kelen  1 , Ama Avornu  1 , Eshan U Patel  3 , Jim Kim  1 , Risha Irvin  4 , David L Thomas  4 , Thomas C Quinn  3
Affiliations

Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department

Yu-Hsiang Hsieh et al. Clin Infect Dis. .

Abstract

Background: The Centers for Disease Control and Prevention (CDC) recommends 1-time hepatitis C virus (HCV) testing in the 1945-1965 birth cohort, in addition to targeted risk-based testing. Emergency departments (EDs) are key venues for HCV testing because of the population served and success in HIV screening. We determined the burden of undocumented HCV infection in our ED, providing guidance for implementation of ED-based HCV testing.

Methods: An 8-week seroprevalence study was conducted in an urban ED in 2013. All patients with excess blood collected for clinical purposes were included. Demographic and clinical information including documented HCV infection was obtained from electronic medical records. HCV antibody testing was performed on excess samples.

Results: Of 4713 patients, 652 (13.8%) were HCV antibody positive. Of these, 204 (31.3%) had undocumented HCV infection. Among patients with undocumented infections, 99 (48.5%) would have been diagnosed based on birth cohort testing, and an additional 54 (26.5%) would be identified by risk-based testing. If our ED adhered to the CDC guidelines, 51 (25.0%) patients with undocumented HCV would not have been tested. Given an estimated 7727 unique ED patients with HCV infection in a 1-year period, birth cohort plus risk-based testing would identify 1815 undocumented infections, and universal testing would identify additional 526 HCV-infected persons.

Conclusions: Birth cohort-based testing would augment identification of undocumented HCV infections in this ED 2-fold, relative to risk-based testing only. However, our data demonstrate that one-quarter of infections would remain undiagnosed if current CDC birth cohort recommendations were employed, suggesting that in high-risk urban ED settings a practice of universal 1-time testing might be more effective.

Keywords: CDC recommendations; HCV; HCV testing; emergency department; undiagnosed infection.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Prevalence of undocumented hepatitis C virus (HCV) infection, by age, race, and sex in 4713 emergency department patients, 2013.
Figure 2.
Figure 2.
Distribution of 204 undocumented hepatitis C virus infections, by baby boomer birth cohort (1945–1965), human immunodeficiency virus (HIV) serostatus, and injection drug use (IDU) status.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ly K, Xing J, Klevens R, Jiles R, Ward J, Holmberg S. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med 2012; 156:271–8. - PubMed
    1. Denniston M, Jiles R, Drobeniuc J et al. . Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med 2014; 160:293–300. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998; 47(RR-19):1–39. - PubMed
    1. Smith B, Morgan R, Beckett G et al. . Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Morb Mortal Wkly Rep 2012; 61(RR-4):1–32. - PubMed
    1. Moyer V; U.S. Preventive Services Task Force. Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 159:51–60. - PubMed

Publication types

MeSH terms

Substances