CDC Recommendations for Hepatitis C Screening Among Adults - United States, 2020

Abstract

Hepatitis C virus (HCV) infection is a major source of morbidity and mortality in the United States. HCV is transmitted primarily through parenteral exposures to infectious blood or body fluids that contain blood, most commonly through injection drug use. No vaccine against hepatitis C exists and no effective pre- or postexposure prophylaxis is available. More than half of persons who become infected with HCV will develop chronic infection. Direct-acting antiviral treatment can result in a virologic cure in most persons with 8-12 weeks of all-oral medication regimens. This report augments (i.e., updates and summarizes) previously published recommendations from CDC regarding testing for HCV infection in the United States (Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rec 2012;61[No. RR-4]). CDC is augmenting previous guidance with two new recommendations: 1) hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of HCV infection is <0.1% and 2) hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is <0.1%. The recommendation for HCV testing that remains unchanged is regardless of age or setting prevalence, all persons with risk factors should be tested for hepatitis C, with periodic testing while risk factors persist. Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.

FIGURE 1

Incidence rates* of reported acute hepatitis C cases ── United States, 2000–2017 * Per 100,000 population.

FIGURE 2

Estimated prevalence of hepatitis C virus RNA positivity among all adults* and hepatitis C among pregnant women,^† by state^§ Abbreviations: HCV = hepatitis C virus; RNA = ribonucleic acid; NHANES = National Health and Nutrition Examination Survey. * State estimates of HCV RNA positivity among all adults are based on a statistical model that allocated nationally representative hepatitis C prevalence from the 2013–2016 NHANES and additional previously published data for populations not sampled in NHANES to states according to the spatial demographics and distributions of 1999–2016 hepatitis C mortality and narcotic overdose deaths in the National Vital Statistics System. ^† Data are from an analysis of 2015, National Center for Health Statistics birth certificate data (live births) (Schillie SF, Canary L, Koneru A, et al. Hepatitis C virus in women of childbearing age, pregnant women, and children. Am J Prev Med 2018;55:633–41). ^§ Connecticut did not report maternal HCV infection on 2015 birth certificates and New Jersey reported infections from only a limited number of facilities; therefore, women residing in these two states were not included in the analysis.