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With Spike in Hepatitis C Virus Infections, CDC Recommends Screening for All Adults

May 25, 2020

All adults age 18 and older should be screened for hepatitis C virus (HCV) infection at least once in their lifetime, while women should be screened during every pregnancy, say new U.S. Centers for Disease Control and Prevention (CDC) recommendations.
These latest recommendations, published on April 10, 2020, expand CDC's 2012 call for one-time HCV screening of all baby boomers, adults born from 1945 through 1965, along with people of any age with certain risk factors. This group includes injection drug users, dialysis patients, people with HIV, children born to mothers with HCV, and incarcerated people, among others. Individuals with any ongoing risk should be screened for HCV periodically, according to the CDC.
The new recommendations do not apply in areas of the U.S. where less than 0.1% of adults have HCV infections, says the CDC. However, no U.S. state currently meets this criterion.
HCV and screening
Most often transmitted by intravenous drug users sharing needles, HCV causes the liver infection hepatitis C. Less commonly, the virus is spread via sexual contact, unregulated tattooing, needlestick injuries in healthcare workers, and from mothers to babies during pregnancy or childbirth.
For some people, infection with HCV is a short-term illness (called acute hepatitis C), usually with few, mild symptoms or no symptoms, and the virus is cleared from the body without specific treatment. Occasionally, this acute stage of infection can cause more severe symptoms, particularly jaundice and fatigue. However, more than half of people infected develop chronic hepatitis C that, without treatment, can lead to serious, long-term health problems like cirrhosis and liver cancer, and may be fatal.
Chronic hepatitis progresses slowly over time, so infected individuals may not be aware they have the condition until it causes enough liver damage to affect liver function. Screening of all adults, including those without symptoms, enables earlier diagnosis and allows healthcare practitioners to properly treat chronic HCV infections and monitor infected patients' liver function more closely.
The most common HCV screening test looks for antibodies in the blood, produced in response to an HCV infection.
Because someone can have positive results on an antibody test even if the infection is cleared, healthcare professionals may order a hepatitis C RNA test, which detects the virus's genetic material. In some cases, this test is done automatically the first time antibodies to HCV are noted in the blood. A positive result on the RNA test means the virus is present, the infection has not resolved, and the person will likely require treatment.
Another test, called the hepatitis C genotype test, identifies the strain of virus and can help healthcare professionals choose the right treatment.
Healthcare professionals may also order other tests that help assess the health of the liver.
Infections Skyrocket, Especially Among Young Adults
A CDC report issued along with the screening recommendation provides a rationale by highlighting a very sharp rise in acute hepatitis C infection and subsequent risk of chronic disease among young adults.
The report says the total number of reported acute hepatitis C cases tripled from 2009 to 2018 and was highest among people ages 20–39. Their rates of acute infection increased about 300% during the period. Among adults ages 30 to 39, rates increased about 400%, according to the report. In 2018, the largest proportion of chronic hepatitis C cases occurred among people ages 20–39 and those ages 50–69, who had almost equal infection rates. Only about 61% of adults with hepatitis C knew that they were infected.
"These findings highlight the need for immediate implementation of the new CDC universal hepatitis C screening recommendations for all adults and pregnant women," the report notes. "Diagnosing HCV infection is a necessary first step to linking persons to cure to prevent life-threatening consequences of long-term chronic infections and transmission to others."
The updated CDC hepatitis C screening recommendations are similar to but wider in scope than new guidelines from the US Preventive Services Task Force (USPSTF) that were finalized on March 2, 2020. In contrast to the CDC's call for screening all adults, the USPSTF established more specific age criteria, recommending HCV screening for adults ages 18-79, along with others at high risk. Also, the USPSTF does not address screening women during pregnancy. (For more, read U.S. Task Force: All Adults Should be Screened for Hepatitis C.)