Issue: June 2016
Perspective from Michael S. Saag, MD
June 15, 2016
3 min read
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CDC: More Americans die of HCV than any other infectious disease

Issue: June 2016
Perspective from Michael S. Saag, MD
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The CDC reported that the number of hepatitis C virus infection-related deaths in the United States reached an all-time high of 19,659 in 2014, making hepatitis C the No. 1 infectious disease killer in the country.

“Because hepatitis C often has few noticeable symptoms, the number of new cases is likely much higher than what is reported. Due to limited screening and underreporting, we estimate the number of new infections is closer to 30,000 per year,” John W. Ward, MD, director of CDC’s Division of Viral Hepatitis, said in a press release. “We must act now to diagnose and treat hidden infections before they become deadly and to prevent new infections.”

In a new study, Kathleen N. Ly, MPH, epidemiologist in the CDC’s Division of Viral Hepatitis, and colleagues evaluated death certificates from the National Center for Health Statistics database from 2003 to 2013. They measured trends in HCV-related mortality in the U.S. and compared them with 60 other infectious conditions that are routinely reported to the CDC.

Results showed that the number of deaths associated with HCV increased from 11,051 in 2003 to 19,368 in 2013. Comparatively, deaths associated with the other 60 infectious conditions combined decreased from 24,745 in 2003 to 17,915 in 2013.

The number of deaths from HCV represented an average annual increase of 865 deaths. The annual percentage increase was 6.2% (P < .05), according to the report. The number of deaths from the other 60 infectious conditions represented an average annual decrease of 718 deaths and an annual percentage decrease of 3.4% (P < .05).

The decrease in the other infectious conditions is attributed to a decline in HIV-related deaths, as well as pneumococcal disease- and tuberculosis-related deaths, the researchers said. When these three diseases were combined, they were associated with a 39.9% decline in deaths from 2003 (n = 17,764) to 2013 (n = 10,683).

“Why are so many Americans dying of this preventable, curable disease? Once hepatitis C testing and treatment are as routine as they are for high cholesterol and colon cancer, we will see people living the long, healthy lives they deserve,” Jonathan H. Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in the release.

According to the study, the HCV-associated mortality rate increased from 3.72 per 100,000 population in 2003 (95% CI, 3.65-3.79) to 5.03 deaths in 2013 (95% CI, 4.96-5.11). This represent an average annual increase of 0.14 deaths per 100,000 population per year and an average annual percentage increase of 3.4% (P < .05).

The researchers also believe that the data they collected in the study may still underestimate the burden of HCV mortality due to the fact that 59% of people who had HCV had their cause of death on their certificate listed as a liver-related death and not HCV-related.

According to the CDC, the greatest HCV burden falls on baby boomers — those born from 1945 to 1965 — many of whom have been living with HCV for years and are unaware of their infection.

A separate study conducted by researchers at the CDC in March showed that the U.S. is experiencing an HCV genotype 1a epidemic that expanded between 1940 and 1960, subsequently declined in the early 1990s, then increased slightly in the late 1990s and early 2000s. They found the epidemic coincided with an increase in medical procedures during and following World War II.

“The unabated increasing trend in the number of hepatitis C-related deaths documented from 1999 to 2013, predominantly among middle-aged persons, underscores the urgency in finding, evaluating and treating patients in the largest infectious disease epidemic in the United States,” Ly and colleagues concluded. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.