Universal screening reveals ‘striking’ HCV antibody prevalence in people born after 1965
Universal hepatitis C virus screening in EDs with the ability to opt out showed that nearly half of infections were identified in people born after 1965, according to findings published in MMWR.
These findings are consistent with two other recent studies in EDs, both of which demonstrated that “an ED-based 1945-1965 birth cohort strategy alone would fail to identify half of persons with HCV infection.”
“U.S. EDs have been shown previously to be highyield venues for the diagnosis of previously unrecognized hepatitis C infection especially among persons born between 1945 and 1965, or the ‘baby boomers,’” James W. Galbraith, MD, associate professor in the department of emergency medicine at the University of Mississippi Medical Center, told Healio.
According to Galbraith, identifying the growing number of hepatitis C infections among a younger population in the United States has been difficult, in part because of the need to identify risk factors in this group, including injection drug use.
“Identifying these risk factors is difficult in the ED setting due to stigma, patient privacy concerns and challenges in operationalizing systematic risk factor questioning,” he said. “These reasons led our four ED study sites to remove the barrier to hepatitis C risk factor identification by implementing opt-out, universal hepatitis C testing for all adult patients unaware of their hepatitis C status.”
Galbraith and colleagues assessed an opt-out, universal HCV testing approach in a retrospective study of four urban academic EDs in Birmingham, Alabama; Oakland, California; Boston, Massachusetts; and Baltimore, Maryland. Testing was conducted in each of the EDs at different times, with unique methodologies, among patients who reported no history of HCV infection. According to the results in MMWR, the observation period lasted 4 months, starting 1 month after implementation of universal screening, although “programmatic changes” at Johns Hopkins ED that occurred during the observation period resulted in only 3 months of observation at that location.
According to Galbraith, the study showed that one in every 11 adult patients (9.2%) in the four urban EDs who previously reported no prior history of HCV infection tested positive for HCV antibodies. The HCV antibody prevalence among baby boomers was 14%, which is consistent with earlier studies in the ED, he continued.
The “most striking” finding, according to Galbraith, was a nearly 7% HCV antibody prevalence among individuals born after 1965, which he says was driven by a 15% HCV antibody prevalence among younger white individuals. Almost half (47.5%) of the infections detected occurred among people born after 1965.
“This is consistent with what is known about national increases in hepatitis C infections in the shadow of the opioid epidemic, as well as MMWR’s 2020 report revealing that the largest proportion of chronic hepatitis C cases occurred in persons aged 20 to 39 years and 50 to 69 years,” he said.
The study findings also support the CDC’s new HCV testing recommendations that include HCV screening once in a lifetime for all adults aged 18 years and older, except in settings where the prevalence of HCV infection is less than 0.1%.
“U.S. EDs are a high yield venue for the identification of previously unrecognized hepatitis C infection. The implementation of a universal testing strategy nearly doubled the number of hepatitis C infections identified compared to ‘baby boomer’ birth cohort testing alone,” Galbraith said. “A universal hepatitis C testing strategy in U.S. EDs may provide both valuable infection surveillance, as well as the referral to curative treatment necessary to meet the National Academy of Sciences (formerly the Institute of Medicine) goal to eliminate hepatitis C in the U.S. by 2030.”