Wednesday, June 21, 2017

Hepatitis C - CDC New Surveillance for Viral Hepatitis

Of Interest
Medscape - New Video Series
About this Series
In the past few years, a new class of direct-acting antiviral agents has made the treatment of HCV easier and more effective than ever before, with cure rates nearing 100%, even among HIV-positive patients. But not all patients with HCV who are eligible for antiviral treatment are identified, and even fewer are being referred for care. Thus, HCV infection remains a significant risk for progression to cirrhosis, liver failure, and hepatocellular carcinoma. Liver specialists at two prestigious Chicago medical centers confront the key issues in the management of patients with chronic HCV infection.
View: Episode 1/ Strides and Obstacles

Surveillance for Viral Hepatitis – United States, 2015
The Centers for Disease Control and Prevention’s (CDC) National Notifiable Diseases Surveillance System (NNDSS) (1) receives viral hepatitis case reports electronically each week from state and territorial health departments in the United States (U.S.) via CDC’s National Electronic Telecommunications System for Surveillance (NETSS), a computerized public health surveillance system. The surveillance system accepts case reports of acute and chronic infections from all states and the District of Columbia, though not all jurisdictions report their data. In 2015, a total of 48 states submitted reports of acute hepatitis B virus (HBV) infection, 40 submitted reports of acute hepatitis C virus (HCV) infection, 40 submitted reports of chronic HBV infection, and 40 submitted reports of chronic HCV infection.

View Report Online - Commentary

Hepatitis C: 
Reported cases of acute HCV infection increased more than 2.9-fold from 2010 through 2015, rising annually throughout this period. Examining annual trends beginning in 2011, reported cases of acute HCV infection increased 44.3% from 2011 to 2012 (n=1,232 and 1,778 cases, respectively), increased 20.3% to 2,138 cases in 2013, increased 2.6% to 2,194 cases in 2014, and increased 11% to 2,436 cases in 2015. The increase in acute HCV case reports reflects new infections associated with rising rates of injection-drug use, and, to a much lesser extent, improved case detection (15). Several early investigations of newly acquired HCV infections reveal that most occur among young, white persons who live in non-urban areas (particularly in states within the Appalachian, Midwestern, and New England regions of the country) (16); trends in these states likely indicate an overall increase in HCV incidence throughout the country (15, 17). States with the highest rate of new HCV infections (e.g., West Virginia, Kentucky, and Tennessee) did not receive CDC support for case finding during these reporting years (2011-2015). After adjusting for under-ascertainment and under-reporting (2), an estimated 33,900 (95% CI=26,800–115,000) new HCV infections occurred in 2015.

Based on the data from national health surveys conducted in the 2003-2010 time period, approximately 3.5 million persons are currently infected with HCV (18). Mortality among HCV-infected persons—primarily adults aged 55–64 years—increased during 2006-2010 (19, 20). In 2013, HCV associated deaths exceeded the combined number of deaths with 60 other infectious diseases as underlying causes (21). CDC data indicate the number of HCV-associated deaths increased 10.9% from 2011 through 2014 and decreased 0.2% to 19,629 in 2015. Approximately one-half of all deaths in 2015 occurred among persons aged 55-64 years. However, deaths associated with HCV are largely underestimated; the only large U.S. study of deaths among persons with confirmed HCV infection indicated that only 19% had HCV listed anywhere on the death certificate despite 75% having evidence of substantial liver disease (20). To increase the proportion of persons with HCV who are tested and linked to recommended care including curative treatment for HCV (12, 13), CDC and USPSTF recommend one-time testing for HCV infection among all adults born during 1945–1965 and among others at increased risk for HCV infection (22).

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