Hospitals and physician practices should perform one-time testing on all "baby-boomers," patients born after 1944 and before 1966, for life-threatening hepatitis C virus because surveillance samples indicate 45% to 85% of infected people in this age bracket don't know it, the Centers for Disease Control and Prevention said Wednesday.
The federal health agency indicates that with this one-time testing, 800,000 asymptomatic infections will be discovered, enabling medical and lifestyle interventions to thwart progression of disease and save more than 120,000 lives.
The CDC's recommendations say that people in this age bracket are more likely than people younger or older to be infected, although it's unclear why that is beyond these possible causes:
- Greater risk from blood transfusions prior to the early 1990s
- Exposure through injection drug use involving sharing of needles
- Blood contact with IV drug users
While hepatitis C can be transmitted through sexual activity, that mode is very ineffective, says Bryce Smith, Lead Health Scientist for the CDC's Division of Viral Hepatitis who helped write the recommendations.
Whether sexual activity transmits Hepatitis C "could depend on the sexual practice," Smith says. "But sometimes it depends on other things (people) may be sharing around the house. Are they sharing a razor or a toothbrush? If there is an opportunity to share something that contains infected blood, that's a way that someone can become infected."
Prior to tighter infection control guidelines in healthcare settings issued subsequent to the HIV epidemic in the mid 1980s, acute and ambulatory care facilities may have been settings for transmission, for example, a patient who underwent a tonsillectomy decades ago.
That, in part, is why the CDC is issuing this much wider guideline for population testing Smith says.
An estimated 2.7 million to 3.9 million people are living with hepatitis C in the U.S., the CDC says. "Incidence increased markedly during the 1970s and 1980s, reaching an average of 230,000 new infections each year throughout the 1980s," the agency's guidelines say.
Incidence declined rapidly in the 1990s because of blood donor screening in 1992 and because of reduced new infections among people who inject drugs through 2006.
Since then, numbers have remained stable, "with 17,000 new infections in 2010." However, the guideline warns that many people have been living with hepatitis C for 20 to 40 years, and now "are at increased risk for HCV-related morbidity and mortality."
In fact, hepatitis C-related mortality has increased more than 50% between 1999 and 2007 and now outpaces deaths from HIV.
Smith says that testing is very inexpensive, and is generally covered under health plans. Treatment for the disease, however, may cost $60,000 and coverage depends on the health plan. The good news is that newer drugs have been shown to eradicate the virus in three out of four chronically infected patients.
CDC recommendations issued in 1998 for hepatitis C testing were limited only to those people with specific risk factors such as high-risk sexual activity, injection drug use or exposure to potentially infected blood or hemodialysis, or had laboratory evidence of liver disease.
Capturing additional infected individuals may save lives and reduce progression of liver damage. For example, since use of alcohol may exacerbate clinical symptoms of hepatitis C, patients who know they are infected may be counseled to reduce consumption.
The guidelines and fact sheet are published in the Aug. 17 issue of the CDC's Morbidity and Mortality Weekly Report and in this week's issue of the Annals of Internal Medicine.