Release: CDC Vital Signs Report and Updated CDC Adult Hepatitis C Screening Recommendations

On April 9, 2020, the Centers for Disease Control and Prevention (CDC), Division of Viral Hepatitis (DVH), released its Vital Signs Report on Newly Reported Cases of Hepatitis C – United States, 2009—2018 and Updated Hepatitis C Testing Recommendations, 2020. The highly anticipated Vital Signs report shows changes in age-group risk for new hepatitis C virus (HCV) infections and highlights increased risk among younger adults. The accompanying newly updated HCV screening recommendations depart from "baby boomer” testing and call for universal adult screening. The new recommendations parallel goals outlined in the U.S. Department of Health and Human Services’ (HHS) National Viral Hepatitis Action plan, 2017-2020 as well as the WHO’s Global Health Sector Strategy on Viral Hepatitis 2016-2021, which specifically outlines expanded testing and treatment as one of the five core interventions necessary to eliminate viral hepatitis as a public health threat.

According to the CDC, HCV kills more Americans than all 60 nationally notifiable infectious diseases combined. Of the estimated 2.4 million people in the U.S. living with HCV, the incidence is highest among persons aged 20-39 years. Over the last decade, in the wake of the opioid crisis and increased injection drug use, there was a three-fold increase in the rate of new infections, therefore, the rates of newly reported chronic infections among baby boomers and millennials are now equal. Additionally, as new HCV infections have risen among adults of reproductive age, rates of live births delivered by women with HCV infection nearly doubled. Therefore, widespread awareness of this shift in new HCV cases among young adults and the updated expanded screening recommendations is essential to ensure action is taken to expand access to testing and linkage to care to all adults, including pregnant individuals.  Specifically, the CDC recommends: 

1. HCV screening at least once in a lifetime for all adults aged 18 years and older, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is less than 0.1%;
2. HCV screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is less than 0.1%;
3. HCV testing regardless of age or setting among persons with recognized conditions or exposure including persons living with HIV; persons who ever injected drugs or shared needles, syringes, or other drug preparation equipment; and children born to mothers with HCV infection.

This 92-page Vital Signs report augments CDC recommendations for HCV testing in response to the changing epidemiology of HCV in the United States and is intended to be used as a resource for health departments, healthcare providers, and community partners working to eliminate viral hepatitis. The new report from the CDC shows four in 10 people living with HCV do not know their status, therefore, health departments play a critical role in ensuring that people are screened, diagnosed, and linked to care for HCV. NASTAD encourages you to access, utilize, and share the full suite of materials through the following platforms: 

1. Access CDC’s Viral Hepatitis Webpage – access to Vital Signs Morbidity and Mortality Weekly (MMWR) Report, fact sheet with graphics, and other communication resources.
2. Join CDC’s webinar on the formal release of the HCV testing recommendations and Vital Signs report on Thursday, April 9 at 3:15 pm EDT; register here.
3. Read the Recommendations for Hepatitis C Screening among Adults—United States, 2020 and share CDC’s new tools and resources through the Know More Hepatitis Campaign.
4. Spread the word through social media – share CDC’s new Know More Hepatitis Campaign tools and resources and repost using hashtag #KnowHepC or repost on @cdchep. 

 NASTAD applauds CDC’s efforts to augment the screening recommendations as part of the acceleration towards viral hepatitis elimination. The updated recommendations are significantly more inclusive and a considerable departure from one-time HCV screening among baby boomers. The expanded recommendations are responsive to several key developments in recent years including the shifting HCV epidemiology in the U.S. highlighting increased cases among young adults—driven largely by the opioid crisis and injection drug use, and increased HCV infections among pregnant adults.  

NASTAD recognizes this a trying time given the COVID-19 pandemic and existing challenges that might delay immediate implementation of the updated HCV testing recommendations. We are committed to ensuring the continuity of essential programming and will support jurisdictions with continuous follow-up for dissemination and implementation of these recommendations.