Higher Rates of Hepatitis C Mean More Testing Needed
Testing for prevalent, infectious diseases has become routine in populations most likely to be affected with high infection rates. Despite this noble public health practice, routine testing can be an unnecessary expense, inconvenience and source of worry if not performed sparingly. Thus, mass education campaigns and testing regimens are usually put in place only if proven to be crucial for aiding the treatment and prevention of an infectious disease. Hepatitis C has demonstrated a prevalence and prognosis that points towards the need for routine testing, but this practice has not yet been implemented for this infectious virus. Further supporting an increase in Hepatitis C testing, a report indicates the prevalence of this infectious virus in the U.S. has been grossly underestimated.
About Hepatitis C
A viral infection of the liver, Hepatitis C is the most common cause of chronic liver disease in the U.S. – with its primary route of infection being blood-to-blood contact. This virus is usually acquired from blood transfusions prior to 1992 (before the blood supply was tested for Hepatitis C) and the sharing of intravenous needles; however, the source of infection is unknown in a third of all Hepatitis C cases. Because many with Hepatitis C don’t know they are infected, the disease is often unknowingly passed on to others. Thus, Hepatitis C screening is the only way to know who is infected so steps to prevent passing it on can be taken.
Some individuals are lucky enough to clear the virus from their system in a short period of time without medical intervention. Unfortunately, about 85 percent of those infected with Hepatitis C go on to develop the chronic form of this illness. Like any kind of chronic liver disease, chronic Hepatitis C progressively damages the liver. Hepatitis C has been referred to as a silent killer because many don’t have any symptoms for years after becoming infected. When vague symptoms like fatigue and abdominal pain finally do appear, the disease is often quite advanced. There is not yet a preventable vaccine for Hepatitis C, but the combination of drugs used to treat Hepatitis C has recently improved – dramatically increasing the likelihood of curing people of this virus when detected before severe liver damage has occurred.
Hepatitis C Prevalence
The lack of symptoms is probably the biggest obstacle to Hepatitis C diagnosis, a fact in and of itself suggesting greater testing efforts. Based on data from the National Health and Nutrition Examination Survey (NHANES) which periodically collects information about health and well-being from a sample of more than 15,000 people living in American households, an estimated 4 million Americans, 1.6 percent of the population, are currently infected with Hepatitis C. This makes the estimated 1 million Americans infected with HIV – the virus that causes AIDS – pale in comparison. Even though the NHANES data indicates that a sizeable percentage of our population has Hepatitis C, research indicates that way more than 4 million Americans have this infectious liver virus.
According to an analysis published in the September 2011 edition of the journal Liver International, the number of people living with Hepatitis C virus in the U.S. is likely greater than the usual estimate due to undercounting of high risk populations in household surveys. Eric Chak from the University of California at Los Angeles and colleagues searched MEDLINE and databases from the Bureau of Justice Statistics, the Center for Medicare and Medicaid, and individual state departments of corrections looking for epidemiological studies regarding Hepatitis C in high prevalence populations.
Focusing on groups not sampled by NHANES, like incarcerated individuals, homeless people, nursing home residents, hospitalized patients and active duty military personnel, the researchers found that approximately 1.9 million Americans with Hepatitis C were not accounted for in the latest NHANES survey. They found:
- Rates of Hepatitis C in prisoners ranged from 23 to 41 percent.
- Rates of Hepatitis C in homeless people ranged from 22 to 52 percent.
- Rates of Hepatitis C in homeless veterans ranged from 41 to 44 percent.
- Rates of Hepatitis C among injection drug users ranged from 27 to 93 percent.
- Rates of Hepatitis C in veterans ranged from 5 to 10 percent.
The investigators concluded that their most conservative estimate suggests at least 5.2 million Americans living with Hepatitis C – more than a million more that were accounted for in the NHANES survey.
With so many more Americans living with this liver virus than previously thought, action to perform routine Hepatitis C screenings takes on a new urgency. Identifying Hepatitis C infection can lead to better transmission prevention practices, enable infected persons to care for their liver to stop progressive liver damage and facilitate earlier (and thus have a better chance of success) treatment. Obviously a prevalent and problematic illness, the evidence favoring routine Hepatitis C screenings just keeps mounting.
Editor’s Note: May 19 has been designated as a national “Hepatitis Testing Day” in the United States. The CDC will use this annual Hepatitis Testing Day on May 19, 2013 as an opportunity to remind health care providers and the public who should be tested for chronic viral hepatitis.
http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02494.x/abstract, Hepatitis C virus infection in USA: an estimate of true prevalence, Eric Chak, et al, Retrieved October 9, 2011, Liver International, September 2011.
http://www.hivandhepatitis.com/hcv-epidemiology/3248-undercounted-populations-raise-estimate-of-true-us-hepatitis-c-prevalence, Undercounted Populations Raise Estimate of True US Hepatitis C Infections, Liz Highleyman, Retrieved October 9, 2011, hivandhepatitis.com, 2011.
http://www.natap.org/2011/HCV/j13652893.pdf, Hepatitis C testing practices and prevalence in a high-risk urban ambulatory care setting, W. N. Southern, et al, Retrieved October 9, 2011, Journal of Viral Hepatitis, March 2010.