Vital Signs: Evaluation of Hepatitis C Virus Infection Testing and Reporting — Eight U.S. Sites, 2005–2011

BACKGROUND Hepatitis C virus (HCV) infection is a serious public health problem. New infections continue to occur, and morbidity and mortality are increasing among an estimated 2.7-3.9 million persons in the United States living with HCV infection. Most persons are unaware of their infection status. Existing CDC guidelines for laboratory testing and reporting of antibody to HCV do not distinguish between past infection that has resolved and current infection that requires care and evaluation for treatment. To identify current infection, a test for HCV RNA is needed. METHODS Surveillance data reported to CDC from eight U.S. sites during 2005-2011 were analyzed to determine the proportion of persons newly reported on the basis of a positive test result for HCV infection. Persons reported with a positive result from an HCV antibody test only were compared with persons reported with a positive result for HCV RNA and examined by birth cohort (1945-1965 compared with all other years), surveillance site, and number of reported deaths. Annual rates of persons newly reported with HCV infection in 2011 also were calculated for each site. RESULTS Of 217,755 persons newly reported, 107,209 (49.2%) were HCV antibody positive only, and 110,546 (50.8%) were reported with a positive HCV RNA result that confirmed current HCV infection. In both groups, persons were most likely to have been born during 1945-1965 (58.5% of those who were HCV antibody positive only; 67.2% of those who were HCV RNA positive). Among all persons newly reported for whom death data were available, 6,734 (3.4%) were known to have died; deaths were most likely among persons aged 50-59 years. In 2011, across all sites, the annual rate of persons newly reported with HCV infection (positive HCV antibody only and HCV RNA positive) was 84.7 per 100,000 population. CONCLUSIONS Hepatitis C is a commonly reported disease predominantly affecting persons born during 1945-1965, with deaths more frequent among persons of relatively young age. The lack of an HCV RNA test for approximately one half of persons newly reported suggests that testing and reporting must improve to detect all persons with current infection. IMPLICATIONS FOR PUBLIC HEALTH In an era of continued HCV transmission and expanding options for curative antiviral therapies, surveillance that identifies current HCV infection can help assess the need for services and link persons with infection to appropriate care and treatment.