Hepatitis C Virus – Reduce Infections

Estimated* new hepatitis C virus infections and annual targets for the United States by year

Source: CDC, National Notifiable Diseases Surveillance System.1
^*The number of estimated viral hepatitis infections was determined by multiplying the number of reported cases by a factor that adjusted for underascertainment and underreporting.12

Summary of findings

The number of new hepatitis C virus infections (HCV) declined for the first time in 2022 after over a decade of consecutive annual increases. However, the number of estimated new HCV infections was 67,600, well above the annual target of 36,617. Changes in drug use practices and other prevention initiatives, such as syringe services programs and medication for opioid use disorder programs, might have contributed to this decrease.34 During 2020–2022, there were major disruptions in access to medical care, testing, and routine viral hepatitis public health activities due to the COVID-19 pandemic; therefore, 2020–2022 data should be interpreted with caution.

This reduction can best be achieved by:

• Supporting routine hepatitis C screening for all adults at least once in their life and for every pregnant person during each pregnancy, and testing of all perinatally exposed infants.
• Implementing periodic testing for persons with recognized exposures (such as use of injection drugs) as long as the risk persists.
• Improving access to life-saving curative treatment for all persons with hepatitis C.
• Supporting medical education and partnerships with service providers to reach people with hepatitis C.
• Building capacity within jurisdictions to collect and use a core set of surveillance data to identify outbreaks, understand transmission networks, and prioritize prevention efforts.
• Increasing access to substance use disorder treatment and medication-assisted treatment programs for disproportionately affected populations.
• Conducting research to improve prevention strategies and increase awareness of hepatitis C.
• Building and harnessing partnerships that amplify the use of effective prevention strategies in persons and places with higher rates of HCV transmission.

Technical notes

Data sources: CDC, National Notifiable Diseases Surveillance System (NNDSS)

Numerator: Number of estimated new (acute) HCV infections

Denominator: Not applicable

Indicator notes: NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable disease-related health information.1 Surveillance for viral hepatitis through NNDSS is based on case definitions developed and approved by the Council of State and Territorial Epidemiologists (CSTE) and CDC. Reported cases of acute hepatitis C are required to meet specific clinical and laboratory criteria. Estimated infections are based on laboratory-confirmed cases of acute viral hepatitis; these estimates are presented in the 2022 Annual Surveillance Report1 along with their 95% confidence intervals to show the range of estimated infections accounting for error. Acute hepatitis C is reportable in all jurisdictions except Alaska. Health care providers, hospitals, and/or laboratories report cases to the local or state health department, and states voluntarily submit reports or notify CDC of newly diagnosed cases of hepatitis C that meet the CSTE/CDC surveillance case definition. To account for underascertainment and underreporting, the number of reported cases is multiplied by 13.9. The methods for developing the multiplication factor have been previously described and used by CDC to estimate the number of annual infections.12

Goal setting: The 2025 goal of 35,000 estimated infections is consistent with CDC's Division of Viral Hepatitis 2025 Strategic Plan and the US Department of Health and Human Services' 2021–2025 Viral Hepatitis National Strategic Plan. Annual targets assume a constant (linear) rate of change from the observed baseline (2017 data year) to the 2025 goal (2023 data year).

Limitations: The number of estimated infections is based on a simple, probabilistic model for estimating the proportion of patients who were symptomatic, received testing, and were reported to health officials in each year.2 This constant multiplier might not account for variations over time in underreporting and underascertainment due to changes in public and provider awareness, laboratory and diagnostic techniques, and the case definition for the condition.