National Progress Report 2025: Goal Reduce estimated* new hepatitis C virus infections by ≥20%

Source: CDC, National Notifiable Diseases Surveillance System
*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 (1–2).

Summary of Findings

New hepatitis C virus (HCV) infections have increased each year since 2013 to 57,500 estimated infections in 2019, well above the 2019 target of 41,467 estimated infections. Recent increases are thought to reflect both true increases in incidence and, to a lesser extent, improved case ascertainment. Injection-drug use is the most common risk reported for persons with new HCV infection, and increases in hepatitis C incidence are temporally associated with increases in this risk behavior. A small proportion of cases can be attributed to health care-associated outbreaks of hepatitis C.

Reduction needed to meet 2025 goal: A 39.1% reduction from the estimated number of new HCV infections in 2019 is needed to meet the 2025 goal of 35,000 estimated infections.

This reduction can best be achieved by

• Supporting local, state, and federal public health surveillance and other data-collection initiatives to detect where HCV transmission is occurring and provide evidence to guide strategies aimed at reducing hepatitis C incidence.
• Applying advanced molecular, computational, and information technologies to better understand transmission networks for outbreak investigations and for delivering targeted prevention interventions.
• Providing hepatitis C-related health services, including routine hepatitis C screening for all adults once and pregnant persons during every pregnancy, regular testing for persons at risk for HCV infection, and appropriate care and curative hepatitis C treatment for persons living with hepatitis C.
• Supporting implementation of comprehensive community-level programs for people who inject drugs (e.g., access to syringe services programs, linkage to medication-assisted treatment programs, testing, and treatment).
• Conducting prevention research to improve the effectiveness of hepatitis C prevention interventions and decrease hepatitis C incidence.
• Building partnerships to promote implementation of prevention strategies in settings associated with increased 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: (1) The NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable-disease-related health information. 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 viral hepatitis C are required to meet specific clinical and laboratory criteria. Estimated infections are based on laboratory-confirmed cases of acute viral hepatitis. Acute hepatitis C is reportable in all jurisdictions. 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 are documented in Klevens, et al (2) with corrected multipliers developed by CDC (1).

Goal Setting: The 2025 goal of 35,000 estimated cases is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and HHS’s 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 may not account for variations over time in underreporting and underascertainment due to changes in public and provider awareness, laboratory and diagnostic techniques, and the definition of the condition.

References

1. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2019. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2021. Available at: https://www.cdc.gov/hepatitis/statistics/2019surveillance/index.htm.
2. Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health. 2014;104(3):482-7.