Reduce estimated new hepatitis C virus infections by 20% or more

Summary of Findings

New hepatitis C virus (HCV) infections have increased each year since 2013 with 66,700 estimated infections in 2020, well above the 2020 target of 39,850 estimated infections. Recent increases are thought to reflect both true increases in incidence and improved case ascertainment resulting from a change in the hepatitis C surveillance case definition in 2020. 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. During 2020, 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 data should be interpreted with caution.

Reduction needed to meet 2025 goal:

A 48% reduction from the estimated number of new HCV infections in 2020 is needed to meet the 2025 goal of 35,000 estimated infections.

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.
• Expanding regular testing and hepatitis C-related services for persons with certain risk factors for HCV infection and persons with hepatitis C to increase their access to curative care and treatment.
• Supporting continuing medical education and developing partnerships to reach people with hepatitis C and their service providers.
• Building capacity within jurisdictions to make it easier for them to collect and use a core set of surveillance data as well as prioritize new data collection initiatives (molecular, computational, informational) that will help pinpoint where HCV infection is occurring, understand transmission networks, enhance what we learn from outbreak investigations and thereby prioritize prevention efforts.
• Increasing access to substance use disorder treatment and care services including medication-assisted treatment programs by implementing comprehensive community-level programs especially for disproportionately affected populations.
• Conducting research focused on improving prevention strategies and increasing 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 acute HCV infections

Denominator:
Not applicable

Indicator Notes:
(1) 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; these estimates are presented in the 2020 Annual Surveillance Report (1) along with their 95% Confidence Intervals to show the range of estimated infections accounting for error. 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). The multipliers have not been recalibrated to account for the 2020 acute hepatitis C case definition change.

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.