Novel epidemiological approach accounting for persons with undiagnosed HCV shows half of cases in US are in 9 states, including 5 in Appalachia.
Eli Rosenberg, PhD
Epidemiologists found a 0.93% overall prevalence of hepatitis C virus (HCV) infection cases in the US while using a novel assessment method in a new study. The report, which included undiagnosed cases among its prevalence rates, found that approximately half of the cases occurred in just 9 states, including 5 in Appalachia.
Understanding the rate of HCV infection is critical for jurisdictions making strategies to reduce HCV burden among their population, Eli Rosenberg, PhD, Department of Epidemiology and Biostatistics at the University at Albany School of Public Health, State University of New York, told MD Magazine®.
"These results can guide how much prevention and treatment efforts need to be scaled, and the resources needed to do so," he said.
Although accurate estimates of the current burden of HCV infection in each US jurisdiction are critical to establishing effective prevention and treatment programs, Rosenberg and colleagues suggested the current analyses provide an incomplete picture.
The investigators noted that while HCV infections are required to be reported to the US Centers for Disease Control and Prevention (CDC)—which supports the current study—these acute and chronic infections represent only a small proportion of cases, and in some states neither are reportable.
"National case surveillance provides an incomplete picture of the burden of HCV infection," Eli and colleagues asserted. "Some jurisdictions maintain enhanced surveillance programs funded by the CDC or other sources, yet a comprehensive jurisdiction-specific picture for the Nation remains inestimable from case surveillance data."
Eli elaborated on the limitations of current methods and the challenges in achieving more accurate assessments, in his discussion with MD Mag.
"Across jurisdiction, hepatitis C surveillance is inconsistently and often substantially underfunded, impacting the completeness of these data," he said. "Estimating those additional infections that are underdiagnosed compounds the challenge."
To obtain more accurate estimations of HCV prevalence in each jurisdiction, Eli and colleagues developed a method to account for persons with and without a diagnosis. They utilized data from the newly released National Health and Nutrition Examination Survey (NHANES), and vital statistics data through 2016 which includes HCV-related and narcotic overdose deaths. The resulting analysis yielded updated estimates that reflect overlaid spatial patterns in HCV infection attributable to both previous and recent transmission.
"Alternative methodologies such as ours provide a way to estimate prevalence systematically, and to accurately compare prevalence between jurisdiction," Eli said.
The prevalence of HCV infection in the US, estimated for the period between 2013 and 2016, shows large variations, but is particularly high in the West and in Appalachia. The investigators calculate an overall prevalence in the US of 0.93%, with jurisdictions ranging between 0.45% and 2.34%.
Nine states contained 51.9% of all persons living with HCV infection. Of 13 states in the western US, 10 were above the median. Three of the 10 states with the highest HCV prevalence were in Appalachia.
"Some of the highest-incidence states had the lowest levels of prevention and treatment access overall, with 47 states lacking comprehensive laws and Medicaid policies for effective prevention and treatment of HCV among persons who inject drugs," investigators noted.
The article, "Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016," was published online in JAMA Network Open.