CDC now recommends universal hepatitis C screening for all U.S. adults and all pregnant women during every pregnancy, except in settings where the prevalence of HCV infection is <0.1% This includes:
All adults aged 18 years and older
All pregnant women during each pregnancy
People who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago
People with HIV
People who have ever received maintenance hemodialysis
People with persistently abnormal ALT levels
People who received clotting factor concentrates produced before 1987
People who received a transfusion of blood or blood components before July 1992
People who received an organ transplant before July 1992
People who were notified that they received blood from a donor who later tested positive for HCV infection
Health care, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCVpositive blood [PDF – 177 KB]
Any person who requests hepatitis C testing
Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children
Test all infants and children born to pregnant persons with current or probable HCV infection.
Pregnant persons with detectable HCV RNA are considered to have current HCV infection. Pregnant persons are considered to have probable HCV infection if HCV antibody testing is reactive, and HCV RNA is not available.
Test all perinatally exposed infants using a nucleic acid test (NAT) for HCV RNA at age 2 – 6 months to identify children who might develop chronic HCV infection *.
Care for infants with detectable HCV RNA should be coordinated in consultation with a health care provider with expertise in pediatric hepatitis C management.
Infants with undetectable HCV RNA do not require further follow up unless clinically warranted.
Additional considerations:
Age 7 – 17 months: Those who have not previously been tested should receive a NAT for HCV RNA.
Healthcare providers should initiate universal hepatitis C screening for patients until they establish that the prevalence of HCV RNA positivity in their population is less than 0.1%, at which point universal screening is no longer explicitly recommended but may occur at the provider’s discretion.
Blood tests used to diagnose HCV infection
Clinicians should use an HCV antibody test followed by an HCV RNA test when antibody is positive/reactive to diagnose current HCV infection. Tests include:
HCV antibody test (anti-HCV) (e.g., enzyme immunoassay [EIA])
Nucleic acid test (NAT) to detect presence HCV RNA (Qualitative RNA test)
Nucleic acid test (NAT) to detect levels of HCV RNA (Quantitative RNA test)
References
Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC recommendations for hepatitis C screening among adults—United States, 2020. MMWR Recomm Rep 2020; 69:(No. RR-2).
Healthcare providers should initiate universal hepatitis C screening for patients until they establish that the prevalence of HCV RNA positivity in their population is less than 0.1%, at which point universal screening is no longer explicitly recommended but may occur at the provider’s discretion. 