Introduction

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). HCV is a bloodborne virus. Transmission can happen through sharing needles, syringes, or other drug-injection equipment; from gestational transfer, parent to baby, during pregnancy or at birth; or rarely through sexual contact.

HCV in the USA

• Hepatitis C virus (HCV) is a National Notifiable Infectious Disease
  • Acute HCV and chronic HCV are mandatory reportable diseases to be reported to state and territorial jurisdictions when identified by a health provider, hospital, or laboratory.
  • Typical Data to Report to State Health Dept.:
    
    

    • Physician’s name and phone number		• Date of diagnosis
    • Name, institution, and phone number of person             reporting		• Symptoms • Date of onset of symptoms
    • Disease or condition		• Lab results: ALT, HBsAg, anti-HCV, specimen site,                 collection date.
    • Patient’s complete name, address, phone, county, date of birth, race, sex, last five digits of social security number		• Patient status: Pregnancy status, In childcare, food-handler, health care worker, childcare worker, nursing home, prisoner/detainee, travel in last 4 weeks.

Acute Hepatitis C in 2021

The number of reported cases of acute hepatitis C has doubled since 2014 (129% increase), and during 2021 increased 5% from 2020. During 2021, rates of acute hepatitis C were highest among males, persons aged 20–39 years, non-Hispanic American Indian/Alaska Native (AI/AN) persons, and those living in the Eastern and Southeastern states. Among cases with risk information reported, the most common was injection drug use.

Prevalence

• HCV infection is the most common chronic blood-borne infection in the United States (Chou, 2020). 
  • 69,800 new cases of acute HCV were estimated during 2021
  • Only 5023 new cases were reported.
• 4.1 million U.S. residents are estimated to be positive for anti-HCV antibody.
• 2.4 million are are believed to be currently HCV infected, defined as having HCV detectable in the blood (Chou, 2020).
• 80 percent of infected patients are asymptomatic.
  
• Symptoms may include fever, abdominal pain, loss of appetite, nausea, jaundice, or dark urine.
  
• Jaundice occurs in 25 percent of patients; liver function test results generally are less pronounced than with HBV infection.
  
• Acute disease tends to be mild and insidious in onset.
  
• Average incubation period is 6-7 weeks (range: 2 weeks to 6 months) (MDOH, 2019).
• The majority of infected persons might not be aware of their infection because acute hepatitis C infection is often asymptomatic.  Greater than 50% of untreated cases will progress to chronic infection, which can be life-threatening. Untreated, HCV infected persons serve as a source of transmission to others for decades after infection (Ryerson, 2020).
  • Approximately 60%-70% of people with untreated chronic hepatitis C eventually develop liver disease and 1%-5% will get liver cancer and die.
  • HCV is most efficiently transmitted through large or repeated percutaneous exposure to infected blood (e.g., through injecting drugs). Although much less frequent, occupational, perinatal, and sexual exposures can also result in transmission of HCV.
• HCV testing and curative treatment substantially reduces long-term risk for morbidity and mortality. The CDC recommends screening of all adults at least once in their lifetime and screening of all pregnant women during every pregnancy.
  • Neonatal HCV infection at delivery increased from 0.8 per 1,000 live births in 2000 to 4.1 in 2015, with the highest increases among women with opioid use disorder
• There is currently no approved vaccine available for hepatitis C. The best way to prevent HCV transmission is by:
  • Adhering to Universal Precautions
  • Avoiding unprotected sex 
  • Avoiding needle sharing or other drug paraphenalia
  • Get tested for hepatitis C, because treatments can cure most people with HCV in 8 to 12 weeks.