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CDC Recommendations for the Identification of Chronic Hepatitis C Virus Infection among Persons Born During 1945–1965

In addition to testing adults of all ages at risk* for HCV infection, CDC recommends:

  • Adults born during 1945–1965 should receive one-time testing for HCV without prior ascertainment of HCV risk (Strong Recommendation, Moderate Quality of Evidence)
  • Testing should be initiated with anti-HCV. A reactive result should be followed by nucleic acid test (NAT) for HCV RNA.
  • All persons identified with HCV infection should receive a brief alcohol screening and intervention as clinically indicated, followed by referral to appropriate care and treatment services for HCV infection and related conditions (Strong Recommendation, Moderate Quality of Evidence) .


Background and Rationale

High Prevalence of HCV Infection in people born during 1945–1965
Of the estimated 3.2 million people chronically infected with hepatitis C in the U.S., 75% were born during 1945-1965.   National prevalence data show that people born during these years have a five times higher prevalence of hepatitis C infection than other adults.

Increasing HCV-Associated Morbidity and Mortality
Hepatitis C is a leading cause of liver transplants and liver cancer. Annual HCV-associated mortality in the US increased more than 50% from 1999 to 2007.  People born during 1945-1965 account for 73% of all HCV- associated deaths. 

Limited Effectiveness of Current Testing Strategies
A high proportion of persons with chronic HCV infection do not know that they are infected (estimates range from 45%-85%).  Testing based solely on elevated ALT levels is estimated to miss 50% of chronic infections.

Benefits of HCV Testing and Care
For those who are chronically infected,  clinical preventive services including regular medical monitoring, Hepatitis A and B vaccination, and behavior changes like alcohol reduction/cessation and achieving and maintaining a healthy BMI can improve health outcomes for persons with HCV infection.

Benefits of HCV Treatment

New therapies, including interferon-free regimens, can halt disease progression and provide a virologic cure in most HCV-infected persons. These treatment options increase the effectiveness and reduce the duration of therapy for many patients. Additional treatment options are in clinical trials.

Resource Implications
Recent studies of the cost effectiveness of birth-year-based HCV testing linked to care and treatment found this strategy to be cost effective.  One-time birth year testing is estimated to identify 800,000 infections and, with linkage to care and treatment, avert more than 120,000 HCV-related deaths.  This strategy is estimated to save $1.5-$7.1 billion in liver disease-related costs.

Source: CDC. Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965 (MMWR 2012;61(RR04);1-18).

* The recommendations for Hepatitis C Virus (HCV) testing among persons born during 1945–1965 are intended to augment the Recommendations for Prevention and Control of Hepatitis C Virus Infection and HCV-Related Chronic Disease issued by CDC in 1998.


USPSTF Recommendations

U.S. Preventive Services Task Force (USPSTF) - Screening for Hepatitis C Virus Infection
USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection and offering one-time screening for HCV infection to adults born during 1945-1965. Grade: B Recommendation.


Testing Guidance

Testing for HCV infection: An update of guidance for clinicians and laboratorians. [PDF - 4 pages]
MMWR 2013; Vol. 62 Early Release.


Know More Hepatitis Education Campaign

CDC has implemented a national education campaign, Know More Hepatitis, to increase awareness about Hepatitis C and encourage testing of those born during 1945-1965.


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