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National Progress Report 2020 Goal: Reduce the rate of reported acute hepatitis C virus (HCV) infections to 0.25 per 100,000 population

Incidence rate* of reported HCV infections

Bar chart for years 2010-2020, charting rate per 100,000, Starting at .29 for 2010, eventually climbing to .98 for 2016 and projected downward to .25 by 2020.

Source: CDC, National Notifiable Diseases Surveillance System (data run, May 25, 2018)
*Rate per 100,000 U.S. population

Summary of Findings

The rate of acute HCV infections reported to CDC has increased each year since 2010 to 0.98 cases per 100,000 U.S. population in 2016, well above the 2016 target rate of 0.57 per 100,000. Recent increases are thought to reflect both true increases in incidence and, to a lesser extent, improved case ascertainment. Injection-drug use is the most common risk reported for persons with 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 healthcare-associated outbreaks of hepatitis C.

Reduction needed to meet 2020 goal: A 74.5% reduction from the 2016 reported acute HCV infection rate is needed to meet the 2020 goal of 0.25 cases per 100,000 U.S. population.

This reduction can best be achieved by

  • Supporting local, state, and federal public health surveillance and other data-collection initiatives to detect where HCV transmission is occurring and provide evidence to guide strategies aimed at reducing hepatitis C incidence.
  • Applying advanced molecular, computational, and information technologies to better understand transmission networks for outbreak investigations and for delivering targeted prevention interventions.
  • Providing hepatitis C-related health services, including routine hepatitis C testing for persons at risk for HCV infection and appropriate care and curative hepatitis C treatment for persons living with hepatitis C.
  • Supporting implementation of comprehensive community-level programs for people who inject drugs (e.g., access to syringe services programs, linkage to medication-assisted treatment programs, testing, and treatment).
  • Conducting prevention research to improve the effectiveness of hepatitis C prevention and decrease hepatitis C incidence.
  • Building partnerships to promote implementation of prevention strategies in settings associated with increased rates of hepatitis C virus transmission.

Technical Notes

Data Sources: CDC, National Notifiable Diseases Surveillance System (NNDSS) and CDC/NCHS/U.S. Census Bureau, Bridged-race Population Estimates

Numerator: Number of acute HCV infections reported annually

Denominator: Total population in reporting states

Indicator Notes: (1) The 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. Only laboratory-confirmed cases of acute viral hepatitis are presented in this report. 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 surveillance case definition. Case rates per 100,000 U.S. population are calculated based on the resident population of the United States during a particular data-collection year. For census years (e.g., 2010), population counts enumerated as of April 1 are used. For all other years, population estimates as of July 1 are used.

Goal Setting: The 2020 goal of 0.25 per 100,000 U.S. population is consistent with the Healthy People 2020 Objective (IID-26) and CDC’s Viral Hepatitis Strategic Plan, 2016-2020 [PDF – 17 pages]. Annual targets assume a constant (linear) rate of change from the observed baseline (2014) to the 2020 goal.

Limitations: Viral hepatitis is largely underreported in the NNDDS. Based on a simple, probabilistic model for estimating the proportion of patients who were symptomatic, received testing, and were reported to health officials in 2016, the actual number of acute hepatitis C cases is estimated to be 13.9 times the number reported to CDC. (2) Additionally, rates may vary over time based on changes in public and provider awareness, changes in laboratory and diagnostic techniques, and changes in the definition of the condition.

References

  1. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2016. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2018. Available at: https://www.cdc.gov/hepatitis/statistics/2016surveillance/pdfs/2016HepSurveillanceRpt.pdf.
  2. Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health. 2014;104(3):482-7.

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