Reduce reported rate of new hepatitis C virus infections among persons who inject drugs by 25% or more

Reduce reported rate of new hepatitis C virus infections among persons who inject drugs by 25% or more
National Progress Report 2025 Goal
Arrow on yellow, indicating "not met, moved toward annual target"

Status: Moving toward annual target, but annual target was not fully met

Reduce reported rate of new hepatitis C virus infections among persons who inject drugs by 25% or more
Check-mark on green, indicating "Met or exceeded current annual target"

Met or exceeded current annual target

Arrow on yellow, indicating "not met, moved toward annual target"

Moving toward annual target, but annual target was not fully met

X on red, indicating "Not met, no change or moved away from annual target"

Annual target was not met and has not changed or moved away  from annual target

Source: CDC, National Notifiable Diseases Surveillance System.1
* Rate per 100,000 population.
† Persons aged 18–40 years were used as a proxy for persons who inject drugs.

Summary of Findings

The rate of new hepatitis C cases reported to CDC among persons aged 18–40 years has increased steadily since 2013 to a peak of 2.9 cases per 100,000 population in 2020; 2021 marks the first year that the rate of new hepatitis C cases among persons aged 18–40 years has decreased after eight consecutive years of increase. The 2021 rate was 2.8 per 100,000 population, above the 2021 target rate of 1.9 per 100,000 population. Injection drug use is the most common risk reported for persons with new hepatitis C virus infection, and increases in hepatitis C incidence, particularly among persons aged 18–40 years, are temporally associated with increases in this risk factor.1 During 2020 and 2021, there were major disruptions in access to medical care, testing, and routine viral hepatitis public health activities due to the COVID-19 pandemic; therefore, 2020 and 2021 data should be interpreted with caution.

Reduction needed to meet 2025 goal:

A 39% reduction from the 2021 rate of reported new hepatitis C cases is needed to meet the 2025 goal of 1.7 cases per 100,000 population.

This reduction can best be achieved by:

  • Encouraging testing among people who inject drugs (PWID) by developing and delivering tailored hepatitis C education materials and meeting people where they are by offering testing in places that PWID go.
  • Supporting efforts to improve access to routine hepatitis C testing among PWID and increasing access to appropriate treatment that can cure PWID with hepatitis C.
  • Supporting continuing medical education and developing partnerships to improve confidence and comfort when working with stigmatized populations.
  • Building capacity within jurisdictions to make it easier for them to collect and use a core set of surveillance data as well as prioritize new data collection initiatives (molecular, computational, informational) that will help pinpoint where HCV infection is occurring, understand transmission networks, and enhance what is learned from outbreak investigations among PWID.
  • Increasing access to syringe services programs and linkage to testing and medication-assisted treatment programs by implementing comprehensive community-level programs for PWID.
  • Increasing availability, access, and use of hepatitis C prevention services in settings that serve PWID by building and leveraging partnerships that promote proven prevention strategies.
  • Conducting research focused on improving strategies to decrease hepatitis C incidence among PWID.

Technical Notes

Data Sources:
CDC, National Notifiable Diseases Surveillance System (NNDSS)

Number of acute HCV infections reported annually among persons aged 1840 years

Total population of persons aged 1840 years in reporting jurisdictions

Indicator Notes:
NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable disease-related health information.1 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 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 except Alaska. Healthcare 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 CSTE/CDC surveillance case definition. Case rates per 100,000 population are calculated based on the projected resident population of the United States as of July 1 during each data collection year.1

Goal Setting:
The 2025 goal of 1.7 per 100,000 population is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and the US Department of Health and Human Services 20212025 Viral Hepatitis National Strategic Plan. Annual targets assume a constant (linear) rate of change from the observed baseline (2017 data year) to the 2025 goal (2023 data year). 

Viral hepatitis is largely underreported in NNDSS. Based on a simple, probabilistic model for estimating the proportion of patients who were symptomatic, received testing, and were reported to health officials in each year, the actual number of acute hepatitis C cases is estimated to be 13.9 times the number reported to CDC.1,2 This estimate has not been revised to reflect the 2020 acute hepatitis C case definition change. Additionally, rates of reported cases may vary over time based on changes in public and provider awareness, laboratory and diagnostic techniques, and the definition of the condition. 

  1. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance – United States, 2021. Published August 2023. Accessed [date]. 
  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.