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Press Briefing Transcript

CDC Telebriefing on Hepatitis C testing

May 7, 2013 1:30 pm E.T.

OPERATOR:  Good afternoon and thank you all for standing by.  This is the conference coordinator.  All lines will be placed on listen only until we're ready for the question and answer session of today's call.  This call is also being recorded.  If you do have any objections, you may disconnect at this time.  I would now like to introduce your first speaker, Mr. Tom Skinner.  You may begin, sir. Thank you. 

TOM SKINNER:  Thank you, Lori.  And thank you all for joining us today for another release of a CDC vital signs.  This one is on the evaluation of Hepatitis C virus infection, testing and reporting.  Eight US Cities 2005 to 2011.  Today we're joined by the director of the CDC, Dr. Tom Frieden, who will provide some opening remarks.  And then we'll turn the call over to Dr. John Ward who is the director of our division of viral hepatitis who will provide some further detail on the report.  And then we will get to your questions.  So without further ado, I’d like to turn the call over to CDC director tom Frieden. 

TOM FRIEDEN:  Good afternoon, everyone.  Welcome and thanks very much for joining the call.  Hepatitis C affects about 3 million Americans, about 3 million people infected.  Most of the infected people in this country are baby boomers.  Born between the years 1945 and 1965.  The bottom line here is, if you were born between those years, get tested.  And if you're positive, get follow-up testing.  Before I head into details, really the take-home message from today's report is that you may not remember everything that happened in the '60s and '70s, but your liver does.  And for that reason, everyone from 45 to 65 should be tested and should get complete testing.  Once someone's infected with Hepatitis C, about four out of five, 80 percent, stay infected for life.  The 3 million people today infected with Hepatitis C, about half will go on to have serious liver problems known as cirrhosis and about one-third may die from complications of their infection.  That's one million people, potentially dying from Hepatitis C unless we effectively address it.  Hepatitis C   is the most common reason people need liver transplants.  And it's the leading cause of liver cancer which is the fastest rising cause of cancer-related death in the U.S at CDC we estimate that if baby boomers get tested and if they're infected, get into care, we could prevent at least 100,000, about 120,000 deaths.  Now, getting into some of the details of today's report, we were able to track Hepatitis C   in eight US Sites, eight cities, from 2005 to 2011.  And although many people were found to be positive, it appears that only about half had complete testing for the virus, meaning that following an initial test, they had follow-up testing.  With Hepatitis C, you really need two stages of testing.  The first test, a screen to see if you've ever been infected with the virus.  And the second see whether you're still infected or whether you're one of the fortunate 20 percent that isn't still infected.  Today's data show that even among young people who get tested positive, only about half had follow-up tests to see if they were still infected.  That's what you need to get appropriate care and treatment.  Right now there are better Hepatitis C treatments available than ever and there are more treatments coming in the coming year.  So confirming that someone is more infected is more important than ever.  Not everyone with Hepatitis C will need treatment, but everyone with Hepatitis C   should be linked to care so that they can monitor how their liver is doing, determine when and if treatment is warranted, avoid things like excess alcohol which can damage their liver, and avoid medications that could also damage their liver as well as getting vaccinated against hepatitis b to protect their liver.  Liver disease is something which is causing an increasing number of deaths, and many of those deaths could be prevented with the current treatments and with preventive actions that people can take if, but only if, they know that they're infected.  Today CDC is also issuing updated guidance for doctors and other health care providers about how to test for Hepatitis C   and how to provide follow-up.  And Dr. Ward will provide more detail on that in his remarks.  Before I turn the call over to Dr. Ward, I’ll be back with you for questions; I want to remind baby boomers to get tested for Hepatitis C.  And if your screening test is positive, make sure you go back for a follow-up test.  We have key messages in the vital signs for patients, for health care providers, for health care systems and for state and local governments, all of which can play an important role in reducing the risks that people will progress from Hepatitis C infection to severe liver disease, because it's possible to stop that progression.  So, again, baby boomers may not remember everything we did in the '60s or '70s, but our liver does.  Get tested to find out if you have the infection now, because if so, care and treatment really could save your life.  Now, Dr. Ward? 

DR JOHN WARD: Thanks, Tom and good afternoon, everyone.  This is Dr. John Ward, the director of the division of hepatitis here at CDC.  Today's report is based on an analysis of data from 2005 through 2011 reported by eight states in major cities across the country that received CDC funding to conduct enhanced surveillance for Hepatitis C.  As Dr. Frieden just remarked, today's findings suggest that when people test positive for Hepatitis C   ant bodies, the follow-up test is often not completed.  The report found that among those individuals who received a positive antibody test, only half, 51 percent, also had a positive follow-up test reported to the health department that indicated that they were still infected.  We already know there's a majority of those with Hepatitis C do not know that they're infected because they haven't been tested.  These data suggest that even among individuals who have received that initial antibody test, as many as half do not know for sure if they still carry the virus.  So what happened to the other half?  They only had a positive antibody test?  Some of these individuals may have cleared the infection on their own because we know that about 20 percent of persons who become infected with Hepatitis C will clear that infection on their own.  So we believe that the larger portion of persons without a positive test, only a small proportion of those fall into this category.  More importantly, we believe it's likely that most of these individuals are still infected with Hepatitis C but have not received that follow-up test necessary to confirm their infection and serve as a gateway to them receiving the care and appropriate treatment they need.  Our findings add to other previous research which also has suggested that a substantial proportion of those with Hepatitis C   antibodies, give us an idea of the gap between those who are and are not receiving the test and show us that we have a substantial challenge in front of us.  Updated Hepatitis C testing guidance published today by CDC reinforces our current recommendations and underscores the importance of follow-up testing for everyone who tests positive for HCV antibodies.  This reinforces CDC guidance published last year.  We are hopeful that the percentage of cases reported RNA test results has already begun to increase since that time.  We strongly urge all health care providers to implement Hepatitis C  testing including the appropriate follow-up testing necessary to identify current infection with Hepatitis C. 

TOM SKINNER: Lori, I believe that we're ready for questions.  Could you please provide instructions for asking questions, please? 

OPERATOR:  Thank you, sir.  We will now begin the question and answer session.  If you would like to ask a question, please press star-one.  You will be prompted to record your name.  Press star-two to withdraw your request.  One moment for the first question.  Our first question comes from Michelle Meryl with the Hospital Employee Health Newsletter. 

MICHELLE MERYL:  Thank you very much for taking my question.  So I had a question about health care workers.  I know they're at risk for Hepatitis C, and they may be at risk for exposures from patients who have -- who are unknown -- it's unknown whether they have Hepatitis C.  So I guess a couple-tiered question, will you have guidelines for management of health care workers with Hepatitis C as you do for hepatitis B?  Are you recommending any special testing in a hospital setting, either of patients when they're admitted or of any kind of routine testing of health care workers who are involved in exposure-prone procedures? 

TOM FRIEDEN: Dr. Ward, why don't you take that question? 

DR. JOHN WARD: CDC has guidelines already for the management of health care workers with Hepatitis B, HIV and Hepatitis C.  And so those are our current recommendations which stipulate the type of management that's indicated.  The second part of that question regarding testing of patients as they come in, I think that really brings up the different settings or strategies that are -- could be brought to bear to put CDC's recommendations into implementation so that -- and so we have actually funded about 25 to 30 -- what we call demonstration sites to test out, what are the best ways to make testing available so that you reach the person's recommending and who can benefit from testing in a more efficient and effective way possible.  So to your point, some hospitals that we're working with are beginning to implement routine screening in the emergency department.  Some of them are experimenting with what's called physician reminders so that when someone checks into the clinic within this date of birth span, a reminder will pop up electronically, indicating that person is recommended for testing.  And then there are various other strategies that health care providers are working with.  But that's a critical piece.  That to be effective, you have to have your policy put into operation, and that's why we're trying to develop best practices for and working with our partners around the country. 


MICHELE MARILL: So if I could just follow up.  So you're not going to update or change anything with regard to your recommendations specifically for health care workers? 

JOHN WARD: That’s correct.

TOM SKINNER: Next question, Lori? 

OPERATOR: Our next question comes from Robert Lowes with Medscape Medical News. 

ROBERT LOWES: Yes, thanks for taking my call.  I wanted to clarify something in the MMWR and in the press release, it says that of these 218,000 people, 49% just had the -- or tested positive on the antibody test.  And then 50.8% were reported with a positive RNA test. Is it the case that the people that went beyond the antibody test, is it safe to construe that almost 51% went beyond getting the antibody test and then all of them turned out to be positive based on the RNA results?  It's hard for me to put my head around how you're trying to express that.  Because it sounds like that, you know, half the people, you know, tested positive in terms of the antibody test.  But then the rest went on -- and of that group, half went on to get the RNA test, and they all were positive. 

TOM FRIEDEN: Why don't we try to clarify that for you.   


TOM FRIEDEN:  And Dr. Ward can explain further.  Among the universe of people who tested positive for the antibody, only 50%, only half, had any record reported to their health department that they had a follow-up test.  So of those who were positive by antibody, only 50% had the recommended follow-up RNA reported.  Dr. Ward, you want to say anything further? 

JOHN WARD: No, I think that's -- I mean, I agree with that -- I don't know if there's a follow-up to that. 

ROBERT LOWES:  But in other words, the people who had the just antibody test, it really wasn't clear whether they harbored the virus because it just showed that at one point, they had the virus, but it did not show that they were -- they still had the virus, right? 

TOM FRIEDEN: That’s right.  What we know from many other studies is about 80% of them probably still did.  So it's concerning that it looks like about half didn't have the follow-up testing since the great majority of them probably had continued infection and may not have gotten the required testing, or recommended testing, I should say. 

JOHN WARD:  I think, you know, both sides of this proportion really lead you to the same conclusion, and that is the testing for viremia is very important.  You have to know -- the most important question to be answered by Hepatitis C testing is am I currently infected with this virus and have this condition?  And that second test has to be conducted to answer that question. 

TOM SKINNER: The next question, Lori? 

OPERATOR: Our next -- as a reminder, if you would like to ask a question, please press star-one.  You will be prompted to record your name.  And our next question comes from Christopher Yi with Hartford Health. 

CHRISTOPHER YI: Hi.  We have a question here in regards to after the initial screening, how far after do you recommend a follow-up?  Testing? 


JOHN WARD:   Well, I think we really -- we just recommended it be done.  You know, at any time, obviously, the sooner, the better.  But we don't put a time limit beyond which it's no longer helpful.  This is a chronic infection that, you know, that lasts really essentially over the course of a lifetime once it's established.  So that testing needs to happen.  We would like for it to happen promptly.  But we want it to happen in any case. 

TOM SKINNER:  Next question, Lori? 

OPERATOR: Our next question comes from Liz Highleyman with 

LIZ HIGHLEYMAN: Yes, thank you for taking my question.  I'd like to see if Dr. Frieden can clarify the percentages of people who turn out to be chronically infected with Hepatitis C who have -- who have gone on to develop cirrhosis, liver cancer and liver related early death.  I know you gave a figure, but I didn't catch it. 

TOM FRIEDEN: It’s about 37%.  Is that correct, Dr. Ward? 

JOHN WARD:  About 37%, we estimate, will die of Hepatitis C related complications such as the ones the caller described over the course of a lifetime.  And about -- we estimate of the 3 million Americans currently living with Hepatitis C now, about half will develop cirrhosis. 


TOM SKINNER:   Next question, Lori? 

OPERATOR: Sir, thank you.  That was our last question.  I'll turn the call back over to you. 

TOM SKINNER:  Dr. Frieden, would you like to close our call with some closing remarks, please? 

TOM FRIEDEN:  Sure.  I would just first thank you all for being a part of this call.  Remind us that 3 million people is a lot of people to have an infection which will seriously harm many of their health.  That three out of four of them don't know they're infected.  And even many of the people who have been tested don't appear to have gotten follow-up testing.  So we have a lot more that we can do and need to do to make sure that we're protecting people as well as possible from serious illness and death from Hepatitis C, cirrhosis and liver cancer, in particular.  So, again, if people born from '65 -- I’m sorry, from 1945 to 1965 may not remember everything that happened in the '60s and '70s, but their liver does.  And so it's very important to get complete testing for Hepatitis C.  For health care providers, it's very important to put in automatic systems to make sure that if someone has a positive antibody test, they go on to have follow-up testing and then get into care so they can avoid further liver damage, and if appropriate, get treated.  And I want to thank you all very much for joining us. 

TOM SKINNER:   Thank you, Lori.  And this concludes our call.  If you have follow-up questions or need additional information on hepatitis or this particular Vital Signs, please call our hepatitis media office at 404-639-8895.  Thanks again for joining us. 

OPERATOR: Thank you.  That does conclude today's conference call.  Thank you all for joining.  You may disconnect at this time.  




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