Hepatitis: March essentials

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The top new studies selected from scanning more than 386 clinical articles on Hepatitis in the past month.

A practice of universal one-time testing may be more effective for high-risk, urban emergency
departments as more than 25% of HCV cases remain undiagnosed when Centers for Disease Control and Prevention screening recommendations were followed

Source: Clin Infect Dis                                                      

Key results

  • Of 4,713 patients, 652 (13.8%) were HCV antibody positive.
  • Of antibody positive patients, 204 (31.3%) had undocumented HCV infection.
  • Of patients with undocumented HCV infection, 99 (48.5%) would have been diagnosed based on birth-cohort testing, and an additional 54 (26.5%) would have been identified through risk-based testing as recommended by the CDC.
  • The remaining 51 patients (25.0%) with undocumented HCV would not have been tested.
  • Given an estimated 7,727 unique ED patients with HCV infection in a 1-year period, testing according to CDC guidelines would identify 1,815 undocumented infections; universal testing would identify an additional 526 HCV-infected patients.

Study design

  • This was an 8-week HCV seroprevalence study conducted in 2013 at an urban ED with an annual census of 66,000 patients, serving a diverse and socioeconomic disadvantaged population.
  • Antibody HCV screening was conducted for all patients with excess blood collected for clinical purposes.
  • Demographic and clinical information, including documented HCV infection, was obtained from electronic medical records.

Why this matters

  • CDC guidelines recommend one-time HCV testing for individuals born during 1945 to 1965 (baby boomer cohort), in addition to targeted risk-based testing.
  • EDs are considered a key setting for HCV testing because of their history of success in HIV screening, given the populations they serve.
  • This study showed a high seroprevalence of both known and undocumented HCV infection in an urban ED, confirming the suitability of this venue for screening purposes.
  • However, limiting HCV screening to CDC guidelines would have allowed 26.5% of undiagnosed patients to ‘slip through the cracks.’
  • The findings suggest that universal one-time testing may be a more effective screening method for HCV in high-risk urban EDs.

PubMed Abstract
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Hepatitis C virus (HCV) mortality, even when grossly undercounted on death certificates, far outstrips deaths from 60 other nationally notifiable infectious conditions (ONNICs) combined

Source: Clin Infect Dis                                                    

Key Results

  • HCV-related deaths increased from 11,051 in 2003 to 19,368 in 2013; the average annual increase was 6.2% (P<.05).
  • ONNIC-related deaths decreased from 24,745 in 2003 to 17,915 in 2013; the average annual decrease was 3.4% (P<.05).
  • The decline in deaths was related to a 41% drop in HIV deaths and, to a lesser extent, deaths associated with pneumococcal disease (decrease of 31%) and tuberculosis (decrease of 28.2%).
  • In 2012, the number of HCV deaths surpassed that of ONNICs.
  • The HCV mortality rate (per 100,000 population) increased from 3.72 in 2003 to 5.03 in 2013; the average annual increase was 3.4% (P<.05).
  • The ONNIC-related mortality rate decreased from 8.51 in 2003 to 5.25 in 2013; the average annual decrease was 4.9% (P<.05).
  • In 2013, 51.1% of HCV-related deaths occurred among individuals aged 55-64 y (mean, 59.7 y).

Study design

  • This was an analysis of multiple-cause-of-death data for 2003-2013, obtained from the US National Center for Health Statistics.
  • Trends in HCV-related mortality were compared with those for ONNICs.
  • Mortality rates were...