Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C

The Centers for Disease Control and Prevention (CDC) estimates that 3.2 million Americans are infected with Hepatitis C, 75 percent of them born from 1945 to 1965 – but most of them don’t know it. Current risk-based screening efforts focus on people with a history of injection drug use, who have persistently elevated liver function tests and who received a blood transfusion before 1992 (before the blood supply was tested for hepatitis C). This leaves many infected people overlooked.

CDC is now evaluating the potential of a new screening strategy – one based on year of birth – to identify people with the virus.  Because about 50 percent of chronically infected people will develop cirrhosis in their lifetimes, researchers hope to prevent a potential wave of liver disease and death by helping people who are infected get beneficial treatment.

People born from 1945 to 1965 at greatest risk

Getting infected with Hepatitis C is much less likely today than it used to be, due primarily to screening of the blood supply and improvements in infection control in healthcare settings. But people born from 1945 to 1965 are more likely than others to have the virus, due to the possibility of exposure decades ago. Individuals may carry the Hepatitis C virus for 20 years before having symptoms, and when they do start feeling weight loss, fatigue or depression, a doctor may attribute those issues to age and miss the underlying cause. This lack of diagnosis and effective treatment allows the illness to progress to liver disease and, in some cases, liver failure; Hepatitis C is the nation's leading cause of liver transplants.

“Many physicians are unfamiliar with hepatitis C and don’t really know the different ways that someone could have been infected, beyond injection drug use, so they frequently don’t do the screening,” said Dr. Bryce Smith, lead CDC investigator for the evaluation program with the CDC's Division of Viral Hepatitis. “Sometimes patients forget that they had a surgery or a car accident decades ago that required a blood transfusion."

And a one-time experiment with injecting drugs can put a person at risk. Says Smith, "If you’re a doctor and have been working with Joe for 30 years, and he is now 58, you are not going to ask Joe about his former injection drug use – those kinds of questions never come up. This is one of the limitations of risk-based testing.”

Study evaluates birth-year-based screening as a way to help more people

Collaborating with medical centers in New York, Detroit, Birmingham and Houston, CDC researchers are reviewing medical records to better understand how well the current risk-based screening approach is working and how much it costs. As part of the study, the medical centers will be using the  birth-year-based approach - recommending a one-time screening for everyone born from 1945 to 1965. They are collecting data on how much the new approach costs, the percentage of patients testing positive, how those patients are connected to treatment and care, and how medical staff and systems are affected. CDC will then compare the costs and benefits of the current approach with the costs and benefits of screening more people through the birth-year based approach.

The findings are expected to provide the scientific foundation for new recommendations on hepatitis C screening, scheduled to be published in 2012.  Researchers are hopeful that their study will yield valuable information that could benefit millions of people.

“In addition to the fact that treatment is improving, there are basic lifestyle changes that people can adopt, like cutting down on drinking or avoiding certain over-the-counter medications, that could decrease the likelihood of developing chronic liver disease,” said Smith. “Current treatments have cure rates of 20-40 percent and, with new treatments being developed, we expect those rates to go much higher – up to 75 percent. Things are changing so rapidly right now. So there are a lot of steps that infected persons can take to limit the damage to their health.”

BEST-C is supported by grants to the CDC Foundation from Genentech, Merck Sharp & Dohme, Johnson & Johnson and Vertex Pharmaceuticals.

CDC is now evaluating the potential of a new screening strategy – one based on year of birth – to identify people with the virus. Because about 50 percent of chronically infected people will develop cirrhosis in their lifetimes, researchers hope to prevent a potential wave of liver disease and death by helping people who are infected get beneficial treatment.