From the Journals

HCV incidence in young women doubled from 2006 to 2014

 

Key clinical point: The incidence of hepatitis C infection increased significantly in reproductive age women during 2006-2014.

Major finding: The incidence of hepatitis C infection in reproductive-age women doubled during 2006-2014 while the number of acute cases increased more than threefold.

Data source: Analysis of data from the National Notifiable Diseases Surveillance System from 2006 to 2014 and the Quest Diagnostics Health Trends national database from 2011 to 2014.

Disclosures: The study was supported by the Centers for Disease Control and Prevention. One author was an employee of Quest Diagnostics, but no other conflicts of interest were declared.

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HCV strategies needed for reproductive-aged women

 

Recognizing hepatitis C infection in pregnant women and neonates is possible, and clinical trials of antiviral therapy may show safety and efficacy in pregnant women and in children. Rather than silence, HCV infection calls out for public health action directed at all aspects of the epidemic, including consideration of screening pregnant women. At the very least, screening of pregnant women for HCV infection risk factors, as well as risk-based testing, requires more emphasis. Another issue in need of attention is the lack of authoritative, consensus-based recommendations for the identification, testing, and case management of newborns of infected mothers.

Much work lies ahead to eradicate HCV, starting with resources for public health surveillance to monitor incidence and prevalence and to fully characterize the infection in the population. Strategies to effectively prevent or cure infection in reproductive-aged women and their sexual and needle-sharing partners are critical.

Alfred DeMaria Jr., MD, is from the Massachusetts Department of Public Health. These comments are taken from an accompanying editorial (Ann Intern Med. 2017 May 8. doi:10.7326/M17-0927). No conflicts of interest were declared.


 

FROM THE ANNALS OF INTERNAL MEDICINE

 

The incidence of hepatitis C virus infection in reproductive-age women has doubled between 2006 and 2014 while the number of acute cases increased more than threefold, according to data published in the Annals of Internal Medicine.

Researchers analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) from 2006 to 2014 and the Quest Diagnostics Health Trends national database from 2011 to 2014, finding 425,322 women with confirmed HCV infection, 40.4% of whom were aged 15 to 44 years.

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The incidence of acute and past or present infection in reproductive-aged women doubled, from 15,550 in 2006 to 31,039 in 2014, and the number of acute cases increased from 249 in 2006 to 848 in 2014.

Around half of all acute infections were in non-Hispanic white women, and of the 2,069 women with available risk information, 63% acknowledged injection drug use (Ann Intern Med. 2017 May 8. doi:10.7326/M16-2350).

The analysis also found 1,859 cases of hepatitis C infection in children aged 2-13 years. According to the Quest data, the proportion of children with current hepatitis C infection was 3.2-fold higher in children aged 2-3 years than in those aged 12-13 years.

Commenting on this age difference, Kathleen N. Ly, MPH, from the Centers for Disease Control and Prevention, and her coauthors noted that it may have been the result of decreased testing over time in children already known to have chronic hepatitis C infection, or could be caused by spontaneous remission of infection, which is more common in infants and children than in adults.

The rate of infection among pregnant women tested for hepatitis C virus between 2011 and 2014 was 0.73%, which the authors calculated would mean that overall, 29,000 women with hepatitis C virus infection gave birth during that period across the United States. Based on data from a recent systematic review and meta-analysis, which found a likely mother-to-child transmission rate of 5.8/100 live births, they estimated that 1,700 infants were born with hepatitis C infection during that period.

“In contrast, only about 200 childhood cases per year are reported to the NNDSS, which may suggest a need for wider screening for HCV in pregnant women and their infants, as is recommended for HIV and hepatitis B virus,” the authors wrote. “However, recommendations for screening in pregnant women and clearer testing guidelines for infants born to HCV-infected mothers do not exist at this time.”

The study was supported by the CDC. One author was an employee of Quest Diagnostics, but no other conflicts of interest were declared.

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