Hepatitis C

Most persons with acute hepatitis C infections do not have symptoms, although 20-30 percent will have mild to severe gastrointestinal symptoms, including jaundice, within six months of infection. Identification of acute cases requires symptom information and laboratory data or evidence of seroconversion, which are often not available. In 2020, 17 confirmed and three probable cases of acute hepatitis C were reported in Allegheny County, all in adults. The CDC estimates that the true number of acute cases is 13.9 times higher than what is reported each year.³

Chronic hepatitis C is associated with liver damage and sometimes liver failure or liver cancer. The number of newly reported chronic hepatitis C cases in Allegheny County has been decreasing since 2017. The trend from 2019 to 2020 was no exception. The reason for the decrease is uncertain, given the disruption in health care testing services during the COVID-19 pandemic. ^1,2 In Allegheny County, there was a 40 percent decrease in the number of newly reported chronic HCV infections from 2019 to 2020.

In 2020, there were 1,036 confirmed and probable cases of chronic hepatitis C cases reported among Allegheny County residents. Of that total, 766 (74%) were classified as confirmed chronic cases and 270 (26%) were classified as probable chronic cases (Figure 1).

• Chronic cases are considered confirmed if a person has a positive HCV NAT, HCV antigen, or genotype results without clinical information consistent with acute infection
• Chronic cases are considered probable if a person has a positive HCV antibody test but no confirmatory test and no clinical information consistent with acute infection

Figure 1. Chronic hepatitis C case by year and classification, Allegheny County, PA, 2011-2020

Of the 1,036 confirmed and probable cases, 614 (59%) were males. The age distribution was bimodal with peaks in the 25-39 year and 55-69 year age groups (Figure 2).

Figure 2. Chronic hepatitis C cases by age group and sex, Allegheny County, PA, 2020

The map below shows the number of newly reported chronic hepatitis C cases by zip code of residence (Figure 3). Case rates tend to be lower in outlying areas of the county.

Figure 3. Newly reported chronic hepatitis C cases per 100,000 population by zip code of residence, Allegheny County, PA, 2020

The hepatitis C virus can be transmitted from an infected mother to her infant at birth. Mother-to-child transmission is the leading cause of childhood HCV infection. According to CDC, the number of infants born to women who are infected with HCV is increasing. The CDC recommends HCV testing during every pregnancy, so infants at risk of infection receive appropriate testing and care. Women with active HCV infections are encouraged to seek treatment prior to becoming pregnant. In 2020, four cases of perinatal HCV were reported in Allegheny County.

Hepatitis C-related mortality, defined as deaths with HCV listed as any cause of death on the death certificate, decreased from an average annual age-adjusted rate of 3.7 per 100,000 in 2009-2017 to 2.9 per 100,000 in 2018-2020 in Allegheny County (Figure 4). Allegheny County has a lower hepatitis C mortality rate than the national rate.

Figure 4. Age-adjusted average annual HCV-related mortality rate in Allegheny County, 2006-2020

Source: CDC WONDER multiple cause of death file

The age-adjusted HCV-related mortality rate was higher for men than for women in Allegheny County during the 2006-2020 time period (Figure 5).

Figure 5. Age-adjusted average annual HCV-related mortality rate by sex, Allegheny County, 2006-2020

Source: CDC WONDER multiple cause of death data file

The age-adjusted HCV-related mortality rate was higher for Black residents than for White residents in Allegheny County during the 2006-2020 time period (Figure 6).

Figure 6. Age-adjusted average annual HCV-related mortality rate by race, Allegheny County, 2006-2020

Source: CDC WONDER multiple cause of death file

The hepatitis C related mortality rate was highest in persons 55-64 years of age in Allegheny County during the 2006-2020 time period. (Figure 7)

Figure 7. Age-specific HCV-related mortality rates, Allegheny County, 2006-2020

For 35-44 and 85+ year age groups - Rate suppressed due to small numbers
Source: CDC WONDER multiple cause of death data

Hepatitis C is the most common bloodborne infection in the United States. It is spread through exposure to the blood of someone who is infected. Even a small amount of blood is enough for a new infection to occur. Here are steps to prevent infection with HCV:

• Never share needles
  People who use intravenous drugs are at highest risk of getting infected with HCV because many share needles
• Avoid direct exposure to blood or blood products
  Any tools that encounter blood or draw blood should be disposed of safely or sterilized
• Don’t share personal care items
  Sharing razors or tooth brushes can also be a vehicle for viral transmission since small cuts sometimes occur on the skin or gums during use
• Use licensed tattoo and piercing artists
  Correct sanitary procedures, such as using new disposable needles and ink wells, should be done for each customer
• Practice safe sex
  Learn how at practice safe sex, thus avoiding sexually-transmitted infections, by visiting the CDC’s website.

Hepatitis C is a curable disease. Effective medications are available to treat the disease with few side effects. Treatments usually involve 8-12 weeks of a one-pill-a-day regimen and cure over 90 percent of people.

Resources

• Testing recommendations – CDC currently recommends testing all adults for Hepatitis C infection
• Hepatitis C screening and follow-up care providers in Allegheny County
• Preventing Infection
• Know More Hepatitis Campaign for Health Care Providers
• Hepatitis C – Pennsylvania Department of Health