PUBLIC HEALTH
KENTUCKY DEPARTMENT OF PUBLIC
HEALTH Updates Hepatitis C Screening
Recommendations
Lori Caloia, MD
I
n April 2018, KRS 214.160 was amended
to establish a requirement that all pregnant
women in Kentucky be tested for hepatitis
C virus (HCV). This statute also requires
that children born to women who have
a positive HCV result be reported to the lo-
cal health department and recommends that
they have follow up HCV testing. This article
is a summary of the most recent Kentucky
Department of Public Health (KDPH) HCV
screening, testing and management recommendations and resources
for care. The HCV updated screening recommendations from the
KDPH can be found at the following website: https://bit.ly/2QKfx6P. More than 70 percent of individuals with hepatitis C report injec-
tion drug use (8), and an estimated incidence of HCV infection
in people who inject drugs (PWID) was 55.5 percent (range 43.8
to 67 percent) (10). In response to these increasing HCV rates in
Kentucky, particularly affecting women of childbearing age and
their offspring, in April 2018, the Commonwealth amended SB 250
KRS 214.160 to establish that all pregnant women in Kentucky be
tested for hepatitis C, and recommended testing for children born
from a pregnant woman who has a positive hepatitis C test result.
BACKGROUND » » Adults born during 1945 through 1965 should be tested once
(without prior ascertainment of HCV risk factors) (11)
» » All pregnant women
» » HCV-testing is recommended for those who have the following
risk factors:
o Have history of injection or intranasal drug use, or use
currently
o Unregulated body piercing and/or tattoos
o Sexual contact with a known HCV-positive person
o History of high risk sexual behavior
o History of sexually transmitted infection
o History of incarceration
o Have certain medical conditions, including persons:
• who received clotting factor concentrates produced
before 1987
• who were ever on long-term hemodialysis
• who have HIV infection
• who have hepatitis B infection
o Were prior recipients of transfusions or organ transplants,
including persons who:
• were notified that they received blood from a donor
who later tested positive for HCV infection
• received a transfusion of blood, blood components or
an organ transplant before 1992
» » HCV - testing based on a recognized exposure is recommended
for:
o Health care, emergency medical and public safety workers
after needle sticks, sharps or mucosal exposures to HCV-pos-
itive blood (note: the risk of HCV infection after needlestick
or sharps exposure to HCV-positive blood is estimated at
Hepatitis C, a blood-borne disease, is usually a chronic viral infection
with few early symptoms. Only 20 to 30 percent of acutely infected
individuals experience fatigue, abdominal pain, poor appetite, or
jaundice (1), most with symptom onset two to 12 weeks following
exposure (range two to 26 weeks)(2, 3). Approximately 15 to 20
percent of acutely infected persons clear the infection(4, 5), with
many predictive variables for spontaneous clearance, including
jaundice, elevated ALT level, hepatitis B virus surface antigen (HB-
sAg) positivity, female sex, younger age, HCV genotype 1 and host
genetic polymorphisms (4, 5).
HCV infection becomes chronic in approximately 75 to 85 per-
cent of cases (4, 5), and patients may develop fibrosis, hepatocellular
carcinoma, and in 10 to 20 percent of cases, cirrhosis. Chronic HCV
infection is the leading indication for liver transplants in the Unit-
ed States (6). Prior infection with HCV infection does not protect
against later infection with the same or different genotypes of the
virus. Presently no vaccine for hepatitis C is available.
The Center for Disease Control (CDC) estimates that 3.5 million
persons are living with chronic HCV infection in the United States
(7). In 2016, the estimated incidence of acute hepatitis C infection
in the US was one case per 100,000 and more than double that in
Kentucky, where the incidence was 2.3 cases per 100,000. Both are
likely underreported due to inadequate surveillance and neither is
near the Healthy People 2020 goal of < 0.25 cases per 100,000 (8).
The hepatitis C epidemic among people who inject drugs con-
tinues to spread throughout Kentucky and the US in both urban
and rural areas, especially among people in their 20s and 30s (8,9).
WHO SHOULD BE TESTED FOR HCV INFECTION?
According to current KDPH guidelines, HCV testing is recom-
mended for anyone at increased risk for HCV infection, including:
OCTOBER 2018
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