Study: Too Few Hep C Cases Reported

According to researchers, there appears to be massive underreporting of acute hepatitis C cases.

The study, conducted by investigators from Massachusetts General Hospital and the Massachusetts Department of Public Health, analyzed the system set up by the federal Centers for Disease Control and Prevention

The research was published in the Annals of Internal Medicine. Specifically, the team found that less than 1 percent of a group of acute HCV patients were reported to the CDC, even though they were taking part in a medical study.

That happened, the investigators said, because data that would have prompted a report wasn’t available soon enough. Another factor: the cases didn’t meet the CDC definitions for acute HCV infection.

“The incidence of HCV can be likened to an ‘iceberg,’ in that only a fraction of cases – the proverbial ‘tip’ – is visible,” says Arthur Kim, MD, of the MGH Division of Infectious Diseases, senior author of the paper.  “That is due to the minimal symptoms that usually accompany acute HCV and the fragmented care available to those at highest risk, such as those who inject drugs.  Many states have limited resources to track and identify HCV cases; and since even Massachusetts, where we have reasonable resources for HCV surveillance, found it difficult to report acute cases during the period we studied, it’s likely that national estimates have been based on inaccurate numbers.”

According to a news release from Massachusetts General, the authors note that, while the reported incidence of HCV infection in the U.S. has been decreasing since the 1990s, the rate of decrease has leveled off in recent years and may now be increasing due to an expanding opioid epidemic. “The CDC is already seeing increasing numbers of acute cases of HCV from a variety of jurisdictions – including a recent report from Kentucky, Tennessee, Virginia and West Virginia,” says Kim. “How large nationally is the ‘iceberg’ of HCV, given the growing numbers of persons who have injected drugs?  An accurate estimate of the incidence of HCV is crucial for guiding public health initiatives, setting priorities and planning for future needs.”