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screening for hepatitis C

Indications: CDC & USPSTF recommend screening all adults 18-79 for HCV at least once [13] - formerly CDC & USPSTF recommended screening for all baby boomers born 1945-1965 [3,5,7] Canadian Task Force on Preventive Health Care (CTFPHC) recommends against screening for hepatitis C virus (HCV) in adults who are not at elevated risk risk factors for hepatitis C virus 1) history of intravenous drug abuse 2) history of receiving blood products prior to 1992 - patients notified that they received blood from a donor identified as having HCV in the 'Look Back' program mandated by federal law 3) history of organ transplantation prior to 1992 4) patients on chronic hemodialysis 5) patients with > 1 unexplained elevated ALT 6) health care workers after an occupational exposure to HCV infected blood 7) children born to HCV+ mothers (check HCV antibody at 1 year) 8) consider screening a) intranasal illicit drug use b) patients with multiple sexual partners c) patients with HCV-infected sexual partners 9) serology may be negative despite chronic HCV infection 10) ref [2] seems to propose routine screening 11) when blood is being drawn in an emergency department for acute-care reasons, an extra tube should probably be sent for HIV screening & HCV screening, unless the patient is already known to be positive [9] Laboratory: 1) HCV Ab in serum/plasma/blood (HCV antibody screening) a) 2nd generation tests available in 1993 b) insensitive for detection of acute HCV infection c) antibody does not confer immunity 2) confirmatory testing of positives with HCV RNA indicated (see hepatitis C infection) [12] Notes: - rapid screening increases detection [6] - screening rates still low [10]

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hepatitis C infection hepatitis C virus

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screening

References

  1. Journal Watch 24(8):66, 2004 US Preventive Services Task Force, Ann Intern Med, 140:462, 2004 http://www.ahrq.gov/clinic/3rduspstf/hepcscr.htm - Chou R et al, Screening for hepatitis C virus infection: A review of the evidence for the US Preventive Services Task Force, Ann Intern Med, 140:465, 2004 PMID: 15023713 http://www.ahrq.gov/clinic/3rduspstf/hepcrev.htm
  2. Coffin PO et al. Cost-effectiveness and population outcomes of general population screening for hepatitis C. Clin Infect Dis 2012 May 1; 54:1259 PMID: 22412061
  3. CDC Announces First Ever National Hepatitis Testing Day and Proposes that All Baby Boomers Be Tested Once for Hepatitis C CDC Press Release, May 18, 2012 http://www.cdc.gov/nchhstp/newsroom/HepTestingRecsPressRelease2012.html - Centers for Disease Control and Prevention Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945-1965 MMWR 61(4) August 17, 2012 http://www.cdc.gov/mmwr/pdf/rr/rr6104.pdf (corresponding NGC guideline withdrawn Jan 2018)
  4. Chou R et al Screening for Hepatitis C Virus Infection in Adults: A Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation Ann Intern Med. 27 November 2012 PMID: 23183613 http://annals.org/article.aspx?articleid=1458679 - Cottrell EB et al Reducing Risk for Mother-to-Infant Transmission of Hepatitis C Virus: A Systematic Review for the U.S. Preventive Services Task Force Ann Intern Med. 27 November 2012 PMID: 23437438 http://annals.org/article.aspx?articleid=1402436
  5. Moyer VA et al Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. June 25, 2013 PMID: 23798026 http://annals.org/article.aspx?articleid=1700383 - Ngo-Metzger Q Expanded Hepatitis C Virus Screening Recommendations Promote Opportunities for Care and Cure. Ann Intern Med. June 25, 2013 PMID: 23797155 http://annals.org/article.aspx?articleid=1700384
  6. Stockman LJ et al Rapid Hepatitis C Testing Among Persons at Increased Risk for Infection - Wisconsin, 2012-2013. MMWR. April 11, 2014 / 63(14);309-311 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6314a3.htm
  7. Smith BD et al. Hepatitis C virus antibody positivity and predictors among previously undiagnosed adult primary care outpatients: Cross-sectional analysis of a multisite retrospective cohort. Clin Infect Dis 2015 Apr 15; 60:1145 PMID: 25595745 http://cid.oxfordjournals.org/content/60/8/1145
  8. Centers for Disease Control and Prevention (CDC) Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep. 2013 May 10;62(18):362-5. PMID: 23657112
  9. Lyons MS et al. Prevalence of diagnosed and undiagnosed hepatitis C in a Midwestern urban emergency department. Clin Infect Dis 2016 Feb 21 PMID: 26908799 http://cid.oxfordjournals.org/content/early/2016/02/21/cid.ciw073
  10. Ahmedin J, Fedewa SA Recent Hepatitis C Virus Testing Patterns Among Baby Boomers. Am J Preventive Med http://www.ajpmonline.org/article/S0749-3797(17)30092-2/fulltext
  11. Flanigan CA, Leung SJ, Rowe KA, et al. Evaluation of the Impact of Mandating Health Care Providers to Offer Hepatitis C Virus Screening to All Persons Born During 1945-1965 - New York 2014. MMWR Morb Mortal Wkly Rep 2017;66:1023 https://www.cdc.gov/mmwr/volumes/66/wr/mm6638a3.htm
  12. Shah H, Bilodeau M, Burak KW et al The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. CMAJ June 04, 2018 190 (22) E677-E687 PMID: 29866893 http://www.cmaj.ca/content/190/22/E677 - Crismale JF, Ahmad J. Expanding treatment for hepatitis C in Canada. CMAJ June 04, 2018 190 (22) E667-E668 PMID: 29866891 http://www.cmaj.ca/content/190/22/E667
  13. U.S. Preventive Services Task Force (USPSTF) Screening for Hepatitis C Virus Infection in Adolescents and Adults. US Preventive Services Task Force Recommendation Statement. JAMA. Published online March 2, 2020 PMID: 32119076 https://jamanetwork.com/journals/jama/fullarticle/2762186 - Chou R, Dana T, Fu R et al Screening for Hepatitis C Virus Infection in Adolescents and Adults. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. Published online March 2, 2020 PMID: 32119034 https://jamanetwork.com/journals/jama/fullarticle/2762185 - Graham CS, Trooskin S Universal Screening for Hepatitis C Virus InfectionA Step Toward Elimination. JAMA. Published online March 2, 2020 PMID: 32119041 https://jamanetwork.com/journals/jama/fullarticle/2762183 - Rosenberg ES, Barocas JA. USPSTF's s Hepatitis C Screening Recommendation - A Necessary Step to Tackling an Evolving Epidemic. JAMA Netw Open. 2020;3(3):e200538. PMID: 32119098 Free Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2762048 - Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults - United States, 2020. MMWR Recomm Rep 2020;69(No. RR-2):1-17 https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm