CDC recommends Hepatitis C screening for all adults

The Centers for Disease Control and Prevention now recommends that all adults aged 18 and older be screened at least once for hepatitis C virus (HCV) infection, and that all pregnant women be screened during each pregnancy.

Hepatitis C virus (HCV) infection is a major source of morbidity and mortality in the United States. HCV is transmitted primarily through parenteral exposures to infectious blood or body fluids that contain blood, most commonly through injection drug use. No vaccine against hepatitis C exists and no effective pre- or postexposure prophylaxis is available

Recommendations-

Universal hepatitis C screening (new recommendations):

Hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%

Hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%

One-time hepatitis C testing regardless of age or setting prevalence among persons with recognized conditions or exposures (existing recommendations):

Persons with HIV

Persons who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago

Persons with selected medical conditions, including persons who ever received maintenance hemodialysis and persons with persistently abnormal ALT levels

Prior recipients of transfusions or organ transplants, including persons who received clotting factor concentrates produced before 1987, persons who received a transfusion of blood or blood components before July 1992, persons who received an organ transplant before July 1992, and persons who were notified that they received blood from a donor who later tested positive for HCV infection

Health care, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV-positive blood

Children born to mothers with HCV infection

Routine periodic testing for persons with ongoing risk factors, while risk factors persist:

Persons who inject drugs and share needles, syringes, or other drug preparation equipment

Persons with selected medical conditions, including persons who ever received maintenance hemodialysis

Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks

The recommendations, published in MMWR Recommendations and Reports, do not apply to adults and pregnant women in areas where the prevalence of HCV infection is below 0.1%. However, the agency notes that no state has a prevalence in adults below that threshold, according to NHANES data, and birth certificate data suggest that just three states have a prevalence that low among pregnant women.

The authors have advised that "health care providers should initiate universal hepatitis C screening until they establish that the prevalence of HCV RNA positivity in their population is <0.1%, at which point universal screening is no longer explicitly recommended but might occur at the provider's discretion."

MMWR Recommendations and Reports article