Hepatitis—Do you “C” it?

Abstract

Recently, the Institute of Medicine and the Centers for Disease Control and Prevention (CDC) urged stepped-up surveillance for hepatitis C virus (HCV) infection. They specifically suggested a focus on “baby boomers” because many infected adults in that demographic do not know they have HCV. The greatest barrier to treatment is lack of diagnosis. The CDC estimates that HCV screening could lead to treatment of 800 000 adults with an estimated 120 000 lives saved. Thus, birth-cohort screening for HCV in primary care settings is cost-effective (Ann Intern Med 2012;156:263-7). So, if this strategy is effective for baby boomers, what about babies? HCV infection in children and adolescents is greatly underestimated; teenagers are the only group in which the number of newly reported cases actually increased from 2002 to 2009 (MMWR 2011;60;537-41). Thus, a strong case can be made for better surveillance to track disease incidence and progression in children. In this issue of The Journal, Delgado-Borrego et al used data from Florida and US health departments to assess pediatric HCV case ascertainment rates relative to the estimated number of actual cases. From 2000 through 2009, only 12% of the expected number of infected children was identified as having positive anti-HCV tests in Florida, and only a small fraction of those identified were receiving treatment. The authors calculated that, across the US, only 5% of the children expected to be infected with HCV have been identified. They conclude that strategies to increase awareness of HCV infection in children and adolescents and to screen at-risk individuals could substantially improve morbidity and mortality while reducing health care costs. Granted, currently approved therapy for patients <18 years of age (pegylated interferon with ribavirin) has limited efficacy and significant side effects. However, there is emerging data from adult trials that a more effective, interferon-free regimen will soon be available. These data will hopefully lead to a greater appreciation of the need to consider HCV infection within the pediatric community. Article page 915▶ Expected and Actual Case Ascertainment and Treatment Rates for Children Infected with Hepatitis C in Florida and the United States: Epidemiologic Evidence from Statewide and Nationwide SurveysThe Journal of PediatricsVol. 161Issue 5PreviewTo evaluate the rate of pediatric hepatitis C virus (HCV) case ascertainment relative to the estimated number of actual cases. Full-Text PDF