Study finds substantial increase in HCV infection among younger women, children

Data from the National Notifiable Diseases Surveillance System and the Quest Diagnostics Health Trends database were used to estimate the incidence of hepatitis C virus (HCV) infection among women ages 15 to 44 years and children ages 2 to 13 years.


Hepatitis C virus (HCV) infections have markedly increased among reproductive-aged women and their children in recent years, according to an analysis of U.S. databases.

Researchers used data from the National Notifiable Diseases Surveillance System and the Quest Diagnostics Health Trends database to estimate the incidence of HCV infection among women ages 15 to 44 years and children ages 2 to 13 years. Results were published online on May 9 by Annals of Internal Medicine.

From 2006 to 2014, a total of 171,801 reproductive-aged women and 1,859 children with HCV infection were reported in the National Notifiable Diseases Surveillance System. In the surveillance database, the number of women with any HCV infection (past or present) nearly doubled from 15,550 in 2006 to 31,039 in 2014. Of 581,255 pregnant women who were tested by Quest between 2011 and 2014, 0.73% (95% CI, 0.71% to 0.75%) had HCV infection.

Only about 200 infections in children were reported each year. Of 57,136 children tested by Quest, 0.76% (95% CI, 0.69% to 0.83%) had HCV infection. The infection rate was 3.2-fold higher among children ages 2 to 3 years compared to those ages 12 to 13 years (1.62% [95% CI, 1.34% to 1.96%] vs. 0.50% [95% CI, 0.41% to 0.62%]).

Researchers applied the HCV infection rate observed in pregnant women tested by Quest (0.73%) to the number of annual live births from 2011 to 2014 (3.9 million) to estimate the number of HCV infections among women and children during that time period. Assuming a mother-to-infant transmission rate of 5.8 in 100 live births, they estimated that a yearly average of 29,000 women with HCV infection (95% CI, 27,400 to 30,900 women) gave birth to 1,700 infants with the infection (95% CI, 1,200 to 2,200 infants).

The study authors noted limitations of the data, such as how changes in testing or case definition may have resulted in more HCV infection cases being reported over time. They added that the percentage of pregnant women with the infection may be inflated because clinicians are more likely to screen at-risk women. However, an ancillary analysis of 2003 to 2012 data from the National Health and Nutrition Examination Survey yielded a comparable positive-test rate of 0.5% (95% CI, 0.3% to 0.7%) among 7,904 women ages 15 to 44 years.

Unlike among baby boomers, where HCV infection is found in a nearly 2:1 male-to-female ratio, younger people are experiencing closer gender parity in infection rates, noted an accompanying editorial.

“Rather than silence, HCV infection calls out for public health action directed at all aspects of the epidemic, including consideration of screening pregnant women,” the editorialist wrote. “At the very least, screening of pregnant women for HCV infection risk factors, as well as risk-based testing, requires more emphasis.”