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2021 Viral Hepatitis Surveillance Report Overview: 60% increase in acute HCV infections since 2017
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The Viral Hepatitis Surveillance Report - United States, 2021 is published by the Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services, Atlanta, Georgia.
https://www.cdc.gov/hepatitis/statistics/2021surveillance/index.htm
"The acute hepatitis C case count corresponds to a reported rate of 1.6 cases per 100,000 population, a 60% increase from the reported rate during 2017 (1.0 cases per 100,000 population) and a 7% increase from the reported rate during 2020 (1.5 cases per 100,000 persons)."
During 2021, a total of 5,023 acute hepatitis C cases were reported to CDC from 42 states, corresponding to 69,800 estimated infections (95% CI: 55,300-238,100) after adjusting for case underascertainment and underreporting.
Acute Hepatitis C in 2020
The incidence rate of acute hepatitis C has more than doubled since 2013, and increased 15% from 2019.
Chronic Hepatitis C in 2020
During 2020, 41 states reported a total of 107,300 newly identified chronic hepatitis C cases in 2020, corresponding to 40.7 chronic hepatitis C cases per 100,000.
Hepatitis C-associated deaths during 2020 increased 4% (3.45 deaths per 100,000 people), compared to 2019 (3.33 deaths per 100,000 people).
The age-adjusted death rate for hepatitis C during 2020 decreased 22% from 2016 (4.42 deaths per 100,000 people).
The death rates were higher among AI/AN and non-Hispanic Black persons (3.2 times and 1.8 times, respectively) than among non-Hispanic White persons.
The state-specific rates of reported acute hepatitis C varied throughout the country during 2020. The states in the lowest rate category of 0.0-0.3 cases per 100,000 population include (in increasing order) New Mexico, California, Idaho, South Carolina, Texas, Vermont, Connecticut, Idaho, Kansas, and Virginia. The states in the highest rate category of 2.4-11.9 cases per 100,000 population include (in increasing rate order) Tennessee, Kentucky, Utah, Indiana, Delaware, West Virginia, Louisiana, Florida, and Maine. Aside from Utah (3.2 cases per 100,000 population), the states with the highest rates of acute hepatitis C are located in the eastern and southern parts of the country, particularly in or near the Appalachian region.
107,000 new Chronic HCV Reported cases.
Racial disparities reported: mortality rates higher for blacks & hispanics compared to whites. Rates high for American Indan/Alaska Native but numbers are a fraction of for other groups.
Of the 107,300 newly reported cases of chronic hepatitis C during 2020, approximately one-third were from 5 states (Florida, California, Pennsylvania, Ohio, and Alabama). The highest rate of newly reported cases of chronic hepatitis C was in West Virginia (122.1 cases per 100,000 population), followed by Alabama (115.8 cases per 100,000 population), Louisiana (90.6 cases per 100,000 population), Mississippi (88.1 cases per 100,000 population), and Arkansas (82.9 cases per 100,000 population).
The number of acute hepatitis C cases reported in the United States increased every year during 2013-2020. During 2020, a total of 4,798 acute cases were reported, corresponding to 66,700 estimated infections after adjusting for case underascertainment and underreporting. The number of cases reported during 2020 corresponded to a 16% increase from the 4,136 cases reported during 2019, and a 124% increase from the 2,138 cases reported during 2013.
Approximately 52% of acute hepatitis C cases reported to CDC during 2021 were among persons aged 20-39 years, meaning 48% were among older people !!!!. The rate of reported cases of acute hepatitis C was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (2.7 cases per 100,000 population), compared with other race and ethnicity groups. Among the 1,449 (29%) reported acute cases that included risk information for injection drug use, 820 (57%) reported injection drug use. A total of 604 patients with acute hepatitis C were hospitalized (31% hospitalization rate among 1,935 cases with hospitalization information available). Rates of acute HCV in table use below show racially increasing rates among Blacks, Hispanic and whites, AI/AN, A/PI.
A total of 107,540 cases of newly reported chronic hepatitis C were reported to CDC from 43 states during 2021, corresponding to a rate of 39.8 cases per 100,000 population. The rate of newly reported chronic hepatitis C was highest among persons aged 30-39 years (74.9 cases per 100,000 population), followed by persons aged 40-49 years (54.6 cases per 100,000 population), compared with other age categories, maintaining a previously reported shift in the chronic hepatitis C disease burden from older (above 65 years old) to younger persons (See Figure 3.8).8 STILL THE NEW CASES ARE HIGH AMONG OLDER PEOPLE TOO, 60-70 reflecting how there remains an older group escaping screening & treatment, which likely contributes to concerting MORTALITY persistence !!! The rate of newly reported chronic hepatitis C cases was highest among non-Hispanic AI/AN persons (68.9 cases per 100,000 population), compared with other race and ethnicity categories.
A total of 199 perinatal hepatitis C cases were reported to CDC from 28 states during 2021, a 21% increase from the 165 cases reported in 2020, and closer to the 217 cases reported in 2019 before the COVID-19 pandemic occurred.
Data from death certificates filed in the vital records offices of the 50 states and the District of Columbia indicated that the age-adjusted death rate associated with hepatitis C during 2021 was 3.18 deaths per 100,000 population, an 8% decrease compared to the rate during 2020 (3.45 deaths per 100,000 population). BUT HIGH RATES PERSIST DESPITE DECREASES - see Tables Below. The age-adjusted death rate for hepatitis C during 2021 represents a 23% decrease from the rate during 2017 (4.13 deaths per 100,000 population).
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