Making the Case for Universal Screening of Pregnant Women for Hepatitis C Virus: One State at a Time

BACKGROUND: New cases of Hepatitis C virus (HCV) infection are climbing in young adults and particularly in women of child-bearing age. Despite this growing burden, a risk-based screening approach is still recommended when testing for HCV in pregnant women and young adults. Risk-based screening was abandoned for “Baby Boomer” adults in favor of universal screening due to concerns for insufficient capture of cases. Objective. We analyzed public health department data for all 50 states to compare the published rates of HCV infection among young adults and Baby Boomers METHODS: Public health department websites for all 50 states were reviewed for the most recent information on HCV incidence and prevalence. Age-specific rates were recorded for young adults (ages 20–39) compared with Baby Boomers (ages 50–70). When specific rates were not available, data on year over year trends were noted for both age groups. RESULTS: Using their own published data, we identified 11 states where rates of HCV infection in young adults surpassed that of Baby Boomers, and 4 states where the rates of HCV were equal between the 2 age groups. These states alone make-up 25% of the entire US population. When we include 6 additional highly populous states with reported HCV incidence on the rise in young adults, these 21 states account for more than half the US population. Only 4 states reported HCV rates in Baby Boomers to be higher than young adults and 25 states had no recent data to review. Of note, most of these states are direct neighbors to states in the first 2 categories with a higher burden of HCV. CONCLUSION: Even using a risk-based screening strategy with lower case capture rate in young adults compared with universal screening in Baby Boomers, we identified that many states have HCV rates in young adults that is as high or higher than Baby Boomers. These results suggest that universal screening in this age group is warranted, where DAA treatment could reduce future spread. Pregnant women represent an easy group to target given their frequent medical visits, frequent lab testing, their exposed infants would require follow-up testing and the women could be referred for DAA treatment after delivery. DISCLOSURES: R. Jhaveri, Gilead: Grant Investigator, Grant recipient. Abbvie: Grant Investigator, Grant recipient. Merck: Grant Investigator, Grant recipient