Gregory L. Armstrong, MD; Annemarie Wasley, ScD; Edgar P. Simard, MPH; Geraldine M. McQuillan, PhD; Wendi L. Kuhnert, PhD; Miriam J. Alter, PhD
The Third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988 and 1994, indicated that 1.8% of people in the United States had been infected with hepatitis C virus (HCV), 70% of whom had chronic infection. Most anti-HCV–positive individuals were between 30 and 49 years of age.
Data from the recent NHANES (1999–2002) show little change in anti-HCV prevalence, but peak prevalence has shifted to individuals between 40 and 49 years of age. More than 85% of HCV RNA–positive individuals may be identified through targeted testing of 18% of adults between 20 and 59 years of age: persons with abnormal serum alanine aminotransferase levels, those who have used injection drugs, and those who received blood transfusions before 1992.
Incarcerated and homeless people were not included in the survey.
Despite a decrease in new HCV infections, aging of chronically infected individuals may presage an imminent increase in complications.
The vertical bars represent 95% CIs. The upper 95% CIs are not shown for 2 groups: 40- to 49-year-old non-Hispanic black men (18.2%) and 50- to 59-year-old Mexican-American men (20.0%).
The vertical bars represent 95% CIs.
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Mark H. Kuniholm
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
June 13, 2006
The prevalence of hepatitis C virus infection: high in the US but higher in many other countries
TO THE EDITOR:
We were encouraged by the recent article by Armstrong et al. (1) that reported both a decline in the overall prevalence of antibody to hepatitis C virus (anti-HCV) in the United States as well as a lower prevalence of anti-HCV among younger compared to older adults. While very good news, it is important to note that the HCV epidemic is a global health problem and the blood supplies of many developing countries are not routinely screened for HCV. In addition, programs to treat injection drug users and educate them about the dangers of needle sharing have had limited impact outside of a few countries in the industrialized world.
In Russia and other countries of the former Soviet Union epidemics of hepatitis C and HIV are expanding rapidly and needle sharing among injection drug users is widely believed to be the major risk factor. We recently conducted a population-based survey in Georgia, a small country in the Caucuses region, using survey methodology not dissimilar to that used for the NHANES series of surveys (2). In a random sample of 2000 adults, we found that 6.7% were anti-HCV positive, and 8.1% had injected illicit drugs during their lifetimes. Over 85% of individuals who had injected illicit drugs had shared needles with others. While Armstrong et al. found that most HCV-infected Americans were born between 1945 and 1964, we found that most HCV-infected Georgians were born between 1974 and 1977.
The United States has learned hard lessons from the now diminishing hepatitis C epidemic, and will reap the "˜bitter harvest' for many years to come (3). Similarly, hepatitis C is poised to cause more morbidity and mortality than any other infectious disease in a number of developing countries. Fortunately, there has been some recognition of the seriousness of this global health problem, and WHO, the SOROS foundation, and governmental entities have invested considerable resources to combat this problem. However, the global epidemics of HCV and illicit drug use will continue to expand unless more effective collective interventions, including injection drug user harm reduction and hepatitis C research and care strategies, are implemented.
From the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 and the Emory University School of Medicine, Atlanta, GA 30322
(1) Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705-14.
(2) Stvilia K, Tsertsvadze T, Sharvadze L, Aladashvili M, del Rio C, Kuniholm MH et al. Prevalence of hepatitis C, HIV, and risk behaviors for blood-borne infections: a population-based survey of the adult population of T'bilisi, Republic of Georgia. J Urban Health. 2006;83:289-98.
(3) Dienstag JL. Hepatitis C: a bitter harvest. Ann Intern Med. 2006;144:770-771.
Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The Prevalence of Hepatitis C Virus Infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705-714. doi: 10.7326/0003-4819-144-10-200605160-00004
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Published: Ann Intern Med. 2006;144(10):705-714.
Gastroenterology/Hepatology, Infectious Disease, Viral Hepatitis.
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