Identification of Maternal HCV Infection Using Public Health Surveillance Systems

Hepatitis C virus (HCV) infection in pregnant women continues to be under-recognized; therefore, alternative approaches are needed to improve HCV case identification so that early treatment may prevent the development of liver disease and reduce HCV transmission, according to a study published in Paediatric and Perinatal Epidemiology.¹

HCV infection is often clinically silent, with fewer than 50% of adults who are chronically infected aware of their diagnosis.^2-4 Current surveillance efforts for maternal HCV rely on birth certificate data; however, universal prenatal screening for HCV may be an effective outreach strategy to close the diagnosis gap among women and identify at-risk infants.¹ 

Using birth certificate data, researchers identified 4695 women who gave birth from 2012 to 2015 in Ohio and had past/present HCV infection. Using a new algorithm that linked the birth certificate data with the Ohio Disease Reporting System HCV case data, they identified an additional 1778 children born to women with past/present infection, including 355 women with confirmed HCV infection during pregnancy who would not have been identified based only on birth certificate data. By integrating data from 2 surveillance systems routinely maintained by the Ohio Department of Health, the researchers developed a new algorithm that could more fully ascertain the prevalence of HCV infection among pregnant women in Ohio. In addition, they found that the prevalence of past/present HCV among pregnant women in Ohio rose from 0.82% in 2012 to 1.54% in 2015.

“Alternative approaches, including enhanced risk factor-based screening or universal prenatal screening in high prevalence settings, are needed to improve rates of HCV recognition among reproductive-aged women and newborns at risk [for] vertical transmission” concluded the authors.¹

References

1. Gowda C, Kennedy S, Glover C, Prasad MR, Wang L, Honegger JR. Enhanced identification of maternal hepatitis C virus infection using existing public health surveillance systems [published online July 4, 2018]. Paediatr Perinat Epidemiol. doi: 10.1111/ppe.12481.
2. Yehia BR, Schranz AJ, Umscheid CA, Lo Re 3rd V.  The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis.PLoS One. 2014;9:e101554.
3. Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, Swan T. Toward a more accurate estimate of the prevalence of hepatitis C in the United States.Hepatology. 2015;62:1353‐1363.
4. Delgado-Borrego A, Smith L, Jonas MM, et al. 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 surveys.J Pediatr. 2012;161:915‐921.