Hepatitis C Infections May Be Vastly Underreported

In a development that underscores the need for dental offices to follow proper infection control protocols, a new study suggests that massive underreporting may occur within the system set up by the U.S. Centers for Disease Control and Prevention (CDC) to estimate the incidence of acute hepatitis C virus (HCV) infection. A paper published online in Annals of Internal Medicine describes how investigators tracked 183 Massachusetts patients diagnosed with acute HCV from 2001 to 2011. Of those 183 cases, only one met the CDC’s definition of a confirmed reportable case. Data that would have triggered reporting were either not available in a timely fashion, or did not meet CDC definitions for acute HCV infection.

“The incidence of HCV can be likened to an iceberg, in that only a fraction of cases — the proverbial ‘tip’ — is visible,” reports senior author Arthur Kim, MD, of Massachusetts General Hospital’s Division of Infectious Diseases. “This is due to the minimal symptoms that usually accompany acute HCV and the fragmented care available to those at highest risk.”

The authors suggest that while the reported incidence of HCV infection in the U.S. has been trending down since the 1990s, the rate of decrease has leveled off, and the number of infections may actually be on the rise again. Noting that an “accurate estimate of the incidence of HCV is crucial for guiding public health initiatives,” Kim speculates that it’s likely national estimates have been based on inaccurate numbers.

“Overall,” he concludes, “I would argue that we should devote more resources to surveillance, so that we can better track cases as part of a comprehensive effort to prevent HCV infection.”