High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017.

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  • Additional Information
    • Affiliation:
      Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
      Department of Emergency Medicine, Alameda Health System-Highland Hospital, Oakland, California
      Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
      Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama
      Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
      Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
      Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
      Department of Emergency Medicine, Boston University, Boston, Massachusetts
      Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Identifying persons with hepatitis C virus (HCV) infection has become an urgent public health challenge because of increasing HCV-related morbidity and mortality, low rates of awareness among infected persons, and the advent of curative therapies (1). Since 2012, CDC has recommended testing of all persons born during 1945-1965 (baby boomers) for identification of chronic HCV infection (1); urban emergency departments (EDs) are well positioned venues for detecting HCV infection among these persons. The United States has witnessed an unprecedented opioid overdose epidemic since 2013 that derives primarily from commonly injected illicit opioids (e.g., heroin and fentanyl) (2). This injection drug use behavior has led to an increase in HCV infections among persons who inject drugs and heightened concern about increases in human immunodeficiency virus (HIV) and HCV infection within communities disproportionately affected by the opioid crisis (3,4). However, targeted strategies for identifying HCV infection among persons who inject drugs is challenging (5,6). During 2015-2016, EDs at the University of Alabama at Birmingham; Highland Hospital, Oakland, California; Johns Hopkins Hospital, Baltimore, Maryland; and Boston University Medical Center, Massachusetts, adopted opt-out (i.e., patients can implicitly accept or explicitly decline testing), universal hepatitis C screening for all adult patients. ED staff members offered HCV antibody (anti-HCV) screening to patients who were unaware of their status.* During similar observation periods at each site, ED staff members tested 14,252 patients and identified an overall 9.2% prevalence of positive results for anti-HCV among the adult patient population. Among the 1945-1965 birth cohort, prevalence of positive results for anti-HCV (13.9%) was significantly higher among non-Hispanic blacks (blacks) (16.0%) than among non-Hispanic whites (whites) (12.2%) (p<0.001). Among persons born after 1965, overall prevalence of positive results for anti-HCV was 6.7% and was significantly higher among whites (15.3%) than among blacks (3.2%) (p<0.001). These findings highlight age-associated differences in racial/ethnic prevalences and the potential for ED venues and opt-out, universal testing strategies to improve HCV infection awareness and surveillance for hard-to-reach populations. This opt-out, universal testing approach is supported by new recommendations for hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of positive results for HCV infection is <0.1% (7).
    • Journal Subset:
      Biomedical; Public Health; USA
    • Instrumentation:
      Boston Diagnostic Aphasia Examination (BDAE) (Goodglass and Kaplan)
      California Verbal Learning Test (CVLT)
    • ISSN:
      0149-2195
    • MEDLINE Info:
      PMID: NLM32407307 NLM UID: 7802429
    • Publication Date:
      In Process
    • Publication Date:
      20200605
    • DOI:
      http://dx.doi.org/10.15585/mmwr.mm6919a1
    • Accession Number:
      143215948
  • Citations
    • ABNT:
      GALBRAITH, J. W. et al. High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017. MMWR: Morbidity & Mortality Weekly Report, [s. l.], v. 69, n. 19, p. 569–574, 2020. DOI 10.15585/mmwr.mm6919a1. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=143215948. Acesso em: 12 ago. 2020.
    • AMA:
      Galbraith JW, Anderson ES, Yu-Hsiang Hsieh, et al. High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017. MMWR: Morbidity & Mortality Weekly Report. 2020;69(19):569-574. doi:10.15585/mmwr.mm6919a1
    • APA:
      Galbraith, J. W., Anderson, E. S., Yu-Hsiang Hsieh, Franco, R. A., Donnelly, J. P., Rodgers, J. B., Schechter-Perkins, E. M., Thompson, W. W., Nelson, N. P., Rothman, R. E., White, D. A. E., & Hsieh, Y.-H. (2020). High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017. MMWR: Morbidity & Mortality Weekly Report, 69(19), 569–574. https://doi.org/10.15585/mmwr.mm6919a1
    • Chicago/Turabian: Author-Date:
      Galbraith, James W., Erik S. Anderson, Yu-Hsiang Hsieh, Ricardo A. Franco, John P. Donnelly, Joel B. Rodgers, Elissa M. Schechter-Perkins, et al. 2020. “High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017.” MMWR: Morbidity & Mortality Weekly Report 69 (19): 569–74. doi:10.15585/mmwr.mm6919a1.
    • Harvard:
      Galbraith, J. W. et al. (2020) ‘High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017’, MMWR: Morbidity & Mortality Weekly Report, 69(19), pp. 569–574. doi: 10.15585/mmwr.mm6919a1.
    • Harvard: Australian:
      Galbraith, JW, Anderson, ES, Yu-Hsiang Hsieh, Franco, RA, Donnelly, JP, Rodgers, JB, Schechter-Perkins, EM, Thompson, WW, Nelson, NP, Rothman, RE, White, DAE & Hsieh, Y-H 2020, ‘High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017’, MMWR: Morbidity & Mortality Weekly Report, vol. 69, no. 19, pp. 569–574, viewed 12 August 2020, .
    • MLA:
      Galbraith, James W., et al. “High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017.” MMWR: Morbidity & Mortality Weekly Report, vol. 69, no. 19, May 2020, pp. 569–574. EBSCOhost, doi:10.15585/mmwr.mm6919a1.
    • Chicago/Turabian: Humanities:
      Galbraith, James W., Erik S. Anderson, Yu-Hsiang Hsieh, Ricardo A. Franco, John P. Donnelly, Joel B. Rodgers, Elissa M. Schechter-Perkins, et al. “High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017.” MMWR: Morbidity & Mortality Weekly Report 69, no. 19 (May 15, 2020): 569–74. doi:10.15585/mmwr.mm6919a1.
    • Vancouver/ICMJE:
      Galbraith JW, Anderson ES, Yu-Hsiang Hsieh, Franco RA, Donnelly JP, Rodgers JB, et al. High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017. MMWR: Morbidity & Mortality Weekly Report [Internet]. 2020 May 15 [cited 2020 Aug 12];69(19):569–74. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=143215948