title: Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention (CDC) recommends 1-time hepatitis C virus (HCV) testing in the 1945-1965 birth cohort, in addition to targeted risk-based testing. Emergency departments (EDs) are key venues for HCV testing because of the population served and success in HIV screening. We determined the burden of undocumented HCV infection in our ED, providing guidance for implementation of ED-based HCV testing.
  
  
  METHODS
  An 8-week seroprevalence study was conducted in an urban ED in 2013. All patients with excess blood collected for clinical purposes were included. Demographic and clinical information including documented HCV infection was obtained from electronic medical records. HCV antibody testing was performed on excess samples.
  
  
  RESULTS
  Of 4713 patients, 652 (13.8%) were HCV antibody positive. Of these, 204 (31.3%) had undocumented HCV infection. Among patients with undocumented infections, 99 (48.5%) would have been diagnosed based on birth cohort testing, and an additional 54 (26.5%) would be identified by risk-based testing. If our ED adhered to the CDC guidelines, 51 (25.0%) patients with undocumented HCV would not have been tested. Given an estimated 7727 unique ED patients with HCV infection in a 1-year period, birth cohort plus risk-based testing would identify 1815 undocumented infections, and universal testing would identify additional 526 HCV-infected persons.
  
  
  CONCLUSIONS
  Birth cohort-based testing would augment identification of undocumented HCV infections in this ED 2-fold, relative to risk-based testing only. However, our data demonstrate that one-quarter of infections would remain undiagnosed if current CDC birth cohort recommendations were employed, suggesting that in high-risk urban ED settings a practice of universal 1-time testing might be more effective.
authors.affiliation: Department of Emergency Medicine.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: Department of Emergency Medicine Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.affiliation: Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Oliver B
authors.initials: OB
authors.lastname: Laeyendecker
authors.affiliation: Department of Emergency Medicine.
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
authors.affiliation: Department of Emergency Medicine.
authors.forename: Ama
authors.initials: A
authors.lastname: Avornu
authors.affiliation: Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Eshan U
authors.initials: EU
authors.lastname: Patel
authors.affiliation: Department of Emergency Medicine.
authors.forename: Jim
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore.
authors.forename: Risha
authors.initials: R
authors.lastname: Irvin
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore.
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.affiliation: Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002487:Centers for Disease Control and Prevention, U.S.; D004636:Emergency Service, Hospital; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000097:blood; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D016036:Seroepidemiologic Studies; D014481:United States; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies
keywords: CDC recommendations; HCV; HCV testing; emergency department; undiagnosed infection