title: Prevalence of Diagnosed and Undiagnosed Hepatitis C in a Midwestern Urban Emergency Department.
abstract: BACKGROUND
  Targeted hepatitis C virus (HCV) screening is recommended. Implementation of screening in emergency department (ED) settings is challenging and controversial. Understanding HCV epidemiology in EDs could motivate and guide screening efforts. We characterized the prevalence of diagnosed and undiagnosed HCV in a Midwestern, urban ED.
  
  
  METHODS
  This was a cross-sectional seroprevalence study using de-identified blood samples and self-reported health information obtained from consecutively approached ED patients aged 18-64 years. Subjects consented to a "study of diseases of public health importance" and were compensated for participation. The Biochain ELISA kit for Human Hepatitis C Virus was used for antibody assay. Viral RNA was isolated using the Qiagen QIAamp UltraSens Virus kit, followed by real-time reverse transcription polymerase chain reaction using a Bio-Rad CFX96 SYBR Green UltraFast program with melt-curve analysis.
  
  
  RESULTS
  HCV antibody was detected in 128 of 924 (14%; 95% confidence interval [CI], 12%-16%) samples. Of these, 44 (34%) self-reported a history of HCV or hepatitis of unknown type and 103 (81%; 95% CI, 73%-87%) were RNA positive. Two additional patients were antibody negative but RNA positive. Fully implemented birth cohort screening for HCV antibody would have missed 36 of 128 (28%) of cases with detectable antibody and 26 of 105 (25%) of those with replicative HCV infection.
  
  
  CONCLUSIONS
  HCV infection is highly prevalent in EDs. Emergency departments are likely to be uniquely important for HCV screening, and logistical challenges to ED screening should be overcome. Birth cohort screening would have missed many patients, suggesting the need for complementary screening strategies applied to an expanded age range.
authors.affiliation: Department of Emergency Medicine.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
authors.affiliation: Division of Digestive Diseases.
authors.forename: Vidhya A
authors.initials: VA
authors.lastname: Kunnathur
authors.affiliation: Division of Digestive Diseases.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Rouster
authors.affiliation: Department of Emergency Medicine.
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.affiliation: Department of Emergency Medicine.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Sperling
authors.affiliation: Division of Infectious Diseases, University of Cincinnati, Ohio.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Fichtenbaum
authors.affiliation: Division of Digestive Diseases.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D016174:Hepacivirus / Q000276:immunology* / Q000378:metabolism; D006526:Hepatitis C / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015146:Midwestern United States; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D016036:Seroepidemiologic Studies; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral
keywords: disease prevalence; emergency medicine; epidemiology; hepatitis C; mass screening