摘要：Objectives. Centers for Disease Control and Prevention has recommended a 1-time HCV test for persons born from 1945 through 1965 to supplement current risk-based screening. We examined indications for testing by birth cohort (before 1945, 1945–1965, and after 1965) among persons with past or current HCV. Methods. Cases had positive HCV laboratory markers reported by 4 surveillance sites (Colorado, Connecticut, Minnesota, and New York) to health departments from 2004 to 2010. Health department staff abstracted demographics and indications for testing from cases’ medical records and compiled this information into a surveillance database. Results. Of 110 223 cases of past or current HCV infection reported during 2004–2010, 74 578 (68%) were among persons born during 1945–1965. Testing indications were abstracted for 45 034 (41%) cases; of these, 29 544 (66%) identified at least 1 Centers for Disease Control and Prevention–recommended risk factor as a testing indication. Overall, 74% of reported cases were born from 1945 to 1965 or had an injection drug use history. Conclusions. These data support augmenting the current HCV risk-based screening recommendations by screening adults born from 1945 to 1965. In the United States, an estimated 3.2 million persons are chronically infected with HCV, 1 and of these, 45% to 85% are unaware of their infection. 2–5 Of those infected, most were born from January 1, 1945, through December 31, 1965. 6 Previous Centers for Disease Control and Prevention (CDC) screening recommendations for hepatitis C were risk-based and included testing of injection drug users, hemodialysis recipients, those with persistently abnormal alanine aminotransferase levels, blood transfusion or organ transplant recipients before 1992, health care workers exposed to HCV, and children born to HCV-positive women. 7 However, research has shown that physicians are often hesitant to elicit a risk history for hepatitis; when this is combined with underreporting of risk factors by patients, there is a lack of identification and underdiagnosis in the primary care setting. 8–10 A recent study that used data from the National Health and Nutrition Examination Survey showed that less than 5% of patients who knew that they were HCV-positive had been tested because of physician-identified risk factors. 11 As the number of persons with complications and mortality related to hepatitis C continues to increase because of undiagnosed and untreated hepatitis C infection, 12–14 CDC has recently recommended a birth cohort–based screening strategy. 15 Using the Grading of Recommendations Assessment, Development, and Evaluation framework, 16–24 CDC recently released a recommendation for 1-time testing for HCV for persons born during 1945–1965 without previous ascertainment of HCV risk. 15 The framework’s approach defines a research question, conducts systematic reviews, determines the overall quality of evidence, and provides strength of the recommendations. 16–24 Recent data suggest that, compared with risk-based screening strategies, routine 1-time HCV screening of persons in the 1945–1965 birth cohort is cost-effective and could prevent 120 000 deaths when combined with direct-acting antiviral treatments. 25 Other economic models have also been utilized and support birth cohort screening of this age group. 26,27 In this study, we describe indications for testing by birth cohort among reported HCV cases from 4 enhanced hepatitis surveillance jurisdictions.
