Hepatitis C

Cause: Hepatitis C virus (HCV), which has 6 genotypes.

Illness and treatment: Most acute infections are asymptomatic but about 20-30% of cases have abrupt onset with fever, abdominal pain, and jaundice. Chronic infections are typically asymptomatic or mildly symptomatic (with non-specific symptoms like fatigue) until complications such as liver damage or liver cancer develop after several decades. Effective all-oral HCV medications with minimal side effects are currently available (i.e., direct-acting antivirals) These medications, typically prescribed for 8-12 weeks, cure HCV infection in almost everyone living with the virus. Hepatitis C treatment is not currently approved for use during pregnancy, but it is safe for pregnant parents to begin treatment after giving birth and finishing breastfeeding. Children can begin treatment starting at three years of age.

Sources: Transmission is usually by blood-to-blood, particularly while sharing equipment used in drug injection, or less commonly through sexual contact with a person living with hepatitis C (particularly among people living with HIV) or through sharing equipment used in drug snorting/smoking. Hepatitis C is transmitted from pregnant parent to baby during pregnancy or childbirth in about 6 percent of pregnancies where the pregnant parent has hepatitis C, and results in perinatal infection.

Developing chronic infection: Chronic infection develops in 75-85% of people with acute infection and is more likely among males, those infected after 25 years of age, and those immunosuppressed including people living with HIV.

Prevention: There is no vaccine to prevent acquisition of HCV. Recommend that people who inject or snort drugs avoid sharing drug use equipment. Recommend that sexually active people use barrier methods, like condoms, when having penetrative sex. Screen blood and tissue products to prevent transmission.

Testing: One-time hepatitis C screening is recommended for all adults 18 years of age and older, and all pregnant persons during each pregnancy. Routine testing is recommended for those with ongoing risk factors, including people who inject drugs. Re-infection is possible, so people who have cleared HCV should receive routine testing if they have ongoing risk factors.

Recent Washington trends: Among people living in Washington, an average of 113 new acute hepatitis C cases were reported annually from 2018 through 2022, and the number of reported acute cases increased each year except in 2019 and 2022.

An average of 5,227 new chronic hepatitis C cases were reported annually to DOH from 2018 through 2022, with the number of reported chronic cases decreasing each year during this timeframe. This decrease from 2018-2022 may be in part due to reduced screening and reporting since the COVID-19 pandemic in 2020, along with a transition to a new disease surveillance system in 2018, which allowed for improved identification of new infections and reduced duplicate person information in the surveillance system. Hepatitis C is still a public health concern in Washington.

Perinatal hepatitis C has been a nationally notifiable condition since 2018. An average of four new perinatal hepatitis C infections were reported to DOH annually from 2018 through 2022.

Purpose of Reporting and Surveillance

• To identify people infected with HCV and support them to prevent further transmission to others
• To identify new groups at risk and prevent additional infections
• To inform people living with HCV about treatment options
• To educate people living with HCV and their contacts about transmission of hepatitis C virus and how to reduce the risk of transmission
• To better understand the epidemiology and burden of morbidity from hepatitis C infection

Legal Reporting Requirements

Laboratories, health care providers, and health care facilities shall report the patient’s race, ethnicity, and preferred language as outlined in WAC Chapter 246-101.

Rapid Screening Tests

Any individual or entity, including DOH-supported HCV screening programs, that conducts an HCV rapid screening test (RST) (e.g. HCV rapid antibody) meets the definition of a laboratory and must report positive results to the local health jurisdiction within 2 business days. They must also report deidentified negative HCV screening results at least annually to DOH.

Laboratories

1. Notifiable to local health jurisdiction within 2 business days:
   • Positive result by any method. Positive and nonpositive results for: HCV nucleic acid detection (NAT or NAAT) for qualitative, quantitative, and genotype tests.
     • If associated with a positive result, and available: Pregnancy status, Hepatocellular enzyme levels (e.g. ALT, total bilirubin), Negative result for IgM anti-HAV, and Negative result for IgM anti-HBc.
2. Deidentified negative screening (e.g. HCV antibody/anti-HCV) results notifiable at least annually to DOH.

Health Care Providers, Health Care Facilities, and Local Health Jurisdictions

1. Acute Hepatitis C (initial diagnosis only)
   • Health care providers and facilities: Notifiable to local health jurisdiction within 24 hours
   • Local health jurisdictions: Acute cases notifiable to Washington State Department of Health (DOH) Office of Infectious Disease (OID) within 7 days of case investigation completion or summary information required within 21 days of initial notification to local health authorities.
      
2. Chronic Hepatitis C (initial diagnosis only)
   • Health care providers and facilities: Notifiable to local health jurisdiction within 3 business days 
   • Local health jurisdictions: Chronic cases notifiable to OID within 7 days of case investigation completion, or summary information required within 21 days of initial notification to local health authorities.
      
3. Perinatal Hepatitis C (initial diagnosis only)
   • Health care providers and facilities: Notifiable to local health jurisdiction within 24 hours
   • Local health jurisdictions: Perinatal cases notifiable to OID within 7 days of case investigation completion or summary information required within 21 days of initial notification to local health authorities.

Contact

Hepatitis C Surveillance Program, Office of Infectious Disease Assessment Unit, Washington State Department of Health (DOH). Email us at Hepatitis@doh.wa.gov.

Resources

• Hepatitis C Investigation Guidelines (PDF)
• Hepatitis C Case Reporting Forms 
• Provider Information
• Hepatitis C Facts
• Prioritizing HCV Investigations for Local Health Jurisdictions (PDF)
• CDC Guidelines for Viral Hepatitis Surveillance and Case Management
• CDC Hepatitis C Information
• Washington Disease Reporting System - WDRS
• Hepatitis C Data Snapshot: Washington State 2021 (PDF)

Notifiable Conditions Directory

2022 Annual Communicable Disease Report (PDF)

Disease Surveillance Data

epiTRENDS

Legal Requirements for Notifiable Conditions Reporting

List of Notifiable Conditions

Local Health Jurisdictions

Specimen Submission Forms