Urban Emergency Departments Confront Emerging Hepatitis C Trends

Urban caregivers on the front lines of fighting HCV.

A hepatitis C testing protocol established by urban emergency departments saw high rates of infection among intravenous drug users and people born between the years 1945 and 1965. Of the 10.3 percent testing positive for hepatitis C, 75% were unaware that they were infected and 70% were chronically infected.

Hepatitis C virus is the most common chronic blood-borne infection in the United States, affecting an estimated 3 million people. The virus is a leading cause of end-stage liver disease, liver cancer and liver transplants.

Of those infected, people born between the years 1945 and 1965 (Baby Boomers) account for at least 4%. Baby boomers account for 75% of people living with HCV infection, with up to 1.75 million of them unaware they are infected.

Typically, those acutely infected with HCV are asymptomatic, with some people developing symptoms such as nausea, fatigue, general aches and pains, and abdominal pain.

Those tested in the study included high-risk patients such as intravenous drug users, Baby Boomers and patients with unspecified liver disease. Factors associated with testing positive for hepatitis C virus included injection drug use (38.4%), homelessness (25.5%), diagnostic testing (14.8%), birth cohort (13.7%) and male sex (12.4%).

“In addition to the myriad public health functions they already perform, urban emergency departments may play an important role as safety net providers for HCV screening,” said Douglas White, MD, of Highland Hospital, Alameda Health System in Oakland, California. “We have a better than even chance of reaching many of the three million people who are infected since they tend to be heavy emergency department users already. It gives us a chance to connect these people to ongoing care at HCV clinics or elsewhere in the health care system.”