Finding the Missing Cases

hand drawing a blood sample tubeAs many as one in four cases of hepatitis C infection may miss the opportunity to be diagnosed – and this dire statistic is projected to happen even when current federal guidelines for hepatitis C screening are closely followed. As a result, experts now urge new guidelines of universal screening.

Where did these “missed cases” come from? Blood samples of nearly 5,000 patients coming through The Johns Hopkins Hospital Emergency Department were tested for the hepatitis C virus (HCV). This screening was conducted on anyone above 18 years old who had blood drawn at the ER. After this HCV screening of 5,000 people, results showed that nearly 14% were infected with HCV. Fully one-third of those testing positive were previously unaware of their infection status.

The current guidelines call for a one-time hepatitis C test for all Baby Boomers (those born between 1945 and 1965), along with testing for anyone with a risk factor (e.g., injection drug use). Yet one-quarter of the ER patients who tested positive for HCV would not have gotten this diagnosis if only those meeting the current guidelines (e.g., Baby Boomer or IV drug user) were tested.

Thus, it is now suggested that a better plan would be a one-time test for all U.S. adults seeking care at inner city ERs; this would identify many more infected individuals. This expanded screening makes sense in light of the fact that this study showed higher than expected infection rates in younger adults – meaning people who would not qualify for the Baby Boomer screening guideline. This new screening guideline, if adopted, would also have the benefit of slowing the spread of infection to new individuals.


McCarthy M. US hepatitis C virus testing recommendations may miss 25% of cases, study finds. BMJ 2016;353:i2337.

Johns Hopkins Medicine. Current hepatitis C virus testing guidelines miss too many cases, study suggest: Urban emergency departments a good place to enact universal screening for adults. ScienceDaily April 13, 2016.

Stephen C. Vogt, Pharm.D.
President and CEO
BioPlus Specialty Pharmacy


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