Hepatitis C

Cause: Hepatitis C virus, which has 6 genotypes.

Illness and treatment: Most acute infections are asymptomatic but about 20% of cases have abrupt onset with fever, abdominal pain, and jaundice. Chronic infection is typically asymptomatic until complications such as liver damage or cancer develop after decades. Effective HCV medications with minimum side effects are currently available (i.e., direct-acting antivirals). 

Sources: Transmission is usually by contact with blood, particularly while sharing drug paraphernalia, or less commonly through sexual contact with a person living with hepatitis C.  

Additional risks: Chronic infection follows acute infection in 75-85% of cases and is more likely among males, those infected after 25 years of age, or the immunosuppressed including HIV co-infection.

Prevention: Use safe sexual practices, avoid sharing drug paraphernalia, and screen blood and tissue products to prevent transmission. 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.  

Recent Washington trends: Among people living in Washington, an average of 107 new acute hepatitis C infections were reported annually from 2017 through 2021, and the number of reported acute infections increased each year except 2019. During 2021, there were 1.6 acute infections reported per 100,000 persons, representing a 60% increase from the 1.0 infections per 100,000 in 2017. An average of 6,341 new chronic hepatitis C infections were reported annually to DOH from 2017 through 2021.

Purpose of Reporting and Surveillance

  • To identify sources of infection and to prevent further transmission from such sources
  • To identify new groups at risk and reduce further cases
  • To inform cases about treatment options
  • To educate cases and 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.

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.

Rapid Screening Tests

Any individual or entity 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.

Contact

Hepatitis C Surveillance Program, Office of Infectious Disease Assessment Unit, Washington State Department of Health (DOH)
360-236-3444 | Hepatitis@doh.wa.gov

Additional 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)

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