North American Hepatitis C Epidemic Peaked Around 1950, 15 Years Earlier Than Previous Estimates

The BC-CfE study revises by 15 years previous estimates of the exponential growth phase of the North American HCV genotype 1a epidemic, the region’s most dominant form of HCV. The oldest members of the baby boomer cohort were roughly five years of age at the peak of the epidemic in 1950.

The peak exponential growth of HCV corresponds to an overall increase in medical procedures following World War II — much earlier than the peak in injection drug use that occurred in North America around 1969. A plateau in the spread of HCV was observed between 1960 and 1990, consistent with the hypothesis that changes in injection technology were a driving factor.

These findings suggest HCV spread among baby boomers was not associated with risky behaviour, but rather reuse of needles and syringes in health care settings before disposables became the uniform standard of practice. The results of the study strongly support routine HCV screening for all people born between 1945 and 1964, in line with recent US CDC recommendations.

“Hepatitis C among baby boomers has been previously linked to sex and drugs. As such, HCV testing has long carried a substantial stigma. Our results should go a long way to remove this persistent barrier to testing among HCV infected baby boomers,” said Dr. Jeff Joy, a Research Scientist with the BC-CfE and the study’s lead author.

“Reduced stigma will facilitate widespread testing and timely access to life saving HCV treatment. Any baby boomer could be living with HCV even in the absence of symptoms or any history of high risk behaviours, and as such they should be encouraged to proactively seek HCV testing,” said Dr. Julio Montaner, Director of the BC-CfE.

These findings are consistent with previous research from other parts of the world — including France, Italy, Japan and Russia — where reusable syringes and needles are recognized to have played a key role in the spread of HCV among baby boomers.

“The vast majority of North Americans with hepatitis C are baby boomers — and most are unaware that they have this infection,” said John Ward, M.D., Director of the Division of Viral Hepatitis at CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “Over time, hepatitis C infection can lead to cirrhosis, liver cancer and other life-threatening conditions. All baby boomers need to be tested for hepatitis C so that those who are infected can receive life-saving care and treatment. This study demonstrates the importance of offering a test to all baby boomers rather than relying on risk based testing alone.”

About the British Columbia Centre for Excellence in HIV/AIDS

The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul’s Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including government, health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS. By developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses, the BC-CfE helps improve the health of British Columbians.

About the US Centers for Disease Control and Prevention

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, stem from human error or deliberate attack, CDC is committed to respond to America’s most pressing health challenges. The Division of Viral Hepatitis is part of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (http://www.cdc.gov/nchhstp) at CDC. In collaboration with domestic and global partners, the division provides the scientific and programmatic foundation and leadership for the prevention and control of hepatitis virus infections and their manifestations.