Incidence Rate and Number of Cases of Acute Hepatitis C Infections in the US

"During 2021, a total of 5,023 acute hepatitis C cases were reported to CDC from 42 states, corresponding to 69,800 estimated infections (95% CI: 55,300–238,100) after adjusting for case under-ascertainment and underreporting (see Technical Notes).⁶ 

"The acute hepatitis C case count corresponds to a reported rate of 1.6 cases per 100,000 population, a 60% increase from the reported rate during 2017 (1.0 cases per 100,000 population) and a 7% increase from the reported rate during 2020 (1.5 cases per 100,000 persons). 

"While the COVID-19 pandemic disrupted healthcare access and reduced the number of persons tested for hepatitis C virus infection,^2,3 anticipated reductions in the number of reported acute hepatitis C cases could have been offset by a change to the acute hepatitis C case definition beginning in 2020. The new case definition was designed to better characterize the number of cases classified as acute hepatitis C (see Technical Notes/Case Definitions). 

"Approximately 52% of acute hepatitis C cases reported to CDC during 2021 were among persons aged 20–39 years. The rate of reported cases of acute hepatitis C was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (2.7 cases per 100,000 population), compared with other race and ethnicity groups. Among the 1,449 (29%) reported acute cases that included risk information for injection drug use, 820 (57%) reported injection drug use. A total of 604 patients with acute hepatitis C were hospitalized (31% hospitalization rate among 1,935 cases with hospitalization information available). 

"A total of 107,540 cases of newly reported chronic hepatitis C were reported to CDC from 43 states during 2021, corresponding to a rate of 39.8 cases per 100,000 population. The rate of newly reported chronic hepatitis C was highest among persons aged 30–39 years (74.9 cases per 100,000 population), followed by persons aged 40–49 years (54.6 cases per 100,000 population), compared with other age categories, maintaining a previously reported shift in the chronic hepatitis C disease burden from older (above 65 years old) to younger persons (See Figure 3.8).⁸ The rate of newly reported chronic hepatitis C cases was highest among non-Hispanic AI/AN persons (68.9 cases per 100,000 population), compared with other race and ethnicity categories. 

"A total of 199 perinatal hepatitis C cases were reported to CDC from 28 states during 2021, a 21% increase from the 165 cases reported in 2020, and closer to the 217 cases reported in 2019 before the COVID-19 pandemic occurred. 

"Data from death certificates filed in the vital records offices of the 50 states and the District of Columbia indicated that the age-adjusted death rate associated with hepatitis C during 2021 was 3.18 deaths per 100,000 population, an 8% decrease compared to the rate during 2020 (3.45 deaths per 100,000 population). The age-adjusted death rate for hepatitis C during 2021 represents a 23% decrease from the rate during 2017 (4.13 deaths per 100,000 population). The death rate among non-Hispanic AI/AN persons (9.99 deaths per 100,000 population) was 3.4 times the rate among non-Hispanic White persons."