When did blood screening for Hepatitis C (HCV) begin?

Blood Screening for Hepatitis C Began in 1992

Blood screening for Hepatitis C virus (HCV) infection began in 1992 when effective multiantigen screening tests were widely implemented. 1 Prior to this, there was a high risk of HCV transmission through blood transfusions and organ transplants.

Historical Timeline of HCV Screening

Pre-1992 Period

• HCV (initially known as Non-A-Non-B hepatitis) incidence increased markedly during the 1970s and 1980s, reaching approximately 230,000 new infections annually throughout the 1980s 1
• Before 1992, recipients of blood transfusions had a significant risk of acquiring HCV infection
• The virus was first identified in 1988, allowing for the development of specific testing methods 1

Implementation of Screening

• In 1992, sensitive multiantigen serologic assays for testing the blood supply were developed and licensed 1
• After implementation of blood donor screening in 1992, HCV infection incidence declined rapidly 1
• The screening program focused on:
  • Testing all donated blood for HCV antibodies
  • Implementing confirmatory testing protocols
  • Notifying recipients of blood from donors who subsequently tested positive 1

Impact of Screening

• Following implementation of screening in 1992, HCV transmission through blood transfusions decreased dramatically
• During 1992-2004, the number of reported cases of new HCV infection decreased by 78.4% 1
• During 1999-2008, HCV prevalence among first-time blood donors decreased by 53% 1

Risk Factors and Screening Recommendations

High-Risk Groups

Blood screening is particularly important for:

• Persons who received blood transfusions or organ transplants before July 1992 1
• Persons with hemophilia who received clotting factor concentrates produced before 1987 1
• Persons who have ever injected drugs 1
• Long-term hemodialysis patients 1

Current Screening Recommendations

• The CDC recommends one-time HCV testing for all adults born between 1945-1965 (the "baby boomer" cohort) regardless of risk factors 1
• This birth cohort accounts for 76.5% of all HCV prevalence 1
• Continued screening is recommended for those with ongoing risk factors 1

Clinical Implications

Importance of Early Detection

• HCV infection is the leading indication for liver transplantation and accounts for more than 50% of incident hepatocellular carcinoma 1
• Without diagnosis and treatment, approximately 1.76 million persons with HCV infection will develop cirrhosis, over 400,000 will develop hepatocellular carcinoma, and over 1 million will die from HCV-associated disease 1

Testing Approach

• Initial testing is typically done by enzyme immunoassay (EIA) 1
• Confirmatory testing with recombinant immunoblot assay (RIBA) is recommended for positive EIA results 1
• Quantitative HCV RNA testing and genotype determination are important for treatment decisions 1

Pitfalls and Caveats

• Persons who received blood transfusions before 1992 may be unaware of their risk and should be encouraged to get tested
• Risk-based testing strategies alone have limited success, with 45-85% of chronically infected adults unaware of their condition 1
• HCV infection is typically asymptomatic until significant liver disease occurs, making screening essential for early detection 1
• False positive results can occur with screening tests, necessitating confirmatory testing 1

The implementation of blood screening for HCV in 1992 represents a critical public health intervention that has significantly reduced the transmission of this potentially deadly infection through the blood supply.