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BACKGROUND: Increases in hepatitis C (HCV) infections among youth have recently been observed in some jurisdictions. The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) analyzed trends in routine HCV surveillance data and investigated reports among 0 to 30 year-olds.
METHODS: We evaluated trends in the number of 0 to 30 year-olds newly reported with HCV from 2000-2012. We investigated all new HCV reports for 0 to 21 year-olds from October 2012-July 2013, and 50% of new reports for 22 to 30 year-olds from April 2013-July 2013. We collected clinical, demographic, and risk factor information from the ordering provider or medical record.
RESULTS: New HCV reports among 0 to 21 year-olds stayed constant at around 200 reports/year. Reports among 22 to 25 year-olds increased from 119 reports in 2000 to 273 reports in 2012. Among 26 to 30 year-olds, reports increased from 351 in 2000 to a peak of 780 in 2007, then decreased to 507 in 2012. Neighborhoods with high rates of youth HCV were identified, which mostly overlapped with neighborhoods with high overall HCV rates. We investigated 95 cases ages 0 to 21 and 73 cases ages 22 to 30. Most were male (52% of 0 to 21 year-olds and 59% of 22 to 30 year-olds). The most common race/ethnicity was white non-Hispanic (44% of 78 cases ages 0 to 21 and 58% of 64 cases ages 22 to 30 with known race/ethnicity). The most common risk factor was ever injection drug use (IDU), reported for 32% of 0 to 21 year-olds and 49% of 22 to 30 year-olds. The most common drug injected was heroin. No risk factors were identified for 32% of 0 to 21 year-olds and 29% of 22 to 30 year-olds.
CONCLUSIONS: From 2000-2012, HCV reports in NYC increased among 22 to 30 year-olds. This could be due to increased incidence, increased testing, and/or increased reporting of HCV to DOHMH. Regardless, these cases most likely represent recent infections and recent IDU initiation. Cases ages 0 to 30 were most likely to be non-Hispanic whites, unlike the overall HCV population in NYC, who are most likely to be black or Hispanic. HCV and IDU prevention activities should focus on white non-Hispanic youths in neighborhoods with high rates of new HCV infections. Future research should focus on this population, to better understand their HCV risk factors and their pathway to injection initiation, including use of prescription opioids.