Newly Reported Chronic Hepatitis C in Alaska Adults, 2016–2023

Hepatitis C virus (HCV) is a leading cause of chronic liver disease, hepatocellular carcinoma and death from liver disease, and it is targeted for elimination as a public health threat by 2030. An estimated 2.2 million U.S. adults had a current infection in 2017–2020. The disease has fallen hardest on American Indian and Alaska Native people. Before 2009, risk was highest among people born from 1945 through 1965, but cases have since risen among young adults along with injection drug use.

Treatment changed in 2014, when direct-acting antivirals arrived that cure more than 95% of people who finish treatment, usually in 8–12 weeks. In 2020 CDC recommended hepatitis C screening at least once for every adult 18 and older, and for pregnant women in every pregnancy, with people found to be infected linked to care; periodic screening based on risk is also advised.

To measure Alaska's progress, CDC and the Alaska Department of Health reviewed chronic hepatitis C cases newly reported among adult residents from 2016 through 2023.

How cases were counted

Data came from the National Electronic Disease Surveillance System Base System as reported to the state by May 21, 2024. A confirmed chronic case needed a positive HCV RNA test, no record of turning from a negative to a positive antibody or RNA test within the previous 12 months, and no report meeting the criteria for acute hepatitis (jaundice, total bilirubin of at least 3 mg/dL, or serum alanine aminotransferase above 200 IU/L). Rates were age-standardized to the 2020 U.S. Census population.

Who was affected

Over the eight years, 5,352 confirmed chronic cases were newly reported among adults. Most were in males (66%) and in adults under 40 (61%), and 25% were in women of reproductive age (18–44). The median age was 38 in 2016 and 35 in 2023.

The average yearly rate was 121 per 100,000 adults. It was highest at ages 30–39 (196) and 18–29 (160) and lowest at 60 and older (60). Rural residents had the highest rate by type of area (162), and the Southeast (156), Gulf Coast (154) and Matanuska-Susitna (153) regions the highest by region. By race, American Indian or Alaska Native adults had the highest rate (223).

Annual age-standardized rate of newly reported chronic hepatitis C per 100,000 adults, Alaska, 2016–2023. CDC figure.

A 30% decline

The rate fell from 142 in 2016–2019 to 99 in 2020–2023, a relative drop of 30% (95% confidence interval 26%–35%), in line with national trends. The decrease was statistically significant in every age group except 40–49 and in every region except the Southwest and Northern regions. Rates fell among American Indian or Alaska Native (−20%), Asian (−45%), White (−26%) and non-Hispanic or Latino (−25%) adults. No group had a significant increase.

Even so, rates among Alaskans under 40 were about double the national rates reported for 2018 and for 2019–2022. Differences by age, region and race may reflect access to or use of health care, and so testing, as well as differences in exposure tied to behavior, environment or social conditions.

Why the decline

The authors saw several likely reasons. Screening and treatment expanded, including the 2020 national recommendation to test all adults and Alaska's provision of direct-acting antivirals through Medicaid. The COVID-19 pandemic also cut testing, treatment and reporting for a time. From 2021 to 2023, opiate-related deaths rose and opioid use shifted from injecting to smoking, both of which may have reduced transmission. A recent analysis of data from a large commercial laboratory estimated that 34% of Alaskans with chronic hepatitis C were cleared of the virus or cured in 2013–2022, close to the national figure; the national target is at least 58% by 2025.

What remains

In Alaska and nationwide, making sure people with a positive antibody test go on to a confirming HCV RNA test and then to treatment remains a challenge, especially in remote areas. CDC's 2023 guidance to draw blood for both steps in a single visit needs to be put into practice, and a point-of-care HCV RNA test approved in June 2024 could help reach remote communities without road access and people who inject drugs.

Alaska aims to widen screening and linkage to care in the hardest-hit groups, follow people from testing through treatment and cure, and strengthen surveillance and prevention of hepatitis C passed from mother to baby. Since September 2023, negative HCV RNA results must be reported to the state, and providers must report pregnancy status for women with hepatitis C. A working group of state partners meets quarterly and is drafting a state plan to eliminate viral hepatitis.

Limitations

• Newly reported cases mix new and long-standing infections, including people who tested positive before 2016 but still need treatment, and miss people never tested.
• Counting confirmed cases only may understate the numbers.
• Missing clinical details and limited reporting of negative RNA results may have led some acute cases to be counted as chronic.
• Small groups and changing completeness of race and ethnicity data limited some comparisons.

Sources

• Scobie HM, Allison J, Masters N, et al. "Newly Reported Chronic Hepatitis C Among Adults — Alaska, 2016–2023." MMWR 2025;74(10).