APHL develops best practices and guidelines, and monitors developments in diagnostic testing for viral hepatitis. The term “viral hepatitis” refers to a group of five viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV). These viruses are grouped together based on the clinical outcome of infection -- an inflammation of the liver -- rather than by how closely related they are. The CDC has recently created a a set of Viral Hepatitis Serology Training Videos for each virus that serve as an excellent resource.
APHL regularly polls its member laboratories to understand testing practices. According to the most recent
Viral Hepatitis Survey, the majority (86%) of public health laboratories in the US continue to play a major role in the provision of HAV, HBV and/or HCV testing.
Hepatitis A Virus
There have been large outbreaks of Hepatitis A Virus in many states starting in 2017 and continuing in 2018. In response APHL has worked with CDC and our members affected by this outbreak to create a resource for Hepatitis A Virus testing for laboraotries or programs that may need to bring on testing or understand what is available.
General Hepatitis C Testing
APHL helped to organize a Hepatitis C Diagnostic Summit, September 8-9 2016 to bring together experts from around the world to discuss everything about diagnosis of HCV in the US and globally as well as the development of new and improved technologies. The full summit was recorded and is available for viewing from CDC.
In May 2013 CDC released updated guidelines for Hepatitis C virus testing, “Testing for HCV Infections: An Update of Guidance for Clinicians and Laboratorians.” The updated recommendations focus on identification of persons with current HCV infections.
In response to the release of the updated testing guidance for Hepatitis C, the APHL HIV and Viral Hepatitis Subcommittee developed a
Frequently Asked Questions document to assist public health laboratories in adoption of the new testing sequence.
The new testing sequence requires an initial screen with an FDA-approved HCV antibody test which, if reactive, is followed by an HCV Nucleic Acid Test (NAT) to detect the viral RNA present in a person with a current infection.
APHL has collaborated with the Division of Viral Hepatitis since 2016 to pilot the Global Hepatitis Outbreak and Surveillance Technology (GHOST) for the molecular surveillance of HCV infection with public health laboratories. Following an APHL RFP four initial public health laboratories successfully piloted the project including successes such as identifying linked cases. The project has since expanded to an additional three public health laboratories that had responded to the initial RFP. To learn more about the project visit CDC.
Expanded Access to HCV NAT
As mentioned above, diagnosis of a current HCV infection requires not just an initial screen with an FDA-approved HCV antibody test but if reactive, a HCV Nucleic Acid Test (NAT). APHL realized that many PHLs are not currently able to offer HCV NAT and wanted to find a mechanism to expand access to HCV NAT through a shared service pilot project. An RFP was issued in March 2017 and the Florida Department of Health-Bureau of Public Health Laboratories was awarded the contract. There are two public health laboratories enrolled to submit samples to Florida as part of the pilot. APHL looks forward to determining how this shared service project will help other public health laboratories.