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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 ​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 laboratories or programs that may need to bring on testing or understand what is available.

Hepatitis C Virus (HCV) Testing

The recommended testing sequence for HCV 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. The APHL HIV and Viral Hepatitis Subcommittee has developed some companion documents to assist public health laboratories and their submitters understand the testing algorithm and how to interpret the results.

APHL recently partnered with NASTAD to develop the Integrating HIV and HCV Testing Toolkit to assist public health programs and laboratories identify strategies to integrate testing at multiple levels. This toolkit and its associated slides will provide health departments(HDs) and laboratories with current information regarding HIV and HCV testing technologies, describe factors HDs should consider in determining when integration of testing is beneficial, and discuss how various testing technologies and strategies for using these technologies can facilitate integration.

APHL Projects

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 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 R​​​FP 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. If you are interested in participating please contact Anne Gaynor at anne.gaynor@aphl.org.

GHOST

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.