Skip to main content

Military Health System

Brief Report: Prevalence of Hepatitis C Virus Infections in U.S. Air Force Basic Military Trainees Who Donated Blood, 2017–2020

Image of U.S. Army Staff Sgt. Brandon Sousa, 424th Engineer Vertical Construction Company, donates blood to the 379th Expeditionary Medical Group’s Blood Support Center, Aug. 30, 2021, at Al Udeid Air Base, Qatar. The blood support center conducted a walking blood bank to collect blood from prescreened and cleared donors. The blood was sent downrange to support Afghanistan evacuation operations. The DoD is committed to supporting the U.S. State Department in the departure of U.S. and allied civilian personnel from Afghanistan, and to evacuate Afghan allies to safety. (U.S. Air Force photo by Senior Airman Kylie Barrow). U.S. Army Staff Sgt. Brandon Sousa, 424th Engineer Vertical Construction Company, donates blood to the 379th Expeditionary Medical Group’s Blood Support Center, Aug. 30, 2021, at Al Udeid Air Base, Qatar. The blood support center conducted a walking blood bank to collect blood from prescreened and cleared donors. The blood was sent downrange to support Afghanistan evacuation operations. The DoD is committed to supporting the U.S. State Department in the departure of U.S. and allied civilian personnel from Afghanistan, and to evacuate Afghan allies to safety. (U.S. Air Force photo by Senior Airman Kylie Barrow)

Recommended Content:

Medical Surveillance Monthly Report

Background

Chronic infection with hepatitis C virus (HCV) can cause significant morbidity to individuals due to inflammatory damage to the liver. This chronic inflammatory damage can lead to further complications, including cirrhosis, hepatocellular carcinoma, and fulminant liver failure. In the military, HCV presents a concern for fitness for duty, readiness, and health care costs of its members.

In the U.S., prevalence of chronic HCV infection is approximately 1%.1 From 2010–2019, estimated annual acute HCV incidence increased 387%2; increased detection was driven at least in part by improved and expanded testing recommendations as well as increased injection drug use within the opioid abuse epidemic.3,4 During this timeframe, the majority of new HCV infections occurred in those aged 20–39 (which approximates the ages of those joining the military).2

In 2020, the American Association for the Study of Liver Diseases (AASLD),5 U.S. Preventive Services Task Force (USPSTF),6 and Centers for Disease Control and Prevention (CDC)7 expanded recommendations for HCV infection screening to include all adults age 18 years or older (and for all pregnant women during each pregnancy) because of cost effectiveness, limited success of risk-based screening, and availability of curative treatment.

Active HCV infection disqualifies an individual from military accession because its proper clinical management conflicts with initial training and mission readiness. Three disqualifying criteria for active or recent HCV infection include: history of chronic HCV without successful treatment or without documentation of cure 12 months after completion of a full course of therapy; acute infection within the preceding 6 months; or persistence of symptoms or evidence of impaired liver function. Force screening for HCV is not currently performed during U.S. Air Force (USAF) Basic Military Training (BMT) although screening is completed for other viral infections (including HIV, hepatitis A, and hepatitis B). As a result, the true prevalence of chronic HCV infection cannot be ascertained in the basic trainee population. However, the prevalence can be estimated based on the number of HCV infections confirmed following positive screening during trainee blood donations.

Trainees voluntarily donate blood near the end of BMT and are thus able to donate only once while at BMT. Concurrent testing for HCV antibody and HCV RNA occurs at the time of blood donation. If a trainee's blood tests positive for HCV antibody but negative for HCV RNA, a third generation enzyme immunoassay (EIA) is used for confirmation. A positive test for HCV antibody in addition to either a positive HCV RNA or EIA test indicates active infection. Alternatively, a positive HCV antibody test in an individual with negative RNA and EIA tests typically denotes a cleared infection.

From Nov. 2013 through April 2016, the estimated prevalence of HCV infection among volunteer recruit blood donors at Joint Base San Antonio (JBSA)-Lackland Blood Donor Center was 0.007%.8 The goal of this inquiry was to estimate the most recent prevalence of HCV infections within the USAF basic training population during 2017–2020.

Methods

The JBSA-Lackland Blood Donor Center was queried for the results of HCV screening for all basic military trainees who donated blood between Jan. 1, 2017 and Dec. 31, 2020. All other blood donations (those from individuals other than basic trainees) during this time period were excluded. HCV prevalence in those who donated blood was calculated using the total trainee donations as the denominator. Since trainees are only able to donate once before departing BMT, these donations represent unique trainees. The numerator included those who screened positive upon donation and were also confirmed to have active infection upon subsequent testing. Positive HCV cases were ascertained from a local database, which included demographic, diagnostic, and laboratory data for all USAF recruits, maintained by Trainee Health Surveillance. This database was queried for International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes K70–K77 (diseases of the liver) and B15–B19 (viral hepatitis); the codes for all hepatitides were initially utilized so as to conduct a wide search in case of coding errors. A possible case was defined as a trainee receiving a qualifying ICD-10 code in any diagnostic position during an outpatient medical encounter and was restricted to 1 case per person during the surveillance period. The electronic medical records of possible cases were reviewed and those diagnosed with current HCV infection due to blood screening from BMT blood donation were counted as true cases. Such screened positive BMT cases were confirmed by comparing them to those reported by the Blood Donation Center. The Fisher's exact test for count data was used to compare the prevalence computed for the period from 2017 through 2020 to the prevalence during the period from 2013 through 2016.

Results

From 2017 through 2020, 29,615 unique individual trainees from USAF BMT donated blood (out of 146,325 total trainees attending BMT during that time) and had their blood donations screened for HCV. From this group, a total of 85 individuals screened positive for HCV antibodies; of these, 6 were confirmed to be positive for active HCV infection (positive HCV RNA or EIA) (Table). The prevalence of HCV in those BMT trainees who were screened from 2017 through 2020 was 0.0203% (6 of 29,615 screened) (data not shown), which is 3.1 times (p=.173) the prevalence of HCV infection in this population during 2013–2016 (0.0065%, 2 of 30,660 screened).8 Of note, during 2017–2020, one additional case of HCV in BMT was diagnosed clinically based on symptoms; however, this case was excluded in the prevalence calculation because it was not from a blood donation.

Editorial Comment

The prevalence of HCV infection in BMT trainee blood donors from 2017 through 2020 was 3.1 times the prevalence among trainees who donated from 2013 through 2016.8 While the difference in prevalence was not statistically significant (p=.173), it may reflect the recent increases in incidence among U.S. young adults, as noted by the CDC,2 perhaps due to increased injection drug use.3,4

This study is limited in that the screened blood came from only those trainees attempting to donate blood, so the data do not directly estimate HCV prevalence for all trainees as would be the case from a random sample of the entire BMT trainee population. If the prevalence in blood donors reflected that in basic trainees overall, there would have been approximately 30 active HCV infections among basic trainees during the 4 year period; and of these, only approximately 20% were detected through blood donor screening.

Instituting accession-wide HCV screening at USAF BMT by adding it to the current lab evaluation would be an efficient method of ensuring that all new USAF enlisted service members are up to date on this screening as recommended by USPSTF, CDC, and AASLD.

Author affiliations: 559th Trainee Health Squadron, JBSA-Lackland, TX (Maj Kasper, Capt Holland, and Maj Kieffer); Office of the Command Surgeon, Air Education and Training, JBSA-Randolph, TX (Maj Frankel); 59th Medical Wing, Science and Technology, JBSA-Lackland, TX (Ms. Cockerell); Air Force Medical Readiness Agency, Falls Church, VA (Lt Col Molchan).

Disclaimer: The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components. In addition, the opinions expressed on this document are solely those of the authors and do not represent endorsement by or the views of the United States Air Force, the Department of Defense, or the United States Government.

References

  1. Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013–2016. Hepatology. 2019;69(3):1020–1031.
  2. Centers for Disease Control and Prevention. 2019 Viral Hepatitis Surveillance Report- Hepatitis C. Published July 2021. Accessed 9 Aug. 2021. https://www.cdc.gov/hepatitis/statistics/2019surveillance/HepC.htm
  3. Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018;108(2):175–181.
  4. Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012. Clin Infect Dis. 2014;59(10):1411–1419.
  5. Ghany MG, Morgan TR; AASLD-IDSA Hepatitis C Guidance Panel. Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases – Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology. 2020;71(2):686–721.
  6. US Preventive Services Task Force; Owens DK, Davidson KW, et al. Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2020;323(10):970–975.
  7. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for hepatitis C screening among adults - United States, 2020. MMWR Recomm Rep. 2020;69(2):1–17.
  8. Taylor DF, Cho RS, Okulicz JF, Webber BJ, Gancayco JG. Brief report: Prevalence of hepatitis B and C virus infections in U.S. Air Force basic military trainees who donated blood, 2013-2016. MSMR. 2017;24(12):20–22.

TABLE. Demographics and disposition of the 6 confirmed HCV cases identified through blood donation screening at Air Force Basic Military Training, 2017–2020

You also may be interested in...

The Cost of Lower Extremity Fractures Among Active Duty U.S. Army Soldiers, 2017

Article
6/1/2021
X-ray image of a fractured tibia.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Medical Encounters for Snakebite Envenomation, Active and Reserve Components, U.S. Armed Forces, 2016–2020

Article
6/1/2021
Masters of camouflage, the Sidewinder Rattlesnakes are out and about aboard Marine Corps Logistics Base Barstow, California, May 11. Watch where you put your hands and feet, and observe children and pets at all times, as this is the natural habitat for these venomous snakes and a bite can cause serious medical problems. Notice the sharp arrow-shaped head with pronounced jaws, and the raised eye sockets, as well as the telltale rattles. Keep in mind, however, that rattles can be broken or lost, so you may or may not hear a rattle before they strike to protect themselves.

Brief Report: Medical Encounters for Snakebite Envenomation, Active and Reserve Components, U.S. Armed Forces, 2016–2020

Recommended Content:

Medical Surveillance Monthly Report

Early Identification of SARS-CoV-2 Emergence in the Department of Defense via Retrospective Analysis of 2019–2020 Upper Respiratory Illness Samples

Article
6/1/2021
Army Maj. Raymond Nagley, S-3 officer assigned to the 50th Regional Support Group (RSG), receives a nasal swab to screen for COVID-19 at Fort Hood, Texas, on Feb. 5, 2021, from Spc. Yoali Muniz, a lab tech assigned to the 7406th Troop Medical Clinic, based in Columbia, Missouri. The 50th RSG, a Florida Guard unit based in Homestead, Florida, is preparing for deployment to Poland. (U.S. Army Guard photo by Sgt. 1st Class Shane Klestinski)

Early Identification of SARS-CoV-2 Emergence in the Department of Defense via Retrospective Analysis of 2019–2020 Upper Respiratory Illness Samples

Recommended Content:

Medical Surveillance Monthly Report

Medical Evacuations out of the U.S. Central Command, Active and Reserve Components, U.S. Armed Forces, 2020

Article
5/1/2021
U.S. Army Soldiers from the 115th Brigade Support Battalion, 1st Armored Brigade Combat Team, evacuate casualties onto waiting HH-60M MEDEVAC Blackhawk helicopters from Charlie Company, 6th Battalion, 101st Combat Aviation Brigade during Combined Resolve XV, Feb. 27, 2021, at Hohenfels Training Area. Combined Resolve XV is a Headquarters Department of the Army directed Multinational exercise designed to build 1st Armored Brigade Combat Team, 1st Cavalry Division’s readiness and enhance interoperability with allied forces and partner nations to fight and win against any adversary.(U.S. Army photo by Sgt. 1st Class Garrick W. Morgenweck)

Medical Evacuations out of the U.S. Central Command, Active and Reserve Components, U.S. Armed Forces, 2020

Recommended Content:

Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2020

Article
5/1/2021
MAYPORT, Fla. (Sept. 18, 2020) – Cmdr. Mary Gracia, a pediatric nurse practitioner at Naval Branch Health Clinic Mayport, checks five-year-old Gabriella’s ears. Gracia, a native of McAllen, Texas, says, “It's been an honor and a privilege to impart my expertise to the children of our active duty members who are graciously serving our country. These children, our future leaders, prayers lifted and bountiful blessings for each one. And to the children I've helped during overseas deployments, prayers continued.” (U.S. Navy photo by Jacob Sippel, Naval Hospital Jacksonville/Released).

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2020

Recommended Content:

Medical Surveillance Monthly Report

Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2020

Article
5/1/2021
Navy Lt. James E. Lamb, left, and Sgt. Ryan Eskandary exercise aboard USS Pearl Harbor

Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2020

Recommended Content:

Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2020

Article
5/1/2021
U.S. Air Force Capt. Sean Wilson, a native of Winston-Salem, N.C., and a physical therapist with the 59th Orthopedic and Rehabilitation Squadron, teaches a patient some home exercises that he can perform on his own at the Craig Joint-Theater Hospital, Jan. 23, 2012. (U.S. Air Force photo by Spc.Cody Barber, Bagram Air Field, Afghanistan/Released)

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2020

Recommended Content:

Medical Surveillance Monthly Report

Ambulatory Visits, Active Component, U.S. Armed Forces, 2020

Article
5/1/2021
Tech. Sgt. Kimberly Weaver, 606th Air Control Squadron noncommissioned officer in charge of medical readiness, measures an Airman’s blood pressure at Aviano Air Base, Italy, May 10, 2021.

Recommended Content:

Medical Surveillance Monthly Report

Hospitalizations, Active Component, U.S. Armed Forces, 2020

Article
5/1/2021
Army Medicine surgeons in the operating room

Hospitalizations, Active Component, U.S. Armed Forces, 2020

Recommended Content:

Medical Surveillance Monthly Report

Surveillance snapshot: Illness and injury burdens, reserve component, U.S. Armed Forces, 2020

Article
5/1/2021
U.S. Army Col. Kris Marshall, co-director of Exercise Agile Spirit 2021, salutes during a closing ceremony August 6, 2021 at Orpholo Training Area, Georgia. Agile Spirit 21 promotes regional stability and security, while increasing readiness, strengthening partner capabilities and fostering trust. Agile Spirit provides vital opportunities, not only for multiple U.S. services to work together, but also for integrated, total force training with U.S. Reserve and National Guard units and our partner nations’ militaries to ensure interoperability. (U.S. Army National Guard photo by Cpl. Rydell Tomas)

Surveillance snapshot: Illness and injury burdens, reserve component, U.S. Armed Forces, 2020

Recommended Content:

Medical Surveillance Monthly Report

Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2020

Article
5/1/2021
A U.S. Marine Corps drill instructor motivates a recruit during a Marine Corps Martial Arts Program (MCMAP) training session

Recommended Content:

Medical Surveillance Monthly Report

Skin and Soft Tissue Infections, Active Component, U.S. Armed Forces, January 2016–September 2020

Article
4/1/2021
Detailed view of elbow with carbuncle or furuncle

Recommended Content:

Medical Surveillance Monthly Report

Update: Exertional Rhabdomyolysis, Active Component, U.S. Armed Forces, 2016–2020

Article
4/1/2021
Marine Corps Recruit Depot, San Diego  Recruits with Bravo Company, 1st Recruit Training Battalion, hydrate after a physical training session

Recommended Content:

Medical Surveillance Monthly Report

Disparities in COVID-19 Vaccine Initiation and Completion Among Active Component Service Members and Health Care Personnel, 11 December 2020–12 March 2021

Article
4/1/2021
Capt. Shamira Conerly, 149th Medical Group, gives Staff Sgt. Timmy Sanders, 149th Maintenance Squadron, his first dose of COVID-19 vaccine

Recommended Content:

Medical Surveillance Monthly Report

Update: Heat Illness, Active Component, U.S. Armed Forces, 2020

Article
4/1/2021
Fort Jackson, SC. A trainee with 2nd Battalion, 60th Infantry Regiment puts his arms in an arm immersion cooling tank during training. The tanks allow Soldiers to rapidly cool by putting their forearms into a tank of ice water. (Photo by Saskia Gabriel)

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 61 - 75 Page 5 of 13
Refine your search
Last Updated: October 18, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery