Screening people admitted to hospital with COVID-19 for
hepatitis C or hepatitis B does not lead to detection of a large number of
undiagnosed infections and is likely to be of limited use in reducing the
number of undiagnosed infections, Spanish researchers have concluded after
evaluating screening outcomes in 2020.
Their evaluation findings, published in the journal Gastroenterologia
y Hepatologia, show that just three chronic hepatitis C infections were
detected among 4662 people with COVID-19 admitted to hospitals in Leon and Burgos in 2020. Two of these were diagnosed in men aged 90 and over, the other in a
person who died of COVID-19.
In 2020, Spanish physicians urged that everyone tested for
SARS-CoV-2 should
also be tested for hepatitis B and C and subsequently recommended testing
for viral hepatitis all people vaccinated
against SARS-CoV-2. These screening strategies were proposed in order to support progress towards hepatitis C elimination targets, since both modalities would reach large numbers of people who might otherwise have little contact with health services.
The yield of testing (the number of cases diagnosed as a proportion of those tested) is an important measure of the utility of a testing method. So far, there is no information on the yield of testing for viral hepatitis as part of testing, vaccination or hospitalisation during the COVID-19 pandemic.
Spanish hospitals began testing people admitted with COVID-19
for hepatitis B and C in March 2020, following recommendations from the Spanish
Ministry of Health. Patients were screened for hepatitis B antibodies and
surface antigen and hepatitis C antibodies and RNA.
Two hospitals in Leon and Burgos admitted 4662 patients
with COVID-19 during 2020. Those admitted were typical of people hospitalised
with COVID-19 in the first wave of the pandemic, prior to vaccination. The
median age was 76 years, 41% were over 80 years old and 56% were male.
Although testing was recommended for all patients admitted,
only 62% of those admitted were tested. Those tested for hepatitis B and C were
significantly younger than the entire population admitted for COVID-19 (72 years
vs 83 years in those not tested).
Among those tested for hepatitis B, 253 had antibodies to
hepatitis B (8.75%) but only eleven had chronic hepatitis B (0.38%) and only
four were undiagnosed. None had significant liver fibrosis, and all were aged
80 or over.
Twenty-four people tested positive for hepatitis C antibodies
(0.83%). Of these, 13 had been diagnosed previously. Ten of these patients had
been cured of hepatitis C, one had spontaneously cleared hepatitis C and two
remained untreated due to advanced age (one had dementia and one refused treatment
due to his age). One previously undiagnosed patient had a chronic HCV infection
(total chronic HCV prevalence, 0.1%).
The Spanish researchers note the low prevalence of hepatitis
C in COVID-19 patients, the majority of whom were over 70 years old. Recent
research shows that the 50-69 age group has the highest prevalence of hepatitis
in Spain. COVID-19 admissions may not yield a large number of new hepatitis C
diagnoses, they conclude.
Instead, hepatitis B testing should be emphasised, to minimise
the risk of hepatitis B reactivation due to immunosuppressive treatments used
to manage severe COVID-19, including high-dose corticosteroids or anti-TNF alpha.
In this study population, seven people with chronic hepatitis received
corticosteroids but none experienced reactivation.