Seroepidemiology of hepatitis C virus infection in people aged 1-69 years in China: a national, cross-sectional study.

BACKGROUND

China has a substantial disease burden of hepatitis C virus (HCV) infection. We aimed to analyse the findings from a national seroepidemiology survey of viral hepatitis in 2020, providing insights into the current state of hepatitis C in China.

METHODS

A national, cross-sectional survey was conducted in China using a stratified, three-stage cluster random sampling method to select individuals aged 1-69 years from 160 national disease surveillance points. Venous blood samples that tested positive for anti-HCV antibodies were further tested for HCV RNA. Point estimates and 95% CIs of anti-HCV antibody and HCV RNA prevalence were calculated using Taylor series linearisation for variance estimations. The prevalence estimates were adjusted using weighted calculations. National HCV burden was estimated by the workbook method.

FINDINGS: From Aug 1, 2020, to June 1, 2021, 91 971 individuals were surveyed in 120 counties, with 91 896 (99·9%) blood samples tested and included in the final analysis. The median age of participants was 33 years (IQR 15-52), 39 627 (43·1%) participants were male, 52 269 (56·9%) were female, 75 170 (81·8%) were of Han ethnicity, and 16 726 (18·2%) were in non-Han ethnic groups. 223 (0·24%) individuals tested positive for anti-HCV antibodies, with weighted prevalence of 0·28% (95% CI 0·24-0·34). Among these, 111 (49·8%) tested positive for HCV RNA, resulting in an HCV RNA positive proportion of 0·12% and weighted prevalence of 0·15% (95% CI 0·11-0·20). We estimated 5·54 million individuals who were anti-HCV antibody-positive and 3·22 million with viraemic infections.

INTERPRETATION: The survey findings confirm that China has made important progress in controlling the hepatitis C epidemic. However, the absolute number of individuals infected with HCV remains substantial due to the large population denominator. Concerted efforts are essential to promote a comprehensive strategy to further curb the hepatitis C epidemic.

FUNDING: Major Science and Technology Special Project of China's 13th 5-Year Plan.

TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.