Many people are infected with hepatitis C virus (HCV), but don’t realize they have it. A California emergency department unveiled such a problem when it initiated an HCV and HIV screening program.

HCV affects about 3 million people in the United States, making it the most prevalent of chronic, bloodborne infections. The disease can lead to serious liver problems and sometimes necessitates transplants, according to an article in the Annals of Emergency Medicine.

“It is estimated that the U.S. prevalence of hepatitis C virus among persons born between 1945 and 1965 is 3% to 4%, that baby boomers account for 75% of persons living with hepatitis C virus infection, and that 1.25 to 1.75 million of them do not know they are infected,” the article stated.

The study took place over 6 months at Highland Hospital-Alameda Health System, an ED in Oakland, Calif., where racial and ethnic minorities make up a large percentage of patients. Researchers attempted to target high-risk groups for HCV, including individuals who were part of the baby boomer generation (born between 1945 and 1965, or had ever used intravenous drugs.

The Centers for Disease Control and Prevention reports that baby boomers represent three-quarters of all HCV cases, yet the reasons for this are unclear, Douglas White, MD, director of emergency department HIV and HCV screening at Highland Hospital and lead author of the study, told CLN Stat. Certain behaviors such as drug use and unprotected sex might explain the high numbers, but it’s also possible that members of this population received blood transfusions before the blood supply was safe, he said.

Not all of the study participants represented these two populations, however. “We tried to target highest groups, but reality is not all nurses adhered to that protocol, and that was the reality of trying to integrate this study into clinical practice,” White said.

More than 2,500 antibody tests were performed on 9.7% of the 26,639 patients who visited the ED during this time period. Among these individuals, 10.3% tested positive for HCV, 70% of whom were diagnosed as chronically infected.

However, just 24% of patients with positive tests were previously aware that they had this condition. A number of factors may explain why people remain unaware of an HCV infection, White said. For the majority of people, symptoms often don’t manifest for many years, underscoring the importance of screening individuals before they develop HCV. “Historically we haven’t put efforts into large scale screening. Nowadays we have incredible treatments that can produce a 90% cure rate.”

Even among those participants who weren’t in the high-risk groups, infection rates hovered around 3%, comparable to national rates among baby boomers. These findings argue the case for offering HCV tests to all patients. White told CLN Stat that the next step at his hospital is to provide universal HCV and HIV screening in the ED.

The study’s authors underscored the importance of EDs as safety nets for HCV testing, as many patients unaware of their HCV status tend to frequent EDs for health care.

“Given skyrocketing rates of injection heroin use around the country, we expect the already high rates of hepatitis C infection to explode,” White said in a statement issued by the American College of Emergency Physicians (ACEP). “Intervention by emergency departments, in the form of screening and referral for treatment, could help slow the spread of this potentially deadly, communicable disease.”