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CDC Analysis Recommends Enhanced Acute Hepatitis C Surveillance

Laurie Barclay, MD


November 5, 2010 — Supporting enhanced acute hepatitis C virus (HCV) surveillance can provide a greater benefit to public health by improving completeness and timeliness of case reporting, according to the results of an analysis by the US Centers for Disease Control (CDC) published in the November 5 issue of the Morbidity and Mortality Weekly Report.

"[HCV] is a major public health problem in the United States and contributes to increased healthcare costs," write R.M. Klevens, DDS, from the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; and R.A Tohme, MD, Epidemic Intelligence Service officer, CDC. "Complete and timely surveillance data for [HCV] infections lead to a timely identification and response to outbreaks, help guide and evaluate prevention strategies, and enable early initiation of treatment, leading to an ultimate decrease in healthcare costs."

This analysis compared data on acute HCV cases reported in 2008 by the CDC's National Notifiable Diseases Surveillance System (NNDSS) with data collected through enhanced surveillance efforts in certain states taking part in the Emerging Infections Program (EIP). To improve public health responses to emerging infectious diseases, the CDC funds the EIP, a network of health departments, to collect detailed surveillance data.

Compared with routine national surveillance, EIP sites reported more acute HCV cases, reported cases sooner after diagnosis, and collected more complete data regarding race, clinical symptoms, and major risk factors for HCV.

"Reporting of acute [HCV] in routine national surveillance missed approximately 22% of cases reported by sites funded through the Emerging Infections Program," the report authors write. "In addition, 60% of the cases in the [NNDSS] lacked information about [HCV] risk factors."

The report authors note that public health efforts mandate enhanced HCV surveillance providing accurate and timely data. Surveillance can help identify and contain outbreaks, direct and assess prevention strategies, and start treatment early among infected persons, thereby preventing advanced liver disease (including chronic infection and liver cancer) and reducing healthcare costs. These essential public health activities could be further improved by providing additional resources for hepatitis surveillance, such as those recently recommended by the Institute of Medicine.

An accompanying editorial note recommends that surveillance data should include race and ethnicity information to reduce disparities through targeted prevention programs.

Limitations of the report are that the data for timeliness calculation were missing from most NNDSS cases, which might have led to an overestimation of timeliness in NNDSS. Estimates of timeliness could have been improved if the CDC had been able to determine the duration between diagnosis and reporting to the local, rather than to the state, health department, but this information was not available. In addition, because the states where enhanced reporting of acute HCV was implemented were not randomly selected, the proportion of diagnoses of acute HCV infections missed at the provider level could not be determined.

"Availability of a nationwide enhanced acute [HCV] surveillance system improves case detection as well as completeness and timeliness of acute [HCV] data," the report authors conclude. "This is essential for a timely public health action and early initiation of treatment, both of which contribute to the prevention of advanced liver disease and a decrease in associated healthcare costs."

Morb Mortal Wkly Rep. 2010;59:1407-1410.


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