Surveillance Programs for Chronic Viral Hepatitis in Three Health Departments

Abstract

Although chronic hepatitis B and chronic hepatitis C are diseases of public health importance, only a few health departments nationally have chronic viral hepatitis under surveillance; these programs rely primarily on direct reporting by medical laboratories. We conducted an evaluation to determine if lessons from these programs can guide other health departments. Between December 2002 and February 2003, we visited the Connecticut Department of Public Health, the Multnomah County Health Department in Portland, Oregon, and the Minnesota Department of Health to determine the capacity of their chronic hepatitis registries to monitor trends and provide case management. We found that the registries facilitated investigations of potentially acute cases by identifying previously known infections, and aided prevention planning by pinpointing areas where viral hepatitis was being diagnosed. For chronic cases, case management (defined as the process of ensuring that infected individuals and their partners receive medical evaluation, counseling, vaccination, and referral to specialists for treatment when indicated) was provided for hepatitis B in Multnomah County, but was limited in other programs; barriers included resource constraints, difficulties confirming chronic infection, and privacy concerns. Finding innovative ways to overcome these barriers and improve case management is important if chronic hepatitis surveillance is to realize its full potential.

Recommendations for identification and public health management of persons with chronic hepatitis B virus infection

“…57 IDUs contribute disproportionately to the burden of infection in the United States: in chronic HBV registries, 4%-12% of chronically infected persons were known to have a history of injection drug use. 58 Prevalence of resolved or chronic HBV infection among IDUs increases with the number of years of drug use and is associated with frequency of injection and with sharing of drug-preparation equipment (e.g., cottons, cookers, and rinse water), independent of syringe sharing. 59,60 HIV-Positive Persons.…”

Periconceptional folic acid use: Still room to improve

“…Chronic HBV infection has been identified in 2.7%‐11% of IDUs in a variety of settings49–56; HBsAg prevalence of 7.1% (95% CI = 6.3%‐7.8%) has been described among IDUs with HIV coinfection 57. IDUs contribute disproportionately to the burden of infection in the United States: in chronic HBV registries, 4%‐12% of chronically infected persons were known to have a history of injection drug use 58. Prevalence of resolved or chronic HBV infection among IDUs increases with the number of years of drug use and is associated with frequency of injection and with sharing of drug‐preparation equipment (e.g., cottons, cookers, and rinse water), independent of syringe sharing 59, 60…”

Using a surveillance system to identify and treat newly acquired hepatitis C infection

“…Use of a public health surveillance system to monitor trends in HCV has been described in a number of countries in Europe and North America. [15][16][17] The identification of acute HCV cases by these passive systems is inherently suboptimal, although improving passive surveillance through enhanced follow-up including actively obtaining previous HCV laboratory tests and liver function tests may increase the proportion of those identified as recently acquired disease. HCV sentinel surveillance systems may improve detection of newly acquired HCV and such a system is currently being piloted in Victoria.…”