Alliance of State and Territorial AIDS Directors interviewed staff involved in enhanced viral-hepatitis surveillance projects funded through CDC’s Emerging Infections Programs early in 2009 (the programs are described in more detail later in this chapter). Committee members also contacted several AVHPCs directly in April and May 2009 to discuss their work.

The recommendations for surveillance based on the committee’s findings focus on the development of a model designed to improve the quality and accuracy of information by developing systems to collect, analyze, and disseminate data on acute and chronic HBV and HCV infections. The recommendations call for a two-part system: core surveillance activities, building the capacity of state and local health departments to conduct standard disease surveillance on newly diagnosed acute and chronic HBV and HCV infections, and targeted surveillance to obtain data on specific populations that are not represented fully in the collection of core surveillance data. Core surveillance means those activities in which all jurisdictions must engage to provide accurate, complete, and timely information to monitor incidence, prevalence, and trends in disease diagnoses. Data from other activities, such as targeted surveillance, supplement information from core surveillance, and are necessary to provide accurate incidence estimates, given the challenges of conducting hepatitis B and C surveillance, as detailed in this chapter. The recommendations also include guidance regarding the interpretation and dissemination of surveillance data.

APPLICATIONS OF SURVEILLANCE DATA

Surveillance data are used in a variety of ways by a broad base of state health-department staff, researchers, clinicians, policy-makers, and private industry. Federal and state health-department surveillance systems provide population-based information that can be used to improve the public’s health. They also offer an opportunity for public-health intervention at the individual level by linking infected people to appropriate care and support services (Klevens et al., 2009). Overall, surveillance data are critical in estimating incidence and prevalence of HBV and HCV infections (CDC, 2008c), and they provide a basis for studying and understanding the mechanisms of diverse outcomes in the natural history of these infections (Thacker, 2000).

Public health surveillance generally involves name-based reporting of cases of specified diseases to state and local health departments. As such, it requires the gathering of information that some people consider private. Public health officials and state legislatures have weighed the costs and benefits of public health surveillance and have required name-based reporting of specific diseases with confidentiality safeguards in place to protect private information (Fairchild et al., 2008). Confidential name-based re-



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