porting is standard practice for infectious diseases surveillance, including HIV surveillance (CDC, 2008d). Acute HBV infections are reportable in all states and acute HCV infections are reportable in all but one state. All states report the cases to CDC. Chronic HBV infections are reportable in all but six states and chronic HCV infections are reportable in all but seven states (CSTE, 2009).

Outbreak Detection and Control

Accurate and timely surveillance data are necessary to identify out-breaks of acute HBV and HCV infection in the health-care and community settings. The data can assist in recognizing and addressing breaches in infection control, and they can help to mitigate the size of outbreaks. There have been several outbreaks of hepatitis B and hepatitis C in health-care settings in recent years (CDC, 2003b, 2003d, 2005b, 2008a, 2009c; Fabrizi et al., 2008; Thompson et al., 2009). Research on those outbreaks has shown that they typically occurred in dialysis units, medical wards, nursing homes, surgery wards, and outpatient clinics and resulted from breaches in infection control (Lanini et al., 2009). In a 2009 study, researchers found evidence of 33 outbreaks in nonhospital health-care settings in the United States in the last 10 years. Transmission was primarily patient to patient and was caused by lapses in infection control and aseptic techniques that allowed contamination of shared medical devices, such as dialysis machines. The authors stated that successful outbreak control depended on systematic case identification and investigation, but most health departments did not have the time, funds, personnel resources, or legal authority to investigate health-care–associated outbreaks (Thompson et al., 2009).

Hepatitis B and hepatitis C surveillance data can be used to identify or quantify new trends in the transmission of HBV and HCV. For example, surveillance data can help epidemiologists to determine whether sexual transmission of HCV reported among some cohorts of HIV-positive men who have sex with men (Matthews et al., 2007; van de Laar et al., 2009) is statistically significant on a population level. Surveillance data have also been used to identify clusters of newly acquired cases of hepatitis C in adolescents and young adults and to direct appropriate interventions to persons in the clusters (CDC, 2008f). Those findings can help public-health officials to target their resources at emerging populations being affected by HBV and HCV, such as racial and ethnic populations or geographically linked active injection-drug users (IDUs).

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