RNA (Alter et al., 2003; Ghany et al., 2009). The difficulty in identifying chronic cases often revolves around the need for two separate tests (or other supplemental antibody tests) and the 6-month timeframe required for a diagnosis of chronic HCV infection. Many infected people are tested at public or nonclinical testing sites—such as drug-treatment facilities, sites for testing for HIV or STDs, or community-based organizations—that conduct only the less expensive anti-HCV tests. Persons tested at those sites might not have access to an HCV RNA test, or the laboratory conducting the initial EIA test might not routinely test for HCV RNA when an EIA has been positive. The process leads to incomplete diagnoses and inaccurate reporting of the number of chronic cases.

The CDC-recommended case definition of nonacute HCV infection also poses some problems in interpreting the collected data. Although it is assumed that the majority of nonacute hepatitis C cases represent chronic infections, this case definition also includes acute cases that do not meet the confirmed acute case classification (CDC, 2005a). However, a case defined only by the presence of anti-HCV could be a late acute infection, a chronic infection, a resolved infection, or a false-positive assay result. It is therefore essential that anti-HCV testing be supplemented by testing for HCV RNA and by followup samples to classify cases correctly and to use the data for program-planning purposes.

Identifying Perinatal Hepatitis B

Since 1992, CDC has awarded funds to 64 grantees to support perinatal hepatitis B prevention programs through its Immunization Services Division’s cooperative agreements with health departments. The funds support perinatal hepatitis B coordinators, who are charged with identifying all HBsAg-positive pregnant women, ensuring the administration of appropriate immunoprophylaxis to all infants born to these women, ensuring the completion of postvaccination serologic testing of the infants, and ensuring the completion of the hepatitis B vaccine series. Most coordinator programs also include ensuring vaccination of household contacts and sexual partners of HBsAg-positive women in their mission (CDC, 2009g).

In an economic analysis of immunization strategies to prevent hepatitis B transmission in the United States, Margolis et al. (1995) found that prevention of perinatal infection and routine infant vaccination would reduce the lifetime risk of HBV infection by at least 68%. They estimated that prevention of perinatal HBV infections would save $41.8 million in medical and work-loss costs. Routine hepatitis B vaccination of infants would provide additional savings of $19.7 million. Both strategies were found to be cost-effective, with estimated costs per year of life saved of $164 for preventing perinatal HBV infection and of $1,522 for infant vaccination.

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