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Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C
chronic HBV and HCV infections (and received data on 133,520 cases of HCV infection in 2007 alone), but these data are not presented routinely in Morbidity and Mortality Weekly Report, which is published by CDC, or elsewhere (Klevens et al., 2009). Although all states but one perform some degree of surveillance for acute HBV and HCV (Daniels et al., 2009b), much of this surveillance is passive at best.
There are significant barriers to implementing more comprehensive surveillance activities. In the previously mentioned survey conducted by NASTAD in 2009, it was reported that of the 43 responding jurisdictions, almost half received between 1,000 and 10,000 HBV laboratory results annually, and over 70% reported the same range for the number of HCV laboratory results received annually (NASTAD, 2009). Many states do not have the staffing or systems to keep up with such a high volume of information received and are often unable to follow up with medical providers to address underreporting or to obtain demographic and risk-history information, such as race, ethnicity, and drug-use details (Klein et al., 2008). The lack of funding to hire adequate staff is the fundamental barrier to complete and accurate surveillance.
Although CDC provides case-reporting forms for the collection of viral-hepatitis surveillance data, the forms do not have required elements, and they ask for data that are often difficult to obtain. Moreover, the use of the forms is inconsistent among states and local jurisdictions. Of the 43 health departments that responded to inquiries from the present committee, 26 have developed their own HBV case-reporting form, and 21 have developed an HCV case-reporting form. The forms were created to capture behavioral-risk information not included on CDC’s form or to improve data collection and entry into the separate jurisdictions’ specific software systems. For example, the CDC case-reporting form does not collect risk-behavior information specific to chronic HBV. Finally, 8 states do not use a case-reporting form at all for reporting HBV, and 12 states do not use one for HCV; these jurisdictions rely solely on the reporting of laboratory-test results.
Paradoxically, efforts to modernize and enhance public-health surveillance systems have led to greater inconsistency in data collection. In 1984, CDC began work on the Epidemiologic Surveillance Project. The goal of the project was to develop computer-based transmission of public-health surveillance data between states and CDC. By 1989, all 50 states were participating in the reporting system for certain acute infectious diseases, and the system was renamed the National Electronic Telecommunications System for Surveillance (NETSS) (CDC, 2009f). Data were transmitted weekly to CDC in a standard record format. However, the system quickly became dated with advances in information and surveillance technology, such as electronic laboratory reporting and electronic medical records.