Moreover, other surveillance systems and software were used for reporting of HIV/AIDS, STDs, tuberculosis, and some vaccine-preventable diseases.

In 1999, CDC developed the concept of the National Electronic Disease Surveillance System (NEDSS), which was designed to promote the development of interoperable surveillance systems (that is, the Public Health Information Network, or PHIN) at federal, state, and local levels (CDC, 2009e). The NEDSS initiative describes information-system standards to which all systems must adhere but does not require use of CDC-produced software. CDC provides the NEDSS Base System, a software system that may be used, but only 16 jurisdictions have opted to use it. Most jurisdictions use PHIN-compliant systems, which are either purchased from a commercial vendor or developed specifically for a particular jurisdiction. A few jurisdictions continue to use the NETSS system while their PHIN-compliant systems are being developed (personal communication, J. Efird, CDC, April 1, 2009). The result is that CDC no longer provides a standardized database for inputting and reporting data on viral hepatitis. Consequently, there is a wide array of state systems with an even wider array of capabilities. The lack of standardization makes it difficult for states to share information efficiently. In addition, creating and modifying their systems can lead to substantial expenses for states and jurisdictions (CDC, 2009i).

Even states and jurisdictions that have PHIN-compliant systems in place may not have the staff to enter the high volume of viral-hepatitis data received. Four of the 43 states that responded to the recent questionnaire for this committee reported not having any staff to enter data. They do not include states that may not be able to enter all received data fully. In the 2009 NASTAD survey of AVHPCs, it was reported that 27 of the 43 reporting jurisdictions had backlogs of HCV data, with an average of 6,200 cases that needed to have data entered (NASTAD, 2009).

Capturing Data on At-Risk Populations

As discussed previously, current surveillance systems do not adequately capture cases of acute and chronic HBV and HCV infections. That is particularly true for members of marginalized populations. IDUs are at high risk for both HBV and HCV infections. The incidence of HCV infection in IDUs ranges from 2% to 40% per year, with most rates in the range of 15–30% per year1 (Maher et al., 2006; Mathei et al., 2005; van den Berg et al., 2007), and the incidence of HBV infection from 10% to 12% per year (Ruan et al., 2007). A study of IDUs in Seattle looked at those who became infected with HBV or HCV during the 12-month study period. The study matched study participants who had become infected to those identified in


HCV prevalence is calculated in percentages from person years.

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