2006). An inability of a health department to identify a case becomes a missed opportunity to prevent future cases and to ensure that HBV-infected and HCV-infected people receive the care that they need.

In 2007, the Massachusetts Department of Public Health piloted the use of STD disease intervention specialists (DISs) to follow up on cases of HCV infection in people 15–25 years old. The DISs were tasked with collecting risk-history data and providing partner-notification services for drug-sharing partners of the infected people. There was some success in reaching a small sample of the high volume of infected people, but no funding was available to support the staff. In addition, the DISs had competing priorities that kept the department from being able to implement its methods fully so that they could be appropriately evaluated (Onofrey et al., 2008).

Given the demands on staff, most state health-department surveillance units indicated that they were barely able to keep up with the basics of data collection. The 2009 NASTAD survey found that only 18 of the 43 jurisdictions conducted any type of followup; in the ones that did conduct followup, there was wide variation in what that comprised (NASTAD, 2009). Followup can consist of making calls to providers or cases to collect demographic, clinical, or risk-history data and contacting infected people by mail, by telephone, or in person to provide education or referral to medical services. For the most part, even the best resourced surveillance units are able to conduct only very limited case management (Fleming et al., 2006).

Furthermore, the utility and cost effectiveness of conducting partner services for persons who test positive for HBV or HCV is yet to be determined. Currently, states conduct partner notification for HIV and some STDs. Services include notifying sex or needle-sharing partners of exposure to disease and testing, counseling, and referrals for other services. Newly revised CDC guidelines on partner services strongly recommend partner services for persons reported to have HIV or early syphilis; services for gonorrhea and chlamydial infection are recommended for high-priority cases as resources allow (CDC, 2008e). Recommendations for persons who have viral hepatitis were not included in the HIV and STD integrated guidelines.

Recommendations

Recommendation 2-1. The Centers for Disease Control and Prevention should conduct a comprehensive evaluation of the national hepatitis B and hepatitis C public-health surveillance system.



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