The evaluation should, at a minimum,

  • Include assessment of the system’s attributes, including completeness, data quality and accuracy, timeliness, sensitivity, specificity, predictive value positive, representativeness, and stability.

  • Be consistent with CDC’s Updated Guidelines for Evaluating Public Health Surveillance Systems.

  • Be used to guide the development of detailed technical guidance and standards for viral hepatitis surveillance.

  • Be published in a report.

The committee found little published information on or systematic review of viral-hepatitis surveillance in the United States. Specific information was obtained from a series of surveys of the AVHPCs. In contrast, the history and status of national HIV surveillance is well reviewed and documented (CDC, 1999; Glynn et al., 2007; Nakashima and Fleming, 2003).

In July 2001, CDC published updated guidelines for evaluating public-health surveillance systems (CDC, 2001b). According to the guidelines, the evaluation should “involve an assessment of system attributes, including simplicity, flexibility, data quality, acceptability, sensitivity, predictive value positive, representativeness, timeliness, and stability.” The lack of sensitivity of state hepatitis-surveillance systems is well documented for acute cases, and many states do not perform surveillance for chronic HBV or chronic HCV infections. Moreover, the movement of CDC away from NETSS, a CDC-provided system, and toward a national network of PHIN-compliant systems has left state and territorial health departments with a wide array of software systems and capabilities (CDC, 2009i). A comprehensive review is needed to document the current systems and capacities of public-health jurisdictions. The evaluation should focus on developing guidance to improve consistency of data, guide the development of detailed technical guidance and standards for hepatitis-surveillance programs, and allow CDC to improve understanding and description of the limitations of the data collected. Completion of this task should not delay the implementation of other components of the surveillance-related recommendations in this report.

Recommendation 2-2. The Centers for Disease Control and Prevention should develop specific cooperative viral-hepatitis agreements with all state and territorial health departments to support core surveillance for acute and chronic hepatitis B and hepatitis C.

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