among all states to maximize their capacity to perform core surveillance for acute and chronic HBV and HCV infection. Standardization will be accomplished through cooperative agreements, improved guidance, and adequate and consistent funding. Systems should be integrated into existing HIV or other disease surveillance infrastructure where feasible. Complementary efforts need to be made in building enhanced supplemental surveillance systems to describe trends in underrepresented at-risk populations better and to address the gaps identified in the current surveillance system. Both types of surveillance activities will provide better information to policymakers and service-delivery systems to improve care for people who are at risk for or living with HBV or HCV infection. Changes should be phased and prioritized, with the first step focused on the development and funding of core surveillance systems for each state.

Core Surveillance

Core surveillance—including collection, processing, analysis, and dissemination of data on cases of acute and chronic HBV and HCV infection—is needed in all states. Because of the public-health importance of quick identification of outbreaks and nosocomial transmission, acute-disease surveillance has had the highest priority in surveillance programs in the past. However, chronic-disease surveillance is also critical in that, if funded appropriately, it will assist in the recognition of acute cases, aid in moving people with recent diagnoses into appropriate care, contribute to an increased understanding of disease burden, allow evaluation of prevention efforts, and, given appropriate case management, save on costs associated with treatment of patients who have cirrhosis, hepatocellular carcinoma, or liver transplantation. Proper chronic-disease surveillance can also improve acute-disease surveillance by enhancing the accuracy and efficiency of related data collection. Evaluation of the core surveillance system should be ongoing to ensure that it is meeting emerging needs.

Funding Mechanism

In the proposed model, the state would be the primary unit of surveillance. Funding should be earmarked for viral-hepatitis surveillance through cooperative agreements with the states. CDC should ensure that all states have sufficient infrastructure to identify and appropriately investigate all suspected cases of acute and chronic HBV and HCV infection. Cooperative agreements should require reporting of standardized viral-hepatitis surveillance data within 3 years of implementation. The agreements should include funding for states to hire staff to process laboratory results, enter data, and follow up cases of acute and chronic HBV and HCV infections.

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