Evaluation of Perinatal Hepatitis B Virus (pHBV) Infections Reported to the National Notifiable Disease Surveillance System (NNDSS) for Infants Born in 2005

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to
(1) understand pHBV infection reporting mechanisms
(2) recognize gaps in current pHBV surveillance
(3) identify actions to strengthen pHBV surveillance

Background:
The Perinatal Hepatitis B Prevention Program's goal is to identify the estimated 24,000 infants born to HBV-infected women annually to ensure administration of newborn immunoprophylaxis (hepatitis B vaccine and HBIG), hepatitis B vaccination, and testing for pHBV infection. Since 1996, grantees have reported pHBV in their Annual Assessment. Since 2003, states have also reported pHBV cases via NNDSS. Concordance of these reporting mechanisms hasn't been previously described.

Objectives:
(1) identify pHBV infections captured by each database
(2) describe discrepancies between the databases
(3) formulate strategies to improve reporting accuracy

Methods:
Cases were defined as any hepatitis B surface antigen (HBsAg)-positive infant aged 1-24 months born in 2005 in the U.S. or territories to an HBsAg-positive mother. Both databases were reviewed on April 30, 2007 to determine that all reported cases met the case definition, all cases reported via the Annual Assessment were reported to NNDSS, and all cases reported via NNDSS were in the Annual Assessment. Programs were then contacted to clarify discrepancies and encouraged to report any missing NNDSS cases and remove cases that didn't meet the case definition before the 2005 reporting year closed. Concordance was re-assessed in October 2007.

Results:
75 unique cases were identified, of which only 56% (n=42) were common to both databases, with 37% (n=28) and 7% (n=5) found exclusively in the Annual Assessment and NNDSS, respectively. Following reconciliation, database concordance increased to 81% (n=63). Reporting errors were observed in both databases.

Conclusions:
Discrepancies occurred in the number of pHBV cases reported via the Annual Assessment and NNDSS. Accuracy and completeness of both systems could be enhanced through collaboration between perinatal HBV coordinators and state NNDSS reporters.