TP 107 Case Finding of Acute Hepatitis C after Implementation of a New Hepatitis C Registry Arkansas, 2013

Tuesday, June 10, 2014
Exhibit Hall
Rachel Gicquelais, MPH1, Carl Long, BS2, Ewelina Sulek, MPH1, Michael Grier, MPH1, Mohammad Azam, MPH1, Ralph Wilmoth, MPH, MPA1, Naveen Patil, MD, MHSA, MA1 and Dirk Haselow, MD, PhD1, 1Infectious Disease Branch, Arkansas Department of Health, Little Rock, AR, 2Analytical Epidemiology Branch, Arkansas Department of Health, Little Rock, AR

Background: In January 2013, the Arkansas Department of Health (ADH) established a registry to track individuals infected with hepatitis C virus (HCV) using CDC’s NEDSS (National Electronic Disease Surveillance System) Base System. Before 2013, HCV reports received through state-mandated communicable disease reporting were not reviewed. ADH reported less than five acute HCV cases per year to CDC from 2003-2012.

Methods: Surveillance procedures implemented in 2013 included review of all HCV reports. Reports noting symptoms or elevated liver enzymes were suspected acute cases and were investigated by communicable disease nurses. Epidemiologists also investigated all suspected chronic cases aged <30 years. Final case status was assigned using the 2012 CSTE case definitions for acute and chronic HCV. Confirmed acute cases reported from January 1–September 30, 2013 were reviewed to determine their identification mode. The true number of acute cases in 2013 was estimated using CDC methodology.

Results: From January 1–September 30, 2013, 18 total confirmed acute cases were identified. Fourteen cases were reported with signs or symptoms of acute hepatitis, most frequently elevated alanine aminotransferase levels. Four cases were initially investigated as chronic and identified as acute after physicians returned the ADH case report form used to investigate cases <30 years. The true burden of acute HCV in Arkansas was estimated as 322 cases in 2013. 

Conclusions: Review of all received hepatitis C reports resulted in the identification of 18 confirmed acute cases and an estimated rate of 2.08 per 100,000 adult Arkansans. The increase in case count in 2013 compared with prior years is likely due to increased detection attributable to intensive surveillance efforts begun in 2013. Without investigation of cases aged <30 years, 22% of the acute cases would not have been identified. Ongoing commitment to investigate all cases is needed to accurately characterize the burden of acute HCV.