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Learning Objectives for this Presentation:
By the end of the presentation participants will be able to understand the epidemiology of acute hepatitis B in a large urban city, and practical challenges of acute hepatitis B surveillance.
Background:
New York City Department of Health and Mental Hygiene recently began investigating all acute hepatitis B reports in order to describe the current epidemiology of hepatitis B; describe risk exposures, including sex, IV drug use, household contact, tattooing/piercing, and occupational exposures; and identify communities in greatest need of hepatitis B vaccination programs.
Methods:
Acute hepatitis B is reported by clinicians and laboratories. Investigations begin with verification of HBcIgM test results. If a patient was erroneously reported as acute hepatitis B, reporters are educated regarding the surveillance criteria. Clinical information is collected by phone, fax or medical record review to determine whether patients meet the case definition (symptoms, HbcIgM positive, and elevated LFTs or jaundice). Patients meeting the case definition are interviewed by telephone about risk factors, counseled to avoid transmitting the virus to others, and educated about the need for follow-up testing to insure that infection resolves.
Results:
During 2004, 645 investigations were completed. There were 95 reporting errors and 86 false-positive HBcIgMs, mainly in patients with chronic infection. An additional 308 did not meet the case definition; most were asymptomatic. There were 156 confirmed cases (1.9/100,000 population). Non-mutually-exclusive risk factors included heterosexual contact (usually with partners of unknown hepatitis B status) (52%), men who have sex with men (20%), IV drug use (2%), other (8%), and unknown (21%).
Conclusions:
The high rate of reporting errors and false-positive results was unexpected and burdensome for health department staff. There appears to be confusion among providers about ordering appropriate hepatitis B tests and interpreting results. Provider education is ongoing. Demographic and risk factor data will be used to target and expand vaccination programs.
See more of A6 - Viral Hepatitis Surveillance
See more of The 2005 National Viral Hepatitis Prevention Conference