Formal surveillance reporting of acute hepatitis C virus (HCV) infection clinical diagnoses were grossly underascertained, according to a review of cases reported to the Massachusetts Department of Public Health (MDPH) and Centers for Disease Control and Prevention.
Investigators assessed rates of electronic case reporting of acute HCV infection to MDPH and rate of subsequent confirmation according to the national case definition and found:
• Of 183 clinical cases, 149 were reported to MDPH.
• Of 149 reports, MDPH investigated 43 reports based on surveillance requirements.
• Only 1 case met the national criteria and was reported to the CDC.
The authors noted hurdles to accurate case ascertainment included incomplete clinician reporting, problematic case definitions, limitations of diagnostic testing, and imperfect data captures.
Citation: Onofrey S, Aneja J, Haney GA, et al. Underascertainment of acute hepatitis C virus infections in the U.S. Surveillance System: a case series and chart review. Ann Intern Med. 2015. doi:10.7326/M14-2939. [Epub ahead of print]
Commentary: Hepatitis C, for which there is now effective and well-tolerated treatment, is an important public health problem affecting over 180 million people worldwide. The USPSTF now recommends screening for Hep C in persons at high risk for infection and also a 1-time screening for HCV infection to adults born between 1945 and 1965.1 Unlike Hep A and Hep B, where the definition of an acute infection is clear with detection of IgM antibody, the definition of acute Hep C is based on a combination of symptoms, laboratory assessments including antibodies to HCV and nucleic acid testing, as well as elevated aminotransferase levels. This study shows that the current estimates of the incidence of new Hepatitis C infections are very inexact. —Neil Skolnik, MD
Citation: Hepatitis C: Screening. US Preventive Services Task Force website.www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/hepatitis-c-screening. Updated June 2013. Accessed July 13, 2015.