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Rates of hepatitis C (HCV) among youth are increasing in Philadelphia, PA, mirroring national trends. In 2011, 557 new diagnoses in persons born after 1982 were reported–a 23% increase from 2010. The epidemiology of HCV beyond age and gender has not been well characterized due to limited resources for surveillance and investigation. To establish a baseline understanding of local HCV burden and identify risk factors associated with increasing youth infection, the Philadelphia Department of Public Health (PDPH) launched an enhanced surveillance program and evaluated its performance.
METHODS:
Investigation tools capturing demographics, clinical information, risk factors, and detailed substance use history (patient interviews only) were developed and integrated into PDPH’s electronic communicable disease management system (CDMS). New reports were identified via cross-checks in state and local communicable disease registries dating to 2002, among all positive HCV results reported to PDPH in persons ≤30 years of age tested between January 1 to June 30, 2012. Investigation approach included 1) phone interview of the patient or guardian (three attempts) and 2) mailing a two-page investigation form to be completed by the ordering provider, to be faxed or mailed back (two attempts). LexisNexis, PDPH Immunization, Philadelphia Prison, and Sexually Transmitted Disease registry databases were utilized to identify missing contact information.
RESULTS:
PDPH received 679 HCV reports, of which 286 were determined to be new. Data were obtained for 179 yielding a 63% response rate. Both investigation arms were completed for 53 (30%) case-patients; 77 (43%) had only patient and 49 (27%) only provider responses. Of the 286 reports, limiting investigation factors included missing or invalid reported phone numbers (43%), lack of ordering provider on report (35%), and/or challenges obtaining confirmatory test results (>43%). CDMS was easily customized to incorporate automatically-generated letters to increase response rates and modify questions. This work was executed by a 0.6 full-time equivalent (FTE) surveillance coordinator, 0.25 FTE intern, and supported by two epidemiologists.
CONCLUSIONS:
Building capacity for enhanced surveillance of HCV reported to PDPH has required dedicated personnel, a flexible data management platform to accommodate system improvements, and an integrated interdepartmental approach to maximize the identification of cases to be investigated and improve response rates. A two-pronged investigation approach has revealed greater yield from direct case interviews compared to provider-reported data. As demonstrated, with limited resources, a reliable model can be developed to ascertain surveillance data that remains critical for public health interventions.