Evaluating Hepatitis C (HCV) Surveillance in New Jersey (NJ)

BACKGROUND:   HCV is a blood-borne viral disease that has been reportable directly to the New Jersey Department of Health (NJDOH) since 2001.  Hepatitis C is a high volume disease and presents unique challenges to effectively perform routine surveillance.  Hepatitis C surveillance in New Jersey (NJ) is complex, due to NJ’s 97 Local Health Departments stretched across 21 counties.  NJ’s electronic surveillance system, the Communicable Disease Reporting Surveillance System (CDRSS), serves to track, monitor, and store information from mandatory reportable conditions including HCV. State regulations require electronic laboratory reporting or web-based manual data entry of positive laboratory studies. As HCV is not easily defined as “acute” versus “chronic” and since duplicate case reports are common, HCV surveillance is often time consuming.

METHODS: The 2001 “Updated Guidelines for Evaluating Public Health Surveillance Systems” were used to evaluate NJ’s HCV Surveillance System. A flow chart was created to describe the operation and purpose of the system. Information on system funding was obtained from a recent grant proposal. Surveillance system performance was analyzed using lab reports and case numbers obtained from CDRSS. The usefulness and acceptance of the system will be gauged by a focus group including infection preventionists, lab technicians, private health clinic representative, as well as, local and state health department staff.

RESULTS:   There are over 2,000 trained users of CDRSS in New Jersey. In 2011 alone, 10,086 positive HCV labs were reported to the NJDOH. Of these,  2,312 were found to be duplicate cases. Case duplication, data entry errors, as well as the sheer volume of manual data entry and case management remains a problem for the system. These are time intensive issues to correct – a problem for an organization that funds only one full time staff member to work on HCV surveillance. Final results will be obtained by June 2013.

CONCLUSIONS:   The NJ HCV Surveillance System is an ambitious attempt to measure and describe this important disease. However, it is also a flawed surveillance system, as the fragmented distribution of the NJ population, vast number of reports, chronic nature of the disease, and limited public health staff all lead to a sprawling, error-prone, and time consuming surveillance system. Despite these limitations, staff at the state and local level attempt to ensure that all cases are counted as accurately as possible, and that case numbers for both acute and chronic cases are as reliable as circumstances allow.