BACKGROUND: Infections with hepatitis C virus (HCV), a leading cause of liver cirrhosis and hepatocellular carcinoma, have been reportable in Washington State since 1990 for the acute subtype (new infection, onset within 12 months of exposure) and since 2001 for the chronic subtype (lifelong unless treated). HCV surveillance is time-consuming due to a high burden of laboratory reports including duplicate records. Case investigations of potential HCV cases are conducted by Washington’s local health jurisdictions (LHJs) and are generally reported through the Public Health Issues Management System (PHIMS).
METHODS: The surveillance system was evaluated for confirmed cases using Centers for Disease Control and Prevention guidelines. Simplicity was assessed using a flowchart that described the operation of the system. Timeliness was evaluated by calculating median days between onset (for acute) or diagnosis date (for chronic) and various endpoints. Data quality was assessed by calculating completeness of demographic and risk factor variables.
RESULTS: The three LHJs with the largest burden of chronic HCV cases do not report chronic cases through PHIMS, as it does not meet their internal needs. This indicates low acceptability for PHIMS as a reporting system, and complicates the reporting process, reducing simplicity of the surveillance system. The median time from onset to case completion was 28 days (acute) and median time from diagnosis date to case completion was 14 days (enhanced chronic surveillance, conducted by one LHJ). Completeness of race/ethnicity information from 2007-2014 was 78.7% (race) and 62.9% (ethnicity) for the acute subtype, and 31.0% and 16.6% for the chronic subtype. Due to the lack of race/ethnicity data, representativeness of the system could not accurately be calculated for these variables. Genotype information and additional laboratory reports for already confirmed chronic cases, when received, often are not entered into the surveillance system.
CONCLUSIONS: The Washington State HCV reporting system is complex, and use of PHIMS is not well accepted for the chronic subtype. Tailoring development of the upcoming replacement for PHIMS, the Washington Disease Reporting System (WDRS) to be acceptable to all LHJs will help improve simplicity and acceptability of the system. Treatment for HCV is becoming more accessible and has high cure rates (>90%), however methods for tracking cases through the care continuum are not well developed. A system that is able to track patients through the care continuum is necessary to in order to direct prevention and control activities and evaluate the impact of these activities.