Summer 1997 Volume 2, Number 2		CDC to re-assess hepatitis surveillance (Minneapolis) Epidemiologists at the CDC Hepatitis Branch are re-assessing methods used by the agency and the states to conduct surveillance for viral hepatitis. The issue was discussed in a workshop at the CDC Hepatitis Coordinators Meeting in Minneapolis in June. The re-assessment effort is being led by Dr. Eric Mast, a senior epidemiologist at the Branch. CDCs currently maintains three surveillance systems for viral hepatitis: (1) the MMWR or National Notifiable Disease Surveillance System, a passive system that collects only date of report, age, and sex, and is reported weekly; (2) the Viral Hepatitis Surveillance Program (VHSP), a stimulated passive system that collects case report forms sent by some, but not all, states; and (3) the Sentinel Counties Study, an intensive surveillance study conducted at six sites around the United States. The agency is worried that these systems will not well serve the surveillance needs of the 21st century. Specifically, they may not be optimal for guiding future prevention programs against hepatitis A and B, and they do not sufficiently recognize the increasing importance of hepatitis-associated chronic liver disease, especially that caused by hepatitis C. The Sentinel Counties Study has long been the jewel of CDC's hepatitis surveillance effort. But the agency is concerned that Sentinel Counties is losing its effectiveness as the incidence of all types of viral hepatitis decreases across the country and in the six participating counties. CDC is also fretting about the utility of its VHSP system. In 1993, 17 states reported less than 15% of their viral hepatitis cases to VHSP (CDC Hepatitis Surveillance Report No. 56, April 1996), and some states simply ignore VHSP. The agency increasingly sees the VHSP data as unreliable and inaccurate. Chronic infection is often reported as acute disease, disparate methods of case ascertainment are used, and risk factor information is often missing or inapplicable. The agency believes that the VHSP system needs to be improved in order to effectively monitor progress towards elimination of hepatitis B and to develop strategies for control of hepatitis A in the United States. As part of its re-assessment effort, CDC is also examining the issue of surveillance for chronic hepatitis B infection. In most states, chronic HBV infection is not a reportable condition, although many hepatitis coordinators spend many hours tracking positive HBsAg laboratory results to determine if they originate from an acute case. At the Minneapolis conference, CDC staffers sought opinions on whether chronic HBV infection should become a reportable disease. The arguments for making it reportable include (1) increasing the ability of public health agencies to counsel and refer HBV carriers for therapy and screening for hepatocellular carcinoma and (2) facilitating the vaccination of household and sexual contacts. But tracking HBsAg-positive laboratory tests is a labor-intensive task, likely beyond the resources of most health departments. Tracking can also be very inefficient, because so many positive HBsAg tests are revealed to be just re-tests of known carriers. The surveillance re-assessment effort is expected to extend over three years. Pilot programs in the states to evaluate new systems could begin next year.