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Hepatitis Surveillance


Issued April, 1996

The total numbers of cases reported to the Viral Hepatitis Surveillance Program (VHSP) are shown in Table 1A. Approximately 36% of hepatitis A cases, 26% of hepatitis B cases, and 18% of NANB hepatitis cases reported to the NNDSS in 1993 were also reported to the VHSP. These percentages reflect a substantial decline in reporting to the VHSP. Reporting to the VHSP remains inconsistent among states, with increasing numbers of states reporting fewer of their NNDSS cases to the VHSP than in previous years (Table 1B). In 1987, six states reported to VHSP less than 15% of their NNDSS cases; in 1993, this trend increased to 12 states.

Table 1A. Cases Reported to Viral Hepatitis Surveillance Program Compared with NNDSS, by Type of Submission, 1991-93
1991 1992 1993
Reports submitted on Form CDC 53.1 Rev. 8-89 (new form) 18,064 16,433 13,563
Reports submitted on Form CDC 53.1 Rev. 8-84 (old form) 1,772 884 617
Reports submitted electronically as extended NETSS* records 810 961 1,427
Total case reports submitted to VHSP 20,646 18,278 15,607
Total cases serologically confirmed 19,014 16,916 14,469
Total cases meeting case definition for acute hepatitis 17,094 15,362 13,199
Symptomatic hepatitis A
9,621 9,735 8,643
Symptomatic hepatitis B
5,771 4,411 3,526
Hepatitis A and B co-infection
237 151 174
Symptomatic non-A, non-B hepatitis
1,465 1,065 856
Total cases reported to NNDSS 47,223 46,132 43,012
Hepatitis A
24,378 23,112 24,238
Hepatitis B
18,003 16,126 13,361
Hepatitis non-A, non-B
3,582 6,010 4,786
Hepatitis, unspecified
1,260 884 627
* National Electronic Telecommunications System for Surveillance
National Notifiable Diseases Surveillance System

Table 1B. Proportion of NNDSS-Reported Cases Reported to VHSP by States, 1993
75%-100%50%-74% 25%-49% 15%-24% 0%-14%
Alabama Colorado New York (excl. NYC) Arizona Alaska
District of Columbia Indiana Rhode Island Georgia Arkansas
Delaware Maine Wyoming California
Florida Massachusetts Connecticut
Hawaii Michigan Idaho
Iowa Missouri Kansas
Illinois New Hampshire Kentucky
Iowa Virginia Mississippi
Louisiana Washington Montana
Maryland Wisconsin New Jersey
Minnesota New Mexico
North Carolina New York City
North Dakota Oregon
Nebraska South Carolina
Nevada South Dakota
Ohio Tennessee
Oklahoma Texas
West Virginia

The agreement between reporting to the NNDSS and to the VHSP does not necessarily measure the completeness of reporting from a particular state, since not all cases may be reported to the NNDSS and the two systems have different reporting criteria. The increasing discrepancy between the two systems has resulted in differences in the relative proportions of types of viral hepatitis reported. Before 1990, the proportions of reported cases by type were similar between the two surveillance systems. Since then, the proportion of hepatitis cases reported as hepatitis A to the two systems have remained similar, but the proportion of cases reported as hepatitis B have been discrepant: 24% to 27% of the total VHSP cases were reported as hepatitis B, compared with 35% to 38% of total cases reported to NNDSS. The VHSP also received reports on smaller proportions of the total number of NANB hepatitis cases (7% to 8% of total cases) than did NNDSS (up to 13% of total cases).

These differences in proportions of cases are partly due to the fact that VHSP excludes cases that do not meet the case definition (VHSP eliminated 15% of reported cases as non-cases in 1993). In addition, because of strict adherence to the case definition, VHSP classified a larger proportion of reported cases as nonspecific hepatitis: 15% of cases were classified as hepatitis unspecified by the VHSP during 1993 compared with 1.5% of cases reported to NNDSS. Beginning with data collected in 1995, hepatitis cases that have type unspecified are no longer requested or printed in the MMWR.

The VHSP excludes reported cases that do not meet the case definition for acute viral hepatitis (see "Case Definition" section), including cases that seem to be due to chronic infections. Some responses to the VHSP questionnaires are incomplete, and the information is insufficient to verify the case as an acute infection, or to confirm the serologic type of hepatitis, even though partial testing may have been done. Cases may also be reported too late to be included in the analysis. The latest date for submitting case reports to the VHSP for the calendar year is March 31 of the following year.

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This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.