An estimated 2.4 million people in the U.S. are living with hepatitis C infection, while up to 1.59 million people could be living with hepatitis B in the U.S. The need for expanded, standardized, and reliable viral hepatitis surveillance continues to impact public health efforts, resources, and response across the U.S. to this epidemic. A lack of robust surveillance data limits the ability to:
In 2021, the Centers for Disease Control and Prevention (CDC) released funding for viral hepatitis surveillance across 59 jurisdictions. Prior to 2021, only 14 states received federal funding specifically for viral hepatitis surveillance. This inaugural viral hepatitis surveillance status report benchmarks the state of viral hepatitis surveillance in the U.S. prior to funding dissemination, establishes a baseline to monitor changes over time as additional resources are allocated, assesses how jurisdictions across the U.S. are measuring the impact of viral hepatitis on their communities, and highlights areas in need of additional resources.
Viral hepatitis surveillance programs need to be expanded to help ensure effective prevention and treatment of hepatitis infections. Collecting information through surveillance can help us to answer questions like:
A robust viral hepatitis surveillance system can help us to understand:
HepVu and NASTAD collaborated to create this first-ever viral hepatitis surveillance
status report.
HepVu
is an interactive online mapping tool that visualizes the impact
of the viral hepatitis epidemics on communities across the United States to promote
data-driven public health decision-making.
NASTAD
is a leading non-partisan non-profit
association that represents public health officials who administer HIV and viral hepatitis programs in the U.S. to end HIV/AIDS, viral hepatitis, and intersecting epidemics.
We worked with a
steering committee
comprised of state and local health department
representatives, national policy/advocacy organizations, and researchers to develop
a set of indicators for survey measurement, determine process, develop a survey, and disseminate results.
In March 2022, a survey requesting information on hepatitis B and C surveillance practices in 2021 (January-June) was sent to 59 state, local, and
territorial jurisdictions across the U.S., and 95% of jurisdictions responded. Data were processed by Emory University and compared to additional
indicators like prior viral hepatitis funding, overdose mortality, and other factors. Moving forward, HepVu and NASTAD will collect data from
jurisdictions on these indicators each year, analyze the results, and prepare a status report describing findings nationally and by jurisdiction.
Staff and dedicated time are needed to perform basic
surveillance activities, such as disseminating state and
local information about viral hepatitis cases and linking
viral hepatitis records with other databases to collect
additional information about cases.
Burden of disease
Who is at increased risk
Who needs treatment
1/3 of jurisdictions did not have a full-time employee (FTE) dedicated to viral hepatitis surveillance.
Just over half (55%) of jurisdictions were able to produce annual surveillance summaries.
Only 2/3 of jurisdictions were able to conduct any data matching* with viral hepatitis surveillance records.
* E.g., matching viral hepatitis surveillance records to death records
Investigating newly diagnosed viral hepatitis cases through medical records or interviews can provide information about patient risk factors and
their needs for prevention, care, and treatment. Interviewing people with recent diagnoses can also help public health programs contact sexual,
household, or injection partners that may also be at risk for infection.
Only 30% of jurisdictions were able to review medical record
data for people with suspected acute (new) hepatitis B and
contact people who may have been exposed to hepatitis B
Only 20% of jurisdictions were able to review medical record
data for people with suspected acute (new) hepatitis C and
contact people who may have been exposed to hepatitis C.
Only 30% of jurisdictions were able to review medical record
data for people with suspected acute (new) hepatitis B and
contact people who may have been exposed to hepatitis B
Percentage of Jurisdictions Who Were Able to Conduct
Investigations into Suspected Acute (new) Hepatitis B Cases
Only 20% of jurisdictions were able to review medical record
data for people with suspected acute (new) hepatitis C and
contact people who may have been exposed to hepatitis C.
Percentage of Jurisdictions Who Were Able to Conduct
Investigations into Suspected Acute (new) Hepatitis C Cases
Effective vaccines are available for hepatitis A and B, successful therapies for hepatitis B, and
curative treatment for hepatitis C. These tools make it possible to eliminate viral hepatitis.
According to the World Health Organization (WHO), viral hepatitis elimination is
defined
as
a 90% reduction in new infections and a 65% reduction in hepatitis-related deaths. The
Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025)
outlines a plan for strategic coordination towards achievement of our nation’s elimination goals
Jurisdictional elimination plans and goals are important benchmarks for establishing localized
approaches that support elimination.
Jurisdictions with funding and resources for at least one full-time employee (FTE) dedicated to viral hepatitis surveillance were more likely to
produce and disseminate information on viral hepatitis prevalence.
Jurisdictions With at Least One FTE
Jurisdictions Without One FTE
Jurisdictions with funding and resources for at least one FTE are more likely to receive and use negative viral hepatitis laboratory results, which
help public health programs know if subsequent positive laboratory tests are the result of new infections. These negative laboratory results also
provide information about people whose hepatitis C has been cured.
Current
diagnoses
Who is at
increased risk
Who is in or out
of treatment
Alongside establishing elimination goals, publishing annual surveillance summaries for viral hepatitis and estimates for hepatitis B and C infections are important for informing programmatic planning and resource allocation. Funding and staffing for surveillance allows jurisdictions to produce these important summaries and estimates.
Among jurisdictions that did not produce annual surveillance summaries or estimates for hepatitis B or C infections in 2021 nearly half were in the top 1/3 of states with the highest overdose mortality in 2020.
Ability to disseminate data impacts the ability to answer questions about Current burden of disease:
Previously Funded Jurisdictions*
Previously Unfunded Jurisdictions
Produced annual surveillance summaries
Did not produce annual surveillance summaries
Previously Funded Jurisdictions*
Previously Unfunded Jurisdictions
Summarized annual number of hepatitis B cases
Did not summarize annual number of hepatitis B cases
Previously Funded Jurisdictions*
Previously Unfunded Jurisdictions
Summarized annual number of hepatitis C cases
Did not summarize annual number of hepatitis C cases
Previously Unfunded Jurisdictions
Produced annual surveillance summaries
Did not produce annual surveillance summaries
Previously Unfunded Jurisdictions
Summarized annual number of hepatitis B cases
Did not summarize annual number of hepatitis B cases
Previously Unfunded Jurisdictions
Summarized annual number of hepatitis C cases
Did not summarize annual number of hepatitis C cases
*Previously funded jurisdictions include 14 states that received federal funding specifically for viral hepatitis surveillance before 2021
Collecting information about pregnancy status and connecting
it to viral hepatitis case records allows providers to screen
for hepatitis C in pregnancy and implement post-partum
treatment plans for the parent and child in accordance with
current recommendations. Meanwhile, less than half (45%)
of jurisdictions were required in 2021 to report pregnancy
status with hepatitis C cases.
Of jurisdictions that were in the top 1/3 of states with the
highest overdose mortality in 2020, 68% did not require
pregnancy status as a reportable conditionfor hepatitis C
in 2021. Collecting information about pregnancy status may
be particularly important in jurisdictions hardest hit by the
opioid epidemic where viral hepatitis infections are increasing.
Collecting information about pregnancy status and connecting
it to viral hepatitis case records allows providers to screen
for hepatitis C in pregnancy and implement post-partum
treatment plans for the parent and child in accordance with
current recommendations. Meanwhile, less than half (45%)
of jurisdictions were required in 2021 to report pregnancy
status with hepatitis C cases.
Of jurisdictions that were in the top 1/3 of states with the
highest overdose mortality in 2020, 68% did not require
pregnancy status as a reportable condition for hepatitis C
in 2021. Collecting information about pregnancy status may
be particularly important in jurisdictions hardest hit by the
opioid epidemic where viral hepatitis infections are increasing.