Epidemiology Department, Primary Healthcare Centre Bijeljina, Republic of Srpska, Bosnia and Herzegovina.
Institute for Global Health and Development, Queen Margaret University Edinburgh, Scotland, United Kingdom.
J Infect Public Health. 2019 Jul-Aug;12(4):516-521. doi: 10.1016/j.jiph.2019.01.061. Epub 2019 Feb 13.
Globally, an estimated 257 million people are living with chronic hepatitis B (HBV) infection and an estimated 71 million people with the chronic hepatitis C virus (HCV). The true public health dimensions and impact of hepatitis epidemics are poorly understood. Case definitions are fundamental parts of disease surveillance, representing sets of standardised criteria used to assess whether or not a person has a certain disease. The study evaluated the sensitivity and specificity of hepatitis B and hepatitis C case definitions, current at the time of data collection, recommended by the European Commission (EC) and the Centers for Disease Prevention and Control (CDC).
The study involved 150 hospital referrals with suspected cases of hepatitis from a Serbian clinic during 2014/2015. Case definitions of hepatitis B and C were tested for their sensitivity, specificity, positive and negative predictive values.
EC 2008 and the CDC 2012 case definitions for acute hepatitis B, and the CDC 2012 case definition for probable case of chronic hepatitis B have low sensitivity. Case definitions which rely on laboratory confirmation only have maximal sensitivity. EC case definitions showed maximal sensitivity and specificity for hepatitis C confirmed cases. The CDC case definition for chronic hepatitis C showed low sensitivity (36.8%) and low negative predictive value (65.6%) for probable cases and maximal sensitivity and specificity for confirmed cases. Hepatitis C case definitions requiring presence of clinical criteria have low sensitivity and high specificity, resulting from presence of infection and absence of any clinical manifestation, but have high positive and negative predictive values.
Syndromic case definitions show low sensitivity and are of limited use. They highlight the importance of laboratory diagnostics (offering maximal sensitivity and specificity, and high positive and negative predictive values), as well as the need for universal case definitions, for confirmed cases only.
据估计，全球有 2.57 亿人患有慢性乙型肝炎（HBV）感染，7100 万人患有慢性丙型肝炎病毒（HCV）感染。乙型肝炎和丙型肝炎的病例定义是疾病监测的基本组成部分，代表了用于评估一个人是否患有某种疾病的一套标准化标准。本研究评估了当时收集数据时建议的欧洲委员会（EC）和疾病预防控制中心（CDC）的乙型肝炎和丙型肝炎病例定义的敏感性和特异性。
本研究涉及 2014/2015 年期间塞尔维亚一家诊所的 150 例疑似肝炎的医院转诊病例。对乙型肝炎和丙型肝炎的病例定义进行了敏感性、特异性、阳性和阴性预测值测试。
EC 2008 年和 CDC 2012 年急性乙型肝炎病例定义，以及 CDC 2012 年慢性乙型肝炎可能病例的病例定义敏感性较低。仅依赖实验室确认的病例定义具有最大的敏感性。EC 病例定义对丙型肝炎确诊病例具有最大的敏感性和特异性。CDC 慢性丙型肝炎病例定义对可能病例的敏感性（36.8%）和阴性预测值（65.6%）较低，对确诊病例的敏感性和特异性较高。需要存在临床标准的丙型肝炎病例定义具有较低的敏感性和较高的特异性，这是由于存在感染而没有任何临床表现，但具有较高的阳性和阴性预测值。
综合征病例定义敏感性较低，用途有限。它们突出了实验室诊断的重要性（提供最大的敏感性和特异性，以及高阳性和阴性预测值），以及仅针对确诊病例使用通用病例定义的必要性。
