Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, United States of America.
Pennsylvania Department of Health, Harrisburg, Pennsylvania, United States of America.
PLoS One. 2019 Jun 6;14(6):e0217455. doi: 10.1371/journal.pone.0217455. eCollection 2019.
In Pennsylvania, reporting of viral hepatitis B (HBV) and viral hepatitis C (HCV) infections to CDC has been mandated since 2002. Underreporting of HBV and HCV infections has long been identified as a problem. Few reports have described the accuracy of state surveillance case registries for recording clinically-confirmed cases of HBV and HCV infections, or the characteristics of populations associated with lower rates of reporting.
The primary objective of the current study is to estimate the proportion of HBV and HCV infections that went unreported to the Pennsylvania Department of Health (PDoH), among patients in the Geisinger Health System of Pennsylvania. As a secondary objective, we study the association between underreporting of HBV and HCV infections to PDoH, and the select patient characteristics of interest: sex, age group, race/ethnicity, rural status, and year of initial diagnosis.
Per medical record review, the study population was limited to Geisinger Health System patients, residing in Pennsylvania, who were diagnosed with a chronic HBV and/or HCV infection, between 2001 and 2015. Geisinger Health System patient medical records were matched to surveillance records of confirmed cases reported to the Pennsylvania Department of Health (PDoH). To quantify the extent that underreporting occurred among the Geisinger Health System study participants, we calculated the proportion of study participants that were not reported to PDoH as confirmed cases of HBV or HCV infections. An analysis of adjusted prevalence ratio estimates was conducted to study the association between underreporting of HBV and HCV infections to PDoH, and the select patient characteristics of interest.
Geisinger Health System patients living with HBV were reported to PDoH 88.4% (152 of 172) of the time; patients living with HCV were reported to PDoH 94.6% (2,257 of 2,386) of the time; and patients who were co-infected with both viruses were reported to PDoH 72.0% (18 of 25) of the time. Patients living with HCV had an increased likelihood of being reported if they were: less than or equal to age 30 vs ages 65+ {PR = 1.2, [95%CI, (1.1, 1.3)]}, and if they received their initial diagnosis of HCV during the 2010-2015 time period vs the 1990-1999 time period {PR = 1.08, [95%CI, (1.05, 1.12)]}.
The findings in this study are promising, and suggests that PDoH has largely been successful with tracking and monitoring viral hepatitis B and C infections, among persons that were tested for HBV and/or HCV. Additional efforts should be placed on decreasing underreporting rates of HCV infections among seniors (ages 65 and over), and persons who are co-infected with HBV and HCV.
自 2002 年以来，宾夕法尼亚州一直要求向疾病预防控制中心报告乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染情况。长期以来，HBV 和 HCV 感染的漏报一直是一个问题。很少有报告描述了州监测病例登记册记录 HBV 和 HCV 感染的临床确诊病例的准确性，以及与报告率较低相关的人群特征。
本研究的主要目的是估计宾夕法尼亚州卫生部门（PDoH）未报告给宾夕法尼亚州 Geisinger 卫生系统患者的 HBV 和 HCV 感染比例。作为次要目标，我们研究了 HBV 和 HCV 感染向 PDoH 的漏报与我们关注的患者特征之间的关系：性别、年龄组、种族/民族、农村状况和初始诊断年份。
通过病历回顾，研究人群仅限于 2001 年至 2015 年间在宾夕法尼亚州居住并被诊断为慢性 HBV 和/或 HCV 感染的 Geisinger 卫生系统患者。Geisinger 卫生系统患者的病历与向宾夕法尼亚州卫生部门（PDoH）报告的确诊病例监测记录相匹配。为了量化 Geisinger 卫生系统研究参与者中漏报的程度，我们计算了未向 PDoH 报告为 HBV 或 HCV 感染确诊病例的研究参与者的比例。进行了调整患病率比估计的分析，以研究向 PDoH 报告 HBV 和 HCV 感染的漏报与我们关注的患者特征之间的关系。
向 PDoH 报告 HBV 感染的 Geisinger 卫生系统患者为 88.4%（172 例中的 152 例）；向 PDoH 报告 HCV 感染的 Geisinger 卫生系统患者为 94.6%（2386 例中的 2257 例）；同时感染两种病毒的患者向 PDoH 报告的比例为 72.0%（25 例中的 18 例）。如果 HCV 感染患者的年龄小于或等于 30 岁，而年龄大于 65 岁{PR=1.2，[95%CI，（1.1，1.3）]}，或者如果他们在 2010-2015 年期间接受 HCV 初始诊断，而不是在 1990-1999 年期间接受诊断{PR=1.08，[95%CI，（1.05，1.12）]}，则他们被报告的可能性更大。
本研究的结果令人鼓舞，表明 PDoH 在追踪和监测乙型肝炎病毒和丙型肝炎病毒感染方面已取得很大成功，这些感染在接受 HBV 和/或 HCV 检测的人群中进行了检测。应进一步努力降低老年人（65 岁及以上）和同时感染 HBV 和 HCV 的人群中 HCV 感染的漏报率。
