Low accuracy of the national reporting system of acute hepatitis C infection in Taiwan, 1995-2004.
OBJECTIVE
This study attempted to clarify accuracy of acute hepatitis C (AHC) and its clinical characteristics.


METHODS
We reviewed 632 reported cases from national surveillance data of the Taiwan Center for Disease Control between 1995 and 2004, and reclassified diagnoses. A definite case was defined as alanine aminotransferase (ALT) > 10 x the upper limit of normal (ULN) with seroconversion of anti-hepatitis C virus antibody (anti-HCV). A probable case was defined as (i) seroconversion of anti-HCV and/or elevated ALT levels; or (ii) anti-HCV(+) but titers increased (from < 40 S/CO to >or= 40 S/CO) and ALT > 10 x the ULN. A suspected case was defined as initial anti-HCV(+) and ALT level > 10 x the ULN and/or jaundice. Excluded cases were defined as ALT levels less than 10 x ULN with initial positive anti-HCV Ab.


RESULTS
A total of 310 (49%) cases were confirmed as AHC; these included 95 (15%) definite and 215 (34%) probable cases. Higher incidence rates and accuracy of AHC were demonstrated in the southern area significantly if compared with northern, eastern and central areas, respectively (all P < 0.05). On comparison between blood centers and hospitals, more AHC cases were found in Southern Taiwan than in other areas (157/73 vs 24/40, P < 0.001), younger mean age (33.3 +/- 11.1 vs 49.3 +/- 16.4, P < 0.001), lower ALT levels (263.1 +/- 200.9 vs 1264.2 +/- 706.8, P < 0.001) and male predominance (191/39 vs 46/18, P = 0.046).


CONCLUSIONS
This study showed our reporting system over-estimated the AHC diagnosis, which is also a common issue worldwide. Greater efforts are needed to establish appropriate reporting systems, as well as more supplemental methods to distinguish between prevalent and incident cases.
Kee
Kwong-Ming
KM
Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Hung
Chi-Ming
CM
Wang
Jing-Houng
JH
Hung
Chao-Hung
CH
Chen
Pao-Fei
PF
Lin
Kuo-Sin
KS
Lu
Sheng-Nan
SN
D000208:Acute Disease; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D016009:Chi-Square Distribution; D019992:Databases as Topic; D015340:Epidemiologic Research Design; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D019562:Viral Load
D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase