title: Review of hepatitis B surveillance in China: improving information to frame future directions in prevention and control.
abstract: BACKGROUND
  As the WHO verified that China reached the target of 1% prevalence of chronic hepatitis B infection among children targeted by universal hepatitis B immunization of newborns, the country considered new options for hepatitis B prevention and control. We reviewed hepatitis B surveillance in the broader context of viral hepatitis surveillance to propose recommendations to improve the system.
  
  
  METHODS
  We described surveillance for viral hepatitis in China with a specific focus on hepatitis B. We assessed critical attributes of the system, including data quality, predictive positive value and usefulness.
  
  
  RESULTS
  While remarkable progress in hepatitis B immunization of infants and children has likely almost eliminated transmission in younger age groups, reported rates of hepatitis B increased steadily in China between 1990 and 2008, probably because of a failure to distinguish acute from chronic infections. Elements that prevented a clearer separation between acute and chronic cases included (1) missed opportunity to report cases accurately among clinicians, (2) low availability and use of tests to detect IgM against the hepatitis B core antigen (IgM anti-HBc) and (3) lack of systems to sort, manage and analyze surveillance data.
  
  
  CONCLUSIONS
  To improve hepatitis B surveillance, China may consider (1) training clinicians to diagnose acute cases and to use IgM anti-HBc to confirm them, (2) improving access and use of validated IgM anti-HBc tests and (3) developing data management and analysis techniques that sort out acute from chronic cases.
authors.affiliation: China Center for Disease Control (CDC), Beijing, China.
authors.forename: Fuqiang
authors.initials: F
authors.lastname: Cui
authors.affiliation: Hepatitis Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Drobeniuc
authors.affiliation: World Health Organization, China Country Office, Beijing, China.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hadler
authors.affiliation: World Health Organization, China Country Office, Beijing, China. Electronic address: yvan.hutin@ecdc.europa.eu.
authors.forename: Yvan J
authors.initials: YJ
authors.lastname: Hutin
authors.affiliation: Jiangsu Center for Disease Control (CDC), Nanjing, China.
authors.forename: Fubao
authors.initials: F
authors.lastname: Ma
authors.affiliation: World Health Organization Headquarters, Geneva, Switzerland.
authors.forename: Steve
authors.initials: S
authors.lastname: Wiersma
authors.affiliation: China Center for Disease Control (CDC), Beijing, China.
authors.forename: Fuzhen
authors.initials: F
authors.lastname: Wang
authors.affiliation: Beijing Center for Disease Control (CDC), Beijing, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Wu
authors.affiliation: China Center for Disease Control (CDC), Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Ningxia Center for Disease Control (CDC), Yinchuan, China.
authors.forename: Liwei
authors.initials: L
authors.lastname: Zhou
authors.affiliation: World Health Organization, China Country Office, Beijing, China.
authors.forename: Shuyan
authors.initials: S
authors.lastname: Zuo
mesh_terms: D002681:China / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods*; D004517:Education, Professional; D062665:Epidemiological Monitoring; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007075:Immunoglobulin M / Q000097:blood; D013223:Statistics as Topic / Q000379:methods
chemical_list: D006510:Hepatitis B Antibodies; D007075:Immunoglobulin M
keywords: China; Hepatitis B; Laboratory diagnosis; Surveillance evaluation