title: Underascertainment of acute hepatitis C virus infections in the U.S. surveillance system: a case series and chart review.
abstract: BACKGROUND
  In 2010, the incidence of hepatitis C virus (HCV) infection in the United States was estimated to be 17 000 cases annually, based on 850 acute HCV cases reported to the Centers for Disease Control and Prevention by local public health authorities. Absence of symptomatic disease and lack of a specific laboratory test for acute infection complicates diagnosis and surveillance.
  
  
  OBJECTIVE
  To validate estimates of the incidence of acute HCV infection by determining the reporting rate of clinical diagnoses of acute infection to the Massachusetts Department of Public Health (MDPH) and Centers for Disease Control and Prevention.
  
  
  METHODS
  Case series and chart review.
  
  
  METHODS
  Two hospitals and the state correctional health care system in Massachusetts.
  
  
  METHODS
  183 patients clinically diagnosed with acute HCV infection from 2001 to 2011 and participating in a research study.
  
  
  METHODS
  Rate of electronic case reporting of acute HCV infection to the MDPH and rate of subsequent confirmation according to national case definitions.
  
  
  RESULTS
  149 of 183 (81.4%) clinical cases of acute HCV infection were reported to the MDPH for surveillance classification. The MDPH investigated 43 of these reports as potential acute cases of HCV infection based on their surveillance requirements; ultimately, only 1 met the national case definition and was counted in nationwide statistics published by the Centers for Disease Control and Prevention. Discordance in clinical and surveillance classification was often related to missing clinical or laboratory data at the MDPH as well as restrictive definitions, including requirements for negative hepatitis A and B laboratory results.
  
  
  CONCLUSIONS
  Findings may not apply to other jurisdictions because of differences in resources for surveillance.
  
  
  CONCLUSIONS
  Clinical diagnoses of acute HCV infection were grossly underascertained by formal surveillance reporting. Incomplete clinician reporting, problematic case definitions, limitations of diagnostic testing, and imperfect data capture remain major limitations to accurate case ascertainment despite automated electronic laboratory reporting. These findings may have implications for national estimates of the incidence of HCV infection.
  
  
  BACKGROUND
  National Institutes of Health.
authors.forename: Shauna
authors.initials: S
authors.lastname: Onofrey
authors.forename: Jasneet
authors.initials: J
authors.lastname: Aneja
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Haney
authors.forename: Ellen H
authors.initials: EH
authors.lastname: Nagami
authors.forename: Alfred
authors.initials: A
authors.lastname: DeMaria
authors.forename: Georg M
authors.initials: GM
authors.lastname: Lauer
authors.forename: Kelsey
authors.initials: K
authors.lastname: Hills-Evans
authors.forename: Kerri
authors.initials: K
authors.lastname: Barton
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kulaga
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Bowen
authors.forename: Noelle
authors.initials: N
authors.lastname: Cocoros
authors.forename: Barbara H
authors.initials: BH
authors.lastname: McGovern
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Church
authors.forename: Arthur Y
authors.initials: AY
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult