Underreporting of hepatitis A in non-endemic countries: a systematic review and meta-analysis.
Information on reporting completeness of passive surveillance systems can improve the quality of and public health response to surveillance data and better inform public health planning. As a result, we systematically reviewed available literature on reporting completeness of hepatitis A in non-endemic countries.



We searched Medline, EMBASE and grey literature sources, restricting to studies published in English between 1997 and 21 May 2015. Primary studies on hepatitis A surveillance and underreporting in non-endemic countries were included, and assessed for risk of bias. A pooled proportion of reporting completeness was estimated using a DerSimonian-Laird random-effects model.



Diagnosed hepatitis A cases identified through positive laboratory tests, physician visits, and inpatient hospital discharges were underreported to public health in all eight included studies. Reporting completeness ranged from 4 to 97 % (pooled proportion 59 %, 95 % confidence interval = 32 %, 84 %). Substantial heterogeneity was observed, which may be explained by differences in the referent data sources used to identify diagnosed cases and in case reporting mechanisms and/or staffing infrastructure. Completeness was improved in settings where case reporting was automated or where dedicated staff had clear reporting responsibilities.



Future studies that evaluate reporting completeness should describe the context, components, and operations of the surveillance system being evaluated in order to identify modifiable characteristics that improve system sensitivity and utility. Additionally, reporting completeness should be assessed across high risk groups to inform equitable allocation of public health resources and evaluate the effectiveness of targeted interventions.
Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, Ontario, M5T 3M7, Canada. rachel.savage@mail.utoronto.ca.
Rachel D
RD
Savage
Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, Ontario, M5T 3M7, Canada.|Public Health Ontario, 480 University Ave, Suite 300, Toronto, Ontario, M5G 1V2, Canada.|Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G1 06, Toronto, Ontario, M4N 3M5, Canada.
Laura C
LC
Rosella
Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, Ontario, M5T 3M7, Canada.
Kevin A
KA
Brown
St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.|Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir #3172, Toronto, Ontario, M5S 1A8, Canada.|Department of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, Ontario, M5T 3M7, Canada.
Kamran
K
Khan
Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, Ontario, M5T 3M7, Canada.|Public Health Ontario, 480 University Ave, Suite 300, Toronto, Ontario, M5G 1V2, Canada.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Medical Sciences Building, 6th Floor, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada.
Natasha S
NS
Crowcroft
D018563:Disease Notification / Q000706:statistics & numerical data*; D062665:Epidemiological Monitoring; D006506:Hepatitis A / Q000453:epidemiology*; D006801:Humans; D011634:Public Health
Disease notification; Hepatitis A; Population surveillance; Underreporting