Is the recent increase in the reported cases of hepatitis C/NANB a real increase?

Since testing for anti-HCV became widely available, county health departments have increasingly relied on laboratories as sources of case reports for hepatitis C/NANB. This has resulted in an artifactual increase in the reported incidence of hepatitis C because of the reporting of persons testing positive for anti-HCV with no clinical or epidemiologic evidence of acute disease. Physician-reported cases continue to be a small proportion of all reported hepatitis C/NANB cases. In addition, many county health departments confirmed that they pass these positive laboratory test results on to the state health departments without sufficient confirmation of acute disease. Primarily because of lack of personnel and other diseases being seen as higher priority, county health departments do not attempt to obtain additional information necessary to confirm acute disease. Further analysis of the survey results is being conducted. Issues to be examined include the purpose of surveillance of viral hepatitis; the importance of focusing on acute, symptomatic disease to determine true incidence; and the need for separate surveillance systems to monitor patients with chronic infections and chronic liver disease. Such surveillance efforts in the future will depend on strict adherence to case definitions and on adequate resources to support them.