A Comparison of Two Hepatitis C Virus Surveillance Systems in Hamilton County, TN Open Access
Van Dolson, Randall (Fall 2019)
Abstract
Background: Hepatitis C virus (HCV) surveillance is difficult to perform, partly due to the asymptomatic nature of many chronic infections and requirement of multiple confirmatory laboratory tests. As the literature reflects this difficulty, I sought to describe and demonstrate significant differences between populations identified of two different HCV surveillance systems in order to identify strengths and weaknesses of each system and inform development of future systems.
Methods: Two datasets were used in this analysis. The first included HCV RNA-positive cases from Hamilton County, TN from June 1, 2016 – October 31, 2016 collected by Tennessee Department of Health’s (TDOH) Global Health Outbreak Surveillance Technology (GHOST) surveillance pilot and the TDOH-based National Electronic Disease Surveillance System (NEDSS) Based System (NBS). The second included l data from the U.S. Census at the Zip Code Tabulation Area (ZCTA) level to provide population-level descriptive variables of the HCV RNA-positive cases. ArcMap was used to create two custom variables that estimated the distance between case and health department. ZCTA-specific variables were categorized at or above and below the median. The two custom variables were categorized into quintiles. Cross tabulation analyses were performed between 74 HCV RNA-positive cases and ZCTA variables.
Results: Both systems identified similar numbers of cases for many of the variables, including educational attainment, employment status, veteran status, disability, private insurance coverage, citizenship status, urban/rural status, Black race, American Indian/Alaska Native race, Asian race, and distance from health departments. Differences between the two systems occurred. GHOST identified more cases at or above the median White population, more cases below the median Hispanic population, and nearly twice as many cases above the median household income than NBS. More cases below the median White population and more cases above the median Hispanic population were identified by NBS.
Conclusion: Both systems are similar in whom they identify and how they identify positive cases, revealing that both opt-out targeting and routine reporting of positive cases are targeting similar populations. The exceptions encourage further investigation into each surveillance system’s gaps. Future directions can include more robust analyses with larger populations and geographical areas to better assess strengths and weaknesses of these surveillance systems.
Table of Contents
I. Introduction ............................................................................................1
II. Background ............................................................................................2
Molecular Epidemiology ......................................................................2
Acute Infection......................................................................................5
Chronic Infection ..................................................................................7
Modes of Transmission .........................................................................8
Intravenous Drug Use ........................................................................8
Receipt of Blood and Organ Products ...............................................10
Occupational Exposure ......................................................................12
Risk of Hepatitis C Virus Infection in Pediatrics ...............................13
Transmission via Personal Items .......................................................14
Sexual Transmission ..........................................................................15
High-Risk Groups .................................................................................17
Baby Boomers ....................................................................................17
American Indians/Alaska Natives ......................................................19
African Americans .............................................................................20
People in Correctional Facilities.......................................................21
Veterans .............................................................................................22
Surveillance...........................................................................................22
III. Methods ...................................................................................................24
Study Design and Population ................................................................24
Study Variables .....................................................................................25
IV. Analysis ...................................................................................................28
V. Results .....................................................................................................28
VI. Discussion................................................................................................30
Bibliography .................................................................................................34
Table ..............................................................................................................46
Appendix .......................................................................................................47
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