Wzw (wirusowe zapalenie wątroby)

Wzw (wirusowe zapalenie wątroby)
Epidemiologia

Wirusowe zapalenie wątroby (WZW) typu B i C stanowi istotne globalne zagrożenie zdrowotne, z około 1,3 miliona zgonów w 2022 roku oraz 254 milionami osób żyjących z przewlekłym WZW B i 50 milionami z WZW C. Największe obciążenie chorobą obserwuje się w Regionie Zachodniego Pacyfiku (97 mln zakażeń) i Afrykańskim (65 mln). Wskaźniki zakażeń u dzieci poniżej 5 lat są niskie (0,9% w 2020 r.), co świadczy o skuteczności szczepień. W USA odnotowano spadek zachorowań na WZW A o 88% w latach 2019-2022, stabilizację WZW B oraz niewielki spadek WZW C o 6,3% w tym samym okresie, choć dane mogą być zniekształcone przez pandemię COVID-19. Zakażenia WZW B nabyte w dzieciństwie prowadzą do przewlekłości w 95% przypadków, podczas gdy u dorosłych poniżej 5%. Tylko 13% zakażonych WZW B jest świadomych swojego statusu, a 3% poddanych leczeniu. W USA obserwuje się znaczne dysproporcje etniczne w zapadalności, szczególnie wśród osób pochodzenia azjatyckiego i z wysp Pacyfiku. WZW C dotyka głównie osoby w wieku 20-39 lat, zwłaszcza użytkowników narkotyków dożylnych, z rosnącą zapadalnością od 2013 roku.

Epidemiologia wirusowego zapalenia wątroby (WZW)

Wirusowe zapalenie wątroby (WZW) stanowi jedno z najpoważniejszych globalnych zagrożeń dla zdrowia publicznego. Według danych Światowej Organizacji Zdrowia (WHO), około 1,3 miliona osób zmarło w 2022 roku z powodu przewlekłego WZW typu B i C, co oznacza około 3500 zgonów dziennie. Globalnie szacuje się, że 254 miliony osób żyje z przewlekłym WZW typu B, a 50 milionów z WZW typu C. Codziennie odnotowuje się około 6000 nowych zakażeń wirusami hepatotropowymi¹.

Obciążenie chorobą jest najwyższe w Regionie Zachodniego Pacyfiku WHO (97 milionów zakażeń) oraz w Regionie Afrykańskim (65 milionów zakażeń), następnie w Azji Południowo-Wschodniej (61,4 miliona zakażeń), Regionie Wschodniego Śródziemnomorza (15,1 miliona), Europie (10,6 miliona) i obu Amerykach (5 milionów)². Wskaźniki zakażeń WZW B u dzieci poniżej piątego roku życia są znacznie niższe (0,9% w 2020 roku), co odzwierciedla skuteczność globalnych programów szczepień³.

Trendy epidemiologiczne w WZW

Najnowsze dane z amerykańskiego Centrum Kontroli i Zapobiegania Chorobom (CDC) wskazują na zmieniającą się dynamikę zachorowań na WZW. Po corocznych wzrostach w latach 2015-2019, wskaźnik zachorowań na WZW typu A zmniejszył się o 88% między 2019 a 2022 rokiem. Wskaźnik ostrego WZW typu B, po spadkach w latach 2020-2021, ustabilizował się między 2021 a 2022 rokiem. Z kolei wskaźnik ostrego WZW typu C, po wzrostach w latach 2015-2021, zmniejszył się o 6,3% między 2021 a 2022 rokiem⁴.

Jednakże dane te należy interpretować ostrożnie ze względu na wpływ pandemii COVID-19 na systemy nadzoru i zgłaszania przypadków. Spadek liczby zgłoszonych przypadków WZW w latach 2020-2021 może być związany z ograniczeniem dostępnego personelu do nadzoru epidemiologicznego oraz mniejszą liczbą osób poszukujących opieki zdrowotnej i poddających się testom w czasie pandemii⁵.

Epidemiologia WZW typu B

Zakażenie WZW typu B nabyte w wieku dorosłym prowadzi do przewlekłego zapalenia wątroby w mniej niż 5% przypadków, podczas gdy zakażenie w okresie niemowlęcym i wczesnym dzieciństwie prowadzi do przewlekłego zapalenia wątroby w około 95% przypadków⁶. Według danych z 2022 roku, tylko 13% wszystkich osób żyjących z WZW B było świadomych swojego zakażenia, a zaledwie 3% (7 milionów) osób żyjących z przewlekłym WZW B było poddanych leczeniu⁷.

W 2021 roku w Stanach Zjednoczonych wskaźnik nowo zgłoszonych przypadków przewlekłego WZW B był 14 razy wyższy wśród osób pochodzenia azjatyckiego i z wysp Pacyfiku niż wśród populacji nie-hiszpańskich białych Amerykanów⁸. Te dysproporcje podkreślają znaczenie ukierunkowanych strategii zdrowia publicznego.

Epidemiologia WZW typu C

Liczba ostrych przypadków WZW typu C zgłoszonych w Stanach Zjednoczonych wzrastała każdego roku w okresie 2013-2020. W 2020 roku zgłoszono łącznie 4798 ostrych przypadków, co odpowiada szacunkowo 66 700 zakażeniom po uwzględnieniu niedoszacowania i niepełnego raportowania⁹.

W 2021 roku zgłoszono łącznie 5023 przypadki ostrego WZW C, co odpowiada szacunkowym 69 800 zakażeniom. Wskaźnik zachorowalności na ostre WZW C podwoił się od 2013 roku i wzrósł o 15% od 2019 roku¹⁰. Około 52% ostrych przypadków WZW C zgłoszonych do CDC w 2021 roku dotyczyło osób w wieku 20-39 lat¹¹.

Osoby przyjmujące narkotyki drogą iniekcji nadal ponoszą główne obciążenie związane z ostrym zakażeniem WZW C. Wśród 32% zgłoszonych ostrych przypadków WZW C, które zawierały informacje o czynnikach ryzyka związanych z iniekcyjnym używaniem narkotyków, 66% zgłosiło taką praktykę¹².

Systemy nadzoru nad wirusowym zapaleniem wątroby

Nadzór zdrowia publicznego jest istotnym narzędziem w zapobieganiu i kontroli chorób zakaźnych oraz w medycznym zarządzaniu osobami, które na nie chorują. Dane nadzoru są wykorzystywane do oszacowania wielkości problemu zdrowotnego, opisania naturalnej historii choroby, wykrywania epidemii, dokumentowania rozmieszczenia i rozprzestrzeniania się zdarzeń zdrowotnych lub chorób, oceny środków kontroli i zapobiegania oraz wspomagania planowania zdrowia publicznego¹³.

Cele systemów nadzoru nad WZW

Główne cele nadzoru nad wirusowym zapaleniem wątroby obejmują:

Oszacowanie obciążenia chorobą¹⁴
Określenie czynników ryzyka¹⁵
Identyfikację ognisk zakażeń¹⁶
Monitorowanie trendów¹⁷
Ocenę środków kontroli, interwencji i programów¹⁸
Identyfikację zakażonych osób w celu skierowania ich do opieki medycznej, edukacji i doradztwa¹⁹

Dane nadzoru są krytyczne w szacowaniu zapadalności i chorobowości zakażeń WZW B i C oraz stanowią podstawę do badania i zrozumienia mechanizmów różnorodnych wyników w naturalnej historii tych zakażeń²⁰.

Wyzwania w nadzorze nad WZW

Systemy nadzoru nad WZW napotykają liczne wyzwania:

Identyfikacja ostrego zakażenia WZW jest z natury wadliwa, ponieważ zdecydowana większość przypadków jest bezobjawowa, a pacjenci nie szukają opieki medycznej ani nie poddają się testom²¹
Zarówno zakażenia WZW B, jak i C są w dużej mierze bezobjawowe, więc większość osób nie otrzymuje diagnozy, dopóki zakażenie nie stanie się przewlekłe²²
Dla celów nadzoru epidemiologicznego, departamenty zdrowia mają trudności z uzyskaniem kompletnych wyników badań laboratoryjnych niezbędnych do klasyfikacji przypadku przewlekłego WZW B zgodnie z definicjami przypadków CDC²³
Obecne systemy nadzoru zdrowia publicznego dla WZW B i C są słabo rozwinięte i niespójne w różnych jurysdykcjach²⁴
Finansowanie nadzoru nad WZW jest wysoce rozdrobnione²⁵

Niedoskonałości w systemach nadzoru prowadzą do niepełnych danych, które nie dostarczają dokładnych szacunków aktualnego obciążenia chorobą, są niewystarczające do planowania i oceny programów oraz nie dostarczają informacji, które pozwoliłyby decydentom na alokację wystarczających zasobów do rozwiązania problemu²⁶.

Globalne i krajowe inicjatywy nadzoru

W odpowiedzi na wyzwania związane z nadzorem nad WZW, rozwijane są liczne inicjatywy:

CDC finansuje projekty rozszerzonego nadzoru poprzez Programy Infekcji Wirusowych (Viral Hepatitis Surveillance Emerging Infections Programs)²⁷
WHO opracowuje raporty dotyczące globalnej epidemiologii WZW, zasięgu usług i dostępu do produktów²⁸
Wiele krajów i stanów publikuje regularne raporty nadzoru epidemiologicznego WZW, takie jak:
- Coroczne raporty CDC o nadzorze nad wirusowym zapaleniem wątroby²⁹
- Raporty nadzoru stanowych departamentów zdrowia³⁰³¹
- Raporty epidemiologiczne Europejskiego Centrum ds. Zapobiegania i Kontroli Chorób (ECDC)³²

Komisje ekspertów zalecają opracowanie dwupoziomowego modelu nadzoru: podstawowego nadzoru oraz nadzoru ukierunkowanego. Standaryzacja zostanie osiągnięta poprzez umowy o współpracy, lepsze wytyczne oraz adekwatne i spójne finansowanie³³.

Znaczenie danych nadzoru epidemiologicznego WZW

Dane z nadzoru nad WZW mają kluczowe znaczenie dla różnych aspektów zdrowia publicznego i opieki klinicznej.

Wykorzystanie danych nadzoru

Dane nadzoru epidemiologicznego WZW są wykorzystywane przez szeroki zakres pracowników stanowych departamentów zdrowia, naukowców, lekarzy, decydentów i prywatny przemysł. Federalne i stanowe systemy nadzoru zdrowotnego dostarczają informacji opartych na populacji, które mogą być wykorzystane do poprawy zdrowia publicznego³⁴.

Dokładne i aktualne dane nadzoru są niezbędne do identyfikacji ognisk ostrego WZW B i C w placówkach opieki zdrowotnej i środowiskach społecznych. Dane nadzoru nad WZW B i C mogą być wykorzystywane do identyfikacji lub kwantyfikacji nowych trendów w przenoszeniu HBV i HCV³⁵.

Alokacja zasobów i polityka zdrowotna

Dane nadzoru są często wykorzystywane do określenia, jak najefektywniej wykorzystać zasoby. Jeśli dane nadzoru nie są dostępne lub niedoszacowują obciążenie chorobą, ustawodawcy i urzędnicy zdrowia publicznego nie przeznaczą wystarczających zasobów na odpowiednią reakcję zdrowia publicznego³⁶.

Organizacje zdrowia publicznego wykorzystują dane nadzoru do projektowania programów ukierunkowanych na odpowiednie populacje. Kluczową potencjalną rolą programów nadzoru nad WZW jest ocena wpływu programów szczepień przeciwko WZW B³⁷.

Wspieranie globalnych celów eliminacji

Dokładny nadzór epidemiologiczny ma kluczowe znaczenie dla wspierania globalnych celów eliminacji wirusowego zapalenia wątroby. Aby osiągnąć cele wyznaczone przez Światową Organizację Zdrowia dotyczące eliminacji wirusowego zapalenia wątroby do 2030 roku, niezbędne jest znaczne zwiększenie dostępu do testów i opracowanie nowatorskich podejść diagnostycznych w celu ułatwienia i usprawnienia powiązania z opieką³⁸.

Dane nadzoru są wykorzystywane do oceny postępów w realizacji celów eliminacji. Na przykład raport z postępów w eliminacji WZW w Nowym Jorku monitoruje postępy w realizacji celów zawartych w Planie eliminacji wirusowego zapalenia wątroby jako głównego zagrożenia dla zdrowia publicznego w Nowym Jorku do 2030 roku³⁹.

Innowacje w nadzorze nad WZW

W odpowiedzi na wyzwania związane z tradycyjnymi systemami nadzoru, rozwijane są innowacyjne podejścia do monitorowania wirusowego zapalenia wątroby.

Nadzór oparty na badaniu ścieków

Wykrywanie zasięgu obecnych ognisk poprzez dane ze ścieków okazuje się wartościowe. Podczas konferencji prasowej dotyczącej ogniska WZW A w hrabstwie Los Angeles, Sharon Balter, Dyrektor Wydziału Kontroli i Zapobiegania Chorobom Zakaźnym, stwierdziła, że hrabstwo ma nowy sposób nadzoru nad chorobami poprzez monitorowanie ścieków⁴⁰.

Wzrost przypadków WZW A odpowiadał niedawnym wzrostom stężenia WZW A w ściekach. Ta nowa metodologia nadzoru pozwala na lepsze monitorowanie rzeczywistego rozprzestrzeniania się choroby w populacji⁴¹.

Integracja systemów nadzoru

Rutynowe łączenie danych nadzoru nad HIV i wirusowym zapaleniem wątroby jest konieczne do monitorowania stanu zdrowia, w tym oceny ryzyka geograficznie skoncentrowanych ognisk. Badania wykazały, że wśród 504 398 osób żyjących z zdiagnozowanym zakażeniem HIV na koniec 2014 roku, 2,0% było jednocześnie zakażonych HBV, a 6,7% było jednocześnie zakażonych HCV⁴².

Wykorzystanie danych nadzoru do oceny współzakażeń ma kluczowe znaczenie dla monitorowania stanu zdrowia i mierzenia punktów odniesienia w celu eliminacji zakażeń HIV i wirusowego zapalenia wątroby⁴³.

Wykorzystanie istniejących systemów nadzoru

Badanie przeprowadzone w Demokratycznej Republice Konga wykazało, że wykorzystanie próbek pozostałych z krajowego systemu nadzoru nad żółtą gorączką jest cennym narzędziem nie tylko do określenia rozpowszechnienia, ale także do uzyskania kompleksowego wglądu w demograficzne i geograficzne cechy wirusowego zapalenia wątroby A, B, C i E⁴⁴.

To badanie wykazało, że wirusowe zapalenie wątroby jest główną przyczyną ostrej gorączki z żółtaczką w DRK, stanowiąc 35,4% badanych przypadków. WZW A było najczęstsze, następnie WZW B, WZW C i WZW E⁴⁵.

Strategie poprawy systemów nadzoru nad WZW

W oparciu o zidentyfikowane wyzwania, proponowane są różne strategie w celu wzmocnienia systemów nadzoru nad wirusowym zapaleniem wątroby.

Dwupoziomowy model nadzoru

Komisje ekspertów zalecają opracowanie dwupoziomowego modelu nadzoru:

Podstawowy nadzór – budowanie zdolności państwowych i lokalnych departamentów zdrowia do prowadzenia standardowego nadzoru nad chorobami w zakresie nowo zdiagnozowanych ostrych i przewlekłych zakażeń WZW B i C⁴⁶
Nadzór ukierunkowany – uzyskiwanie danych na temat określonych populacji, które nie są w pełni reprezentowane w zbiorze danych podstawowego nadzoru⁴⁷

Ten dwupoziomowy system ma na celu poprawę jakości i dokładności informacji poprzez rozwój systemów gromadzenia, analizy i rozpowszechniania danych dotyczących ostrych i przewlekłych zakażeń HBV i HCV⁴⁸.

Standaryzacja procedur diagnostycznych i raportowania

Ocena systemu nadzoru nad wirusowym zapaleniem wątroby B w Chinach wykazała rozbieżności w dokładności raportowania przypadków WZW B. Tylko 60% przypadków przewlekłego WZW B i 7% przypadków ostrego WZW B zostało prawidłowo zgłoszonych do krajowego systemu nadzoru. Większość błędnych klasyfikacji dotyczyła pacjentów z przewlekłym WZW B lub nosicieli HBV, lub pacjentów bez wymaganych informacji diagnostycznych, którzy zostali zgłoszeni jako mający ostre zakażenie⁴⁹.

Badanie zaleciło szkolenia na miejscu w zakresie stosowania testów anty-HBc IgM, a także definicji przypadków WZW B i procedur raportowania, aby dokładnie ocenić skuteczność programu i zapewnić, że pacjenci są kierowani do odpowiedniego leczenia i opieki⁵⁰.

Ulepszanie systemów laboratoryjnych

W Indiach Narodowe Centrum Kontroli Chorób wdraża Krajowy Program Nadzoru nad Wirusowym Zapaleniem Wątroby, który ma na celu:

Ustanowienie sieci laboratoryjnej dla nadzoru nad wirusowym zapaleniem wątroby w różnych lokalizacjach geograficznych Indii⁵¹
Ustalenie rozpowszechnienia różnych typów wirusowego zapalenia wątroby w różnych strefach kraju⁵²
Zapewnienie wsparcia laboratoryjnego do badania ognisk zapalenia wątroby poprzez ustanowioną sieć laboratoriów⁵³

Program obejmuje ustanowienie laboratoryjnego nadzoru nad wirusowym zapaleniem wątroby w kraju w celu gromadzenia danych, opracowanie wytycznych dotyczących testowania i nadzoru oraz ich rozpowszechnianie, a także utworzenie sieci laboratoriów z wysoką jakością testów markerów zapalenia wątroby, obejmujących cały kraj⁵⁴.

Adresowanie nierówności w nadzorze

Raport nadzoru nad wirusowym zapaleniem wątroby z 2020 roku zawierał pierwszą w historii sekcję „Health Equity Takeaways”, która zawiera analizę danych i raportowanie na temat nierówności w obciążeniu chorobą wirusowego zapalenia wątroby i śmiertelności⁵⁵.

Wpływ pandemii COVID-19 na ogólną sieć dostawców usług w zakresie WZW, przedstawiony w raportach nadzoru i postępów z 2020 roku, wskazuje na zwiększoną pilność wzmocnienia zdolności wykrywania i reagowania na ogniska w stanowych i lokalnych programach departamentów zdrowia dotyczących WZW oraz priorytetowe traktowanie interwencji, które koncentrują się na równości zdrowotnej i koncentrują się na wrażliwych populacjach, zwłaszcza Azjatach i mieszkańcach wysp Pacyfiku, rdzennych Amerykanach i rdziennych mieszkańcach Alaski, nie-hiszpańskich czarnoskórych/Afroamerykanach oraz osobach przyjmujących narkotyki drogą iniekcji⁵⁶.

Wnioski

Nadzór zdrowia publicznego nad wirusowym zapaleniem wątroby jest kluczowym narzędziem w walce z globalnym obciążeniem tą chorobą. Mimo znaczących postępów w ostatnich latach, nadal istnieją istotne wyzwania w dokładnym monitorowaniu, raportowaniu i analizie danych dotyczących WZW.

Dokładny i kompleksowy nadzór epidemiologiczny ma fundamentalne znaczenie dla osiągnięcia celów eliminacji HBV i HCV wyznaczonych przez WHO. Współpraca między rządami, organizacjami zdrowia publicznego, pracownikami służby zdrowia i społecznościami jest niezbędna do poprawy systemów nadzoru i wspierania interwencji opartych na danych⁵⁷.

Innowacje w metodach nadzoru, takie jak monitoring ścieków, integracja systemów nadzoru i wykorzystanie istniejących platform, oferują obiecujące podejścia do pokonania obecnych ograniczeń. Jednocześnie standaryzacja procedur diagnostycznych i raportowania, wzmocnienie systemów laboratoryjnych oraz adresowanie nierówności w nadzorze są kluczowe dla poprawy dokładności i użyteczności danych nadzoru⁵⁸.

Wzmocnione systemy nadzoru nad WZW nie tylko dostarczą lepszych danych do podejmowania decyzji w zakresie zdrowia publicznego, ale także pomogą w identyfikacji osób zakażonych, które mogą skorzystać z interwencji zdrowia publicznego i opieki medycznej, co ostatecznie przyczyni się do zmniejszenia globalnego obciążenia wirusowym zapaleniem wątroby⁵⁹.

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Materiały źródłowe

#1 Key figures
https://www.who.int/data/gho/data/themes/chronic-viral-hepatitis
Data from 187 countries shows that viral hepatitis is a major public health challenge of this decade. An estimated 1.3 million people died from chronic viral hepatitis B and C in 2022, i.e., 3500 deaths per day. An estimated 254 million people are living with hepatitis B and 50 million people are living with hepatitis C worldwide, and 6000 people are newly infected with viral hepatitis each day. […] High-impact interventions are available, such as an effective cure for hepatitis C and vaccines for hepatitis B, but access to these interventions must be urgently expanded to save lives and prevent a future generation of new infections, cancers and deaths. […] This is the first consolidated WHO report on viral hepatitis epidemiology, service coverage and product access, with improved data for action.
#2 Epidemiology, transmission, and prevention of hepatitis B virus infection – UpToDate
https://www.uptodate.com/contents/epidemiology-transmission-and-prevention-of-hepatitis-b-virus-infection
Epidemiology, transmission, and prevention of hepatitis B virus infection […] Hepatitis B virus (HBV) infection is a global public health problem. The World Health Organization estimated that, in 2022, there were 245 million HBV carriers, 1.2 million new infections per year, and an annual mortality of 1.1 million individuals (mostly from complications of liver cirrhosis and hepatocellular carcinoma). The implementation of effective vaccination programs in many countries has resulted in a significant decrease in the incidence of new hepatitis B infection. Nevertheless, HBV infection remains an important cause of morbidity and mortality. […] It is estimated that approximately two billion people worldwide have evidence of past or present infection with HBV, and 245 million individuals are chronic carriers (ie, positive for hepatitis B surface antigen [HBsAg]). The overall prevalence of HBsAg is reported to be 3.2 percent; however, it varies depending upon the geographic area. The prevalence is highest in the Western Pacific (96.8 million infections), followed by the African region (64.7 million infections), Southeast Asia (61.4 million infections), the Eastern Mediterranean region (15.1 million infections), the European region (10.6 million infections), and the Americas (5 million infections).
#3 Epidemiology, transmission, and prevention of hepatitis B virus infection – UpToDate
https://www.uptodate.com/contents/epidemiology-transmission-and-prevention-of-hepatitis-b-virus-infection
Among children less than five years of age, the prevalence of chronic HBV was 0.9 percent in 2020. The lower prevalence in children less than five years old reflects the effectiveness of the global vaccination program against hepatitis B. However, there is a need for higher vaccination coverage, in particular birth-dose HBV vaccine, to completely eliminate HBV infection among children.
#4 2022 Viral Hepatitis Surveillance Report | 2022 Hepatitis Surveillance | CDC
https://www.cdc.gov/hepatitis-surveillance-2022/about/index.html
After annual increases during 2015-2019, the rate of hepatitis A decreased 88% between 2019 and 2022. […] After annual decreases during 2020-2021, the rate of acute hepatitis B remained stable between 2021 and 2022. […] After annual increases during 2015-2021, the rate of acute hepatitis C decreased 6.3% between 2021 and 2022. […] The Viral Hepatitis Surveillance Report United States, 2022 presents information from the ongoing, systematic collection, analysis, and interpretation of viral hepatitis-related data. The surveillance process is essential to monitor trends that inform planning, implementation, and evaluation that are needed to improve viral hepatitis public health policy and practice in support of national viral hepatitis elimination goals.
#5 CDC Publishes 2 Reports on Hepatitis Incidence Rates and Progress Towards 2025 Goals
https://www.contagionlive.com/view/cdc-publishes-latest-report-on-hepatitis-incidence-rates
The CDC has published its Viral Hepatitis Surveillance Report United States, 2021, which details the incidence rates during that time period. Although the rates of acute infections decreased for both hepatitis A and B, the reports authors note the effects of the pandemic may have not been able to provide a true accounting of statistics due to various factors. In addition, hepatitis C rates did increase during this time. […] The pandemic may have affected incidence numbers. The findings in this report should be interpreted with caution, the authors wrote. The number of viral hepatitis cases reported to CDC in 2020 and 2021 may be lower than in years before the COVID-19 pandemic began. The decrease may be related to fewer people seeking healthcare and being tested for viral hepatitis during the COVID-19 pandemic.
#6
https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases. […] As of 2022, 13% of all people estimated to be living with hepatitis B were aware of their infection, while 3% (7 million) of the people living with chronic hepatitis B were on treatment. […] WHO recommends that all blood donations be tested for hepatitis B to ensure blood safety and avoid accidental transmission. […] Chronic hepatitis B infection can be treated with oral medicines, including tenofovir or entecavir. […] With the updated Hepatitis B Guidelines, it is estimated that more than 50% of people with chronic hepatitis B infection will require treatment, depending on setting and eligibility criteria. […] Hepatitis B is preventable with a vaccine. […] This can be prevented by taking antiviral medicines to prevent transmission, in addition to the vaccine. […] WHO organizes annual World Hepatitis Day campaigns to increase awareness and understanding of viral hepatitis.
#7
https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases. […] As of 2022, 13% of all people estimated to be living with hepatitis B were aware of their infection, while 3% (7 million) of the people living with chronic hepatitis B were on treatment. […] WHO recommends that all blood donations be tested for hepatitis B to ensure blood safety and avoid accidental transmission. […] Chronic hepatitis B infection can be treated with oral medicines, including tenofovir or entecavir. […] With the updated Hepatitis B Guidelines, it is estimated that more than 50% of people with chronic hepatitis B infection will require treatment, depending on setting and eligibility criteria. […] Hepatitis B is preventable with a vaccine. […] This can be prevented by taking antiviral medicines to prevent transmission, in addition to the vaccine. […] WHO organizes annual World Hepatitis Day campaigns to increase awareness and understanding of viral hepatitis.
#8 CDC Issues 2021 Viral Hepatitis Surveillance Report | NASTAD
https://nastad.org/blog/cdc-issues-2021-viral-hepatitis-surveillance-report
On August 7, the Centers for Disease Control and Prevention (CDC) Division of Viral Hepatitis (DVH) released the 2021 Viral Hepatitis Surveillance Report, which includes analyses of hepatitis data submitted by health departments through the CDC National Notifiable Diseases Surveillance System (NNDSS) from January 1, 2021 to December 31, 2021. […] The 2021 report showed increases in cases of hepatitis C virus (HCV) and persistent racial disparities in hepatitis B virus (HBV) and HCV incidence and mortality. […] In 2021, the rate of newly reported chronic HBV cases were 14x higher for Asian American and Pacific Islander (AAPI) than non-Hispanic white populations. […] The number of reported cases of acute HCV has doubled since 2014 (129% increase), and during 2021 increased 5% from 2020. […] The data presented in the 2021 report mirror the mixed results on ten key indicators for viral hepatitis control and prevention shown in the 2023 Viral Hepatitis National Progress Report.
#9
https://www.natap.org/2024/HCV/012924_05.htm
The number of acute hepatitis C cases reported in the United States increased every year during 2013-2020. […] During 2020, a total of 4,798 acute cases were reported, corresponding to 66,700 estimated infections after adjusting for case underascertainment and underreporting. […] Approximately 52% of acute hepatitis C cases reported to CDC during 2021 were among persons aged 20-39 years, meaning 48% were among older people. […] A total of 107,540 cases of newly reported chronic hepatitis C were reported to CDC from 43 states during 2021, corresponding to a rate of 39.8 cases per 100,000 population. […] The age-adjusted death rate associated with hepatitis C during 2021 was 3.18 deaths per 100,000 population, an 8% decrease compared to the rate during 2020 (3.45 deaths per 100,000 population). […] The age-adjusted death rate for hepatitis C during 2021 represents a 23% decrease from the rate during 2017 (4.13 deaths per 100,000 population).
#10
https://www.natap.org/2024/HCV/012924_05.htm
2021 Viral Hepatitis Surveillance Report Overview: 60% increase in acute HCV infections since 2017 […] „The acute hepatitis C case count corresponds to a reported rate of 1.6 cases per 100,000 population, a 60% increase from the reported rate during 2017 (1.0 cases per 100,000 population) and a 7% increase from the reported rate during 2020 (1.5 cases per 100,000 persons).” […] During 2021, a total of 5,023 acute hepatitis C cases were reported to CDC from 42 states, corresponding to 69,800 estimated infections (95% CI: 55,300-238,100) after adjusting for case underascertainment and underreporting. […] The incidence rate of acute hepatitis C has more than doubled since 2013, and increased 15% from 2019. […] During 2020, 41 states reported a total of 107,300 newly identified chronic hepatitis C cases in 2020, corresponding to 40.7 chronic hepatitis C cases per 100,000.
#11
https://www.natap.org/2024/HCV/012924_05.htm
The number of acute hepatitis C cases reported in the United States increased every year during 2013-2020. […] During 2020, a total of 4,798 acute cases were reported, corresponding to 66,700 estimated infections after adjusting for case underascertainment and underreporting. […] Approximately 52% of acute hepatitis C cases reported to CDC during 2021 were among persons aged 20-39 years, meaning 48% were among older people. […] A total of 107,540 cases of newly reported chronic hepatitis C were reported to CDC from 43 states during 2021, corresponding to a rate of 39.8 cases per 100,000 population. […] The age-adjusted death rate associated with hepatitis C during 2021 was 3.18 deaths per 100,000 population, an 8% decrease compared to the rate during 2020 (3.45 deaths per 100,000 population). […] The age-adjusted death rate for hepatitis C during 2021 represents a 23% decrease from the rate during 2017 (4.13 deaths per 100,000 population).
#12 2020 Viral Hepatitis Surveillance Report | NASTAD
https://nastad.org/blog/2020-viral-hepatitis-surveillance-report
Reported cases of acute hepatitis B virus (HBV) declined by 30% compared to 2019, but the reduction is likely due to the challenges posed by the COVID-19 pandemic. […] In 2022, there was a 15% increase in the rate of reported cases of acute hepatitis C virus (HCV), largely driven by increases in injection drug use. […] The 2020 surveillance report also included the first-ever Health Equity Takeaways section, which features data analysis and reporting on inequities in viral hepatitis disease burden and mortality. […] The rate of chronic HBV cases is 12x higher in Asian and Pacific Islander (API) persons than among non-Hispanic White persons, and the rate of HBV-associated deaths is highest in API populations. […] People who inject drugs continue to bear the burden of acute HCV infection: among the 32% of reported acute HCV cases that included risk information for injection drug use, 66% reported it.
#13 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Public-health surveillance is an essential tool in the prevention and control of infectious and chronic diseases and the medical management of people who have the diseases. Surveillance data are used to estimate the magnitude of a health problem, to describe the natural history of a disease, to detect epidemics, to document the distribution and spread of a health event or disease, to evaluate control and prevention measures, and to aid in public-health planning (Thacker, 2000). […] The committee has defined (see Box 2-1) the role of surveillance for hepatitis B virus (HBV) and hepatitis C virus (HCV) that is within the scope of its study. […] This chapter describes how surveillance data are used or could be used to determine the focus and scope of viral hepatitis prevention and control efforts. The committee reviewed the weaknesses of the current surveillance system for hepatitis B and hepatitis C, including the timeliness, accuracy, and completeness of data collection, analysis, and dissemination. […] The recommendations for surveillance based on the committees findings focus on the development of a model designed to improve the quality and accuracy of information by developing systems to collect, analyze, and disseminate data on acute and chronic HBV and HCV infections.
#14 Hepatitis Surveillance and Reporting
https://www.health.ny.gov/diseases/communicable/hepatitis/surveillance.htm
Surveillance is the ongoing and systematic collection, analysis, and interpretation of health data for the purposes of planning, implementing and evaluating public health programs. The goals of viral hepatitis surveillance are to measure the burden of disease; determine risk factors; identify outbreaks; monitor trends; evaluate control measures, interventions and programs; and identify infected persons for medical referral, education and counseling. […] Annual reports on the number of cases and rates per 100,000 population of hepatitis A, hepatitis B and hepatitis C by county and by age group can be found at Communicable Disease Annual Reports. […] New York State Department of Health Communicable Disease Reporting Requirements (PDF) […] Centers for Disease Control and Prevention Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection) […] Centers for Disease Control and Prevention Testing Recommendations for Hepatitis C Virus Infection […] Laboratory Reporting Guidelines 2020, New York State Department of Health (PDF)
#15 Hepatitis Surveillance and Reporting
https://www.health.ny.gov/diseases/communicable/hepatitis/surveillance.htm
Surveillance is the ongoing and systematic collection, analysis, and interpretation of health data for the purposes of planning, implementing and evaluating public health programs. The goals of viral hepatitis surveillance are to measure the burden of disease; determine risk factors; identify outbreaks; monitor trends; evaluate control measures, interventions and programs; and identify infected persons for medical referral, education and counseling. […] Annual reports on the number of cases and rates per 100,000 population of hepatitis A, hepatitis B and hepatitis C by county and by age group can be found at Communicable Disease Annual Reports. […] New York State Department of Health Communicable Disease Reporting Requirements (PDF) […] Centers for Disease Control and Prevention Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection) […] Centers for Disease Control and Prevention Testing Recommendations for Hepatitis C Virus Infection […] Laboratory Reporting Guidelines 2020, New York State Department of Health (PDF)
#16 Hepatitis Surveillance and Reporting
https://www.health.ny.gov/diseases/communicable/hepatitis/surveillance.htm
Surveillance is the ongoing and systematic collection, analysis, and interpretation of health data for the purposes of planning, implementing and evaluating public health programs. The goals of viral hepatitis surveillance are to measure the burden of disease; determine risk factors; identify outbreaks; monitor trends; evaluate control measures, interventions and programs; and identify infected persons for medical referral, education and counseling. […] Annual reports on the number of cases and rates per 100,000 population of hepatitis A, hepatitis B and hepatitis C by county and by age group can be found at Communicable Disease Annual Reports. […] New York State Department of Health Communicable Disease Reporting Requirements (PDF) […] Centers for Disease Control and Prevention Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection) […] Centers for Disease Control and Prevention Testing Recommendations for Hepatitis C Virus Infection […] Laboratory Reporting Guidelines 2020, New York State Department of Health (PDF)
#17 Hepatitis Surveillance and Reporting
https://www.health.ny.gov/diseases/communicable/hepatitis/surveillance.htm
Surveillance is the ongoing and systematic collection, analysis, and interpretation of health data for the purposes of planning, implementing and evaluating public health programs. The goals of viral hepatitis surveillance are to measure the burden of disease; determine risk factors; identify outbreaks; monitor trends; evaluate control measures, interventions and programs; and identify infected persons for medical referral, education and counseling. […] Annual reports on the number of cases and rates per 100,000 population of hepatitis A, hepatitis B and hepatitis C by county and by age group can be found at Communicable Disease Annual Reports. […] New York State Department of Health Communicable Disease Reporting Requirements (PDF) […] Centers for Disease Control and Prevention Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection) […] Centers for Disease Control and Prevention Testing Recommendations for Hepatitis C Virus Infection […] Laboratory Reporting Guidelines 2020, New York State Department of Health (PDF)
#18 Hepatitis Surveillance and Reporting
https://www.health.ny.gov/diseases/communicable/hepatitis/surveillance.htm
Surveillance is the ongoing and systematic collection, analysis, and interpretation of health data for the purposes of planning, implementing and evaluating public health programs. The goals of viral hepatitis surveillance are to measure the burden of disease; determine risk factors; identify outbreaks; monitor trends; evaluate control measures, interventions and programs; and identify infected persons for medical referral, education and counseling. […] Annual reports on the number of cases and rates per 100,000 population of hepatitis A, hepatitis B and hepatitis C by county and by age group can be found at Communicable Disease Annual Reports. […] New York State Department of Health Communicable Disease Reporting Requirements (PDF) […] Centers for Disease Control and Prevention Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection) […] Centers for Disease Control and Prevention Testing Recommendations for Hepatitis C Virus Infection […] Laboratory Reporting Guidelines 2020, New York State Department of Health (PDF)
#19 Hepatitis Surveillance and Reporting
https://www.health.ny.gov/diseases/communicable/hepatitis/surveillance.htm
Surveillance is the ongoing and systematic collection, analysis, and interpretation of health data for the purposes of planning, implementing and evaluating public health programs. The goals of viral hepatitis surveillance are to measure the burden of disease; determine risk factors; identify outbreaks; monitor trends; evaluate control measures, interventions and programs; and identify infected persons for medical referral, education and counseling. […] Annual reports on the number of cases and rates per 100,000 population of hepatitis A, hepatitis B and hepatitis C by county and by age group can be found at Communicable Disease Annual Reports. […] New York State Department of Health Communicable Disease Reporting Requirements (PDF) […] Centers for Disease Control and Prevention Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection) […] Centers for Disease Control and Prevention Testing Recommendations for Hepatitis C Virus Infection […] Laboratory Reporting Guidelines 2020, New York State Department of Health (PDF)
#20 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Surveillance data are used in a variety of ways by a broad base of state health-department staff, researchers, clinicians, policy-makers, and private industry. Federal and state health-department surveillance systems provide population-based information that can be used to improve the publics health. […] Overall, surveillance data are critical in estimating incidence and prevalence of HBV and HCV infections (CDC, 2008c), and they provide a basis for studying and understanding the mechanisms of diverse outcomes in the natural history of these infections (Thacker, 2000). […] Accurate and timely surveillance data are necessary to identify outbreaks of acute HBV and HCV infection in the health-care and community settings. […] Hepatitis B and hepatitis C surveillance data can be used to identify or quantify new trends in the transmission of HBV and HCV.
#21 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Surveillance data are often used to determine how to use resources most effectively. […] If surveillance data are not available or understate the disease burden, legislators and public-health officials will not allocate sufficient resources to mount an appropriate public-health response. […] Public-health organizations use surveillance data to design programs that target appropriate populations. […] A key potential role of hepatitis surveillance programs is to evaluate the effect of HBV vaccination programs (Wasley et al., 2007). […] Many of the difficulties that surveillance systems face in identifying and tracking cases of hepatitis B and hepatitis C are related to the complexity of the infections and their associated progression. […] The identification of acute hepatitis infection is inherently flawed because the vast majority of cases are asymptomatic and patients do not seek medical care or testing.
#22 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Given that both hepatitis B and hepatitis C infections are largely asymptomatic, most people do not receive a diagnosis until the infection is chronic. […] For disease-surveillance purposes, it can be challenging for health departments to obtain the complete laboratory results that are necessary to classify a chronic hepatitis B case according to CDCs case definitions. […] Current public-health surveillance systems for hepatitis B and hepatitis C are poorly developed and are inconsistent among jurisdictions. […] The inability of health departments to track all diagnosed cases also seriously undermines case-management and prevention efforts. […] CDC has funded seven enhanced projects through the Viral Hepatitis Surveillance Emerging Infections Programs (EIPs). […] The projects focus on surveillance for hepatitis A, hepatitis B, and hepatitis C, they all take different approaches, including multiple approaches in individual jurisdictions.
#23 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Given that both hepatitis B and hepatitis C infections are largely asymptomatic, most people do not receive a diagnosis until the infection is chronic. […] For disease-surveillance purposes, it can be challenging for health departments to obtain the complete laboratory results that are necessary to classify a chronic hepatitis B case according to CDCs case definitions. […] Current public-health surveillance systems for hepatitis B and hepatitis C are poorly developed and are inconsistent among jurisdictions. […] The inability of health departments to track all diagnosed cases also seriously undermines case-management and prevention efforts. […] CDC has funded seven enhanced projects through the Viral Hepatitis Surveillance Emerging Infections Programs (EIPs). […] The projects focus on surveillance for hepatitis A, hepatitis B, and hepatitis C, they all take different approaches, including multiple approaches in individual jurisdictions.
#24 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Given that both hepatitis B and hepatitis C infections are largely asymptomatic, most people do not receive a diagnosis until the infection is chronic. […] For disease-surveillance purposes, it can be challenging for health departments to obtain the complete laboratory results that are necessary to classify a chronic hepatitis B case according to CDCs case definitions. […] Current public-health surveillance systems for hepatitis B and hepatitis C are poorly developed and are inconsistent among jurisdictions. […] The inability of health departments to track all diagnosed cases also seriously undermines case-management and prevention efforts. […] CDC has funded seven enhanced projects through the Viral Hepatitis Surveillance Emerging Infections Programs (EIPs). […] The projects focus on surveillance for hepatitis A, hepatitis B, and hepatitis C, they all take different approaches, including multiple approaches in individual jurisdictions.
#25 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Funding for hepatitis surveillance is highly fragmented. […] The recent survey of AVHPCs conducted by NASTAD found that fewer than one-fourth of the 43 responding jurisdictions reported receiving funding for surveillance for either chronic HBV or chronic HCV infection. […] The committee recommends that a two-tiered model be developed: core surveillance and targeted surveillance. […] Standardization will be accomplished through cooperative agreements, improved guidance, and adequate and consistent funding.
#26 2 Surveillance | Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C | The National Academies Press
https://nap.nationalacademies.org/read/12793/chapter/4
Accurate and timely surveillance data are necessary to identify outbreaks of acute HBV and HCV infection in the health-care and community settings. […] Hepatitis B and hepatitis C surveillance data can be used to identify or quantify new trends in the transmission of HBV and HCV. […] The inability of health departments to track all diagnosed cases also seriously undermines case-management and prevention efforts. […] Current public-health surveillance systems for hepatitis B and hepatitis C are poorly developed and are inconsistent among jurisdictions. As a result, surveillance data do not provide accurate estimates of the current burden of disease, are insufficient for program planning and evaluation, and do not provide the information that would allow policy-makers to allocate sufficient resources to address the problem.
#27 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Given that both hepatitis B and hepatitis C infections are largely asymptomatic, most people do not receive a diagnosis until the infection is chronic. […] For disease-surveillance purposes, it can be challenging for health departments to obtain the complete laboratory results that are necessary to classify a chronic hepatitis B case according to CDCs case definitions. […] Current public-health surveillance systems for hepatitis B and hepatitis C are poorly developed and are inconsistent among jurisdictions. […] The inability of health departments to track all diagnosed cases also seriously undermines case-management and prevention efforts. […] CDC has funded seven enhanced projects through the Viral Hepatitis Surveillance Emerging Infections Programs (EIPs). […] The projects focus on surveillance for hepatitis A, hepatitis B, and hepatitis C, they all take different approaches, including multiple approaches in individual jurisdictions.
#28 2024 Global Hepatitis Report (WHO) | CGHE
https://www.globalhep.org/tools-resources/resources/2024-global-hepatitis-report-who
This is the first consolidated WHO report on viral hepatitis epidemiology, service coverage and product access, with improved data for action. This report presents the latest estimates on the disease burden and the coverage of essential viral hepatitis services from 187 countries across the world. […] The report provides a regional perspective, analysing the barriers and opportunities for countries in each of the 6 WHO regions to expand access to health products for viral hepatitis. It presents actions for countries and stakeholders to accelerate the scaling up of effective viral hepatitis interventions within a public health approach.
#29 Viral Hepatitis Surveillance Reports | Viral Hepatitis | CDC
https://www.cdc.gov/hepatitis/php/statistics-surveillance/index.html
CDC 2023 Hepatitis Surveillance Report Overview 2023 Viral Hepatitis Surveillance Report See the 2023 Viral Hepatitis Surveillance Report, published by CDCs Viral Hepatitis Program Apr. 15, 2025 […] CDC 2022 Hepatitis Surveillance Report Overview 2022 Viral Hepatitis Surveillance Report See the latest viral hepatitis-related data, trends and analysis from CDC. Apr. 3, 2024 […] CDC 2021 Hepatitis Surveillance Report Overview 2021 Viral Hepatitis Surveillance Report See the latest viral hepatitis-related data, trends and analysis from CDC. Apr. 3, 2024 […] 2020 Viral Hepatitis Surveillance Overview 2020 Viral Hepatitis Surveillance Report See the 2020 viral hepatitis surveillance report, published by the Division of Viral Hepatitis. Aug. 18, 2022 […] Viral Hepatitis Surveillance 2019 Viral Hepatitis surveillance report for 2019, including background, national profile, technical note… […] Hepatitis is an inflammation of the liver often caused by a virus. Learn about viral hepatitis, statistics, surveillance, resources, populations and impact.
#30 Hepatitis – Disease Surveillance Epidemiology Program – MeCDC; DHHS Maine
https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/hepatitis/index.shtml
DHHS MeCDC Disease Surveillance Epidemiology Hepatitis […] Hepatitis A Surveillance Reports 2018 | 2019 | 2020 | 2021 | 2022 | 2023 (PDF) […] Hepatitis B Surveillance Reports 2018 | 2019 | 2021 | 2022 | 2023 (PDF) […] Hepatitis C Surveillance Reports 2018 | 2019 | 2021 | 2022 | 2023 (PDF)
#31 Colorado hepatitis data | Colorado Department of Public Health and Environment
https://cdphe.colorado.gov/hepatitis-data
Colorado hepatitis data […] Viral Hepatitis in Colorado: 2023 Surveillance Report […] Viral Hepatitis in Colorado: 2022 Surveillance Report […] Viral Hepatitis in Colorado: 2021 Surveillance Report […] Viral Hepatitis in Colorado: 2020 Surveillance Report […] Viral Hepatitis in Colorado: 2019 Surveillance Report […] Viral Hepatitis in Colorado: 2018 Surveillance Report […] Viral Hepatitis in Colorado: 2017 Surveillance Report […] Viral Hepatitis in Colorado: 2016 Surveillance Report […] Viral Hepatitis in Colorado: 2015 Surveillance Report
#32 Surveillance and updates for hepatitis C
https://www.ecdc.europa.eu/en/hepatitis-c/surveillance-and-disease-data
Surveillance and monitoring […] Hepatitis C – Annual Epidemiological Report for 2023 […] Surveillance report […] Hepatitis C – Annual Epidemiological Report for 2022 […] Surveillance report […] Hepatitis C – Annual Epidemiological Report for 2020 […] Surveillance report […] Hepatitis C – Annual Epidemiological Report for 2019 […] Surveillance report […] Hepatitis C – Annual Epidemiological Report for 2018 […] Surveillance report […] Systematic review on hepatitis B and C prevalence in the EU/EEA […] Surveillance report.
#33 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Funding for hepatitis surveillance is highly fragmented. […] The recent survey of AVHPCs conducted by NASTAD found that fewer than one-fourth of the 43 responding jurisdictions reported receiving funding for surveillance for either chronic HBV or chronic HCV infection. […] The committee recommends that a two-tiered model be developed: core surveillance and targeted surveillance. […] Standardization will be accomplished through cooperative agreements, improved guidance, and adequate and consistent funding.
#34 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Surveillance data are used in a variety of ways by a broad base of state health-department staff, researchers, clinicians, policy-makers, and private industry. Federal and state health-department surveillance systems provide population-based information that can be used to improve the publics health. […] Overall, surveillance data are critical in estimating incidence and prevalence of HBV and HCV infections (CDC, 2008c), and they provide a basis for studying and understanding the mechanisms of diverse outcomes in the natural history of these infections (Thacker, 2000). […] Accurate and timely surveillance data are necessary to identify outbreaks of acute HBV and HCV infection in the health-care and community settings. […] Hepatitis B and hepatitis C surveillance data can be used to identify or quantify new trends in the transmission of HBV and HCV.
#35 2 Surveillance | Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C | The National Academies Press
https://nap.nationalacademies.org/read/12793/chapter/4
Accurate and timely surveillance data are necessary to identify outbreaks of acute HBV and HCV infection in the health-care and community settings. […] Hepatitis B and hepatitis C surveillance data can be used to identify or quantify new trends in the transmission of HBV and HCV. […] The inability of health departments to track all diagnosed cases also seriously undermines case-management and prevention efforts. […] Current public-health surveillance systems for hepatitis B and hepatitis C are poorly developed and are inconsistent among jurisdictions. As a result, surveillance data do not provide accurate estimates of the current burden of disease, are insufficient for program planning and evaluation, and do not provide the information that would allow policy-makers to allocate sufficient resources to address the problem.
#36 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Surveillance data are often used to determine how to use resources most effectively. […] If surveillance data are not available or understate the disease burden, legislators and public-health officials will not allocate sufficient resources to mount an appropriate public-health response. […] Public-health organizations use surveillance data to design programs that target appropriate populations. […] A key potential role of hepatitis surveillance programs is to evaluate the effect of HBV vaccination programs (Wasley et al., 2007). […] Many of the difficulties that surveillance systems face in identifying and tracking cases of hepatitis B and hepatitis C are related to the complexity of the infections and their associated progression. […] The identification of acute hepatitis infection is inherently flawed because the vast majority of cases are asymptomatic and patients do not seek medical care or testing.
#37 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Surveillance data are often used to determine how to use resources most effectively. […] If surveillance data are not available or understate the disease burden, legislators and public-health officials will not allocate sufficient resources to mount an appropriate public-health response. […] Public-health organizations use surveillance data to design programs that target appropriate populations. […] A key potential role of hepatitis surveillance programs is to evaluate the effect of HBV vaccination programs (Wasley et al., 2007). […] Many of the difficulties that surveillance systems face in identifying and tracking cases of hepatitis B and hepatitis C are related to the complexity of the infections and their associated progression. […] The identification of acute hepatitis infection is inherently flawed because the vast majority of cases are asymptomatic and patients do not seek medical care or testing.
#38 Editorial: Epidemiology and Control of Hepatitis Viruses
https://www.mdpi.com/2075-1729/14/11/1369
Five hepatitis virusesâhepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV)âhave a huge impact on human health with their ability to cause acute and often chronic infection. […] To meet the goals set by the World Health Organization for the elimination of viral hepatitis by 2030, it is essential that access to testing is enhanced substantially and novel diagnostic approaches are developed to facilitate and streamline linkage to care. […] Understanding the global prevalence of these viruses is crucial for effective prevention and treatment strategies. […] The recent review by Tsaneva-Damyanova and Georgieva, âEpidemiology Pattern, Prevalent Genotype Distribution, Fighting Stigma, and Control Options for Hepatitis D in Bulgaria and Other European Countriesâ highlights the persistent challenge HDV poses in Bulgaria and other European nations.
#39 Health Department Releases 2023 Hepatitis A, B, and C Annual Report – NYC Health
https://www.nyc.gov/site/doh/about/press/pr2024/health-department-releases-2023-hepatitis-report.page
Health Department Reports 11% Decreases In New Chronic Hepatitis C and Increases In Chronic Hepatitis B and Hepatitis A Compared With 2022 […] The New York City Health Department today released its 2023 Hepatitis A, B, and C Annual Report highlighting surveillance data and programming for New York City and updates on progress toward meeting the goals in the Plan to Eliminate Viral Hepatitis as a Major Public Health Threat in New York City by 2030. […] While we continue to make progress toward our overall hepatitis C elimination goals, 2023 saw increases in chronic hepatitis B and hepatitis A, and inequities by a range of sociodemographic factors among people newly reported with chronic hepatitis B and C persisted, said Acting Health Commissioner Dr. Michelle Morse. […] The 2023 Hepatitis A, B, and C Annual Report provides critical information outlining surveillance data and programmatic developments to inform future planning as we strive for viral hepatitis elimination in New York City.
#40 LA County Declares Hepatitis AÂ Outbreak, Urges Vaccination – The San Fernando Valley Sun
https://sanfernandosun.com/2025/05/07/la-county-declares-hepatitis-a-outbreak-urges-vaccination/
LOS ANGELES (CNS) The Los Angeles County Department of Public Health declared Monday, May 5, a community-wide outbreak of hepatitis A, citing a sustained rise in cases and elevated virus levels in wastewater. […] The ongoing increase in hepatitis A cases signals that quick action is needed to protect public health, Davis said in a statement. […] County officials continue to monitor and investigate suspected cases. […] Public Health officials noted that although unhoused individuals face a higher risk of hepatitis A due to limited access to handwashing and restrooms, most of the 29 reported cases have involved people without travel or housing-related risk factors. […] During a news conference via Zoom, Sharon Balter, Director Division of Communicable Disease Control and Prevention, said the county has a new way of disease surveillance by monitoring wastewater. […] The department strongly urged L.A. County residents who havent been vaccinated, along with unhoused individuals and people who use drugs including non-injection to get the hepatitis A vaccine. […] Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus.
#41 Hepatitis A outbreak declared in L.A. County. What you need to know – Los Angeles Times
https://www.latimes.com/california/story/2025-05-05/hepatitis-a-outbreak-declared-in-la-county
This outbreak already far surpasses what had been L.A. Countys most significant hepatitis A outbreak in the last decade, when 87 confirmed cases were reported in 2017. […] Detecting the scope of the current outbreak through wastewater data has been valuable, officials say. […] A recently released federal budget proposal would significantly cut or eliminate a number of grants such as those for epidemiology laboratory capacity and hospital preparedness, Balter said. […] These would really impact our ability to track an illness and, especially, to respond to it. […] Residents with insurance can get the hepatitis A vaccine through their healthcare providers and retail pharmacies. Uninsured and underinsured residents can get vaccinated through L.A. Countys public health clinics.
#42 HIV and viral hepatitis coinfection analysis using surveillance data from 15 US states and two cities | Epidemiology & Infection | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/hiv-and-viral-hepatitis-coinfection-analysis-using-surveillance-data-from-15-us-states-and-two-cities/D57A7D8AAEB09FA87493A64D87A13FD6
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
#43 HIV and viral hepatitis coinfection analysis using surveillance data from 15 US states and two cities | Epidemiology & Infection | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/hiv-and-viral-hepatitis-coinfection-analysis-using-surveillance-data-from-15-us-states-and-two-cities/D57A7D8AAEB09FA87493A64D87A13FD6
We report here on a multijurisdictional HIV and viral hepatitis coinfection match conducted by using routinely collected nationally notifiable disease surveillance data in the USA. The project summarised results from 500 000 persons living with diagnosed HIV infection, 250 000 persons reported with HBV, and 1 million persons reported with HCV from 15 states and two cities. Overall, among persons living with diagnosed HIV infection, we determined that the proportion coinfected with HBV was 2.0% and HCV was 6.7%. Among persons ever reported to be infected with HBV, 5.2% were ever reported to be infected with HIV, whereas among persons ever reported to be infected with HCV, 4.3% were ever reported to be infected with HIV. […] Using surveillance data to assess coinfections is crucial for monitoring health status and measuring benchmarks to eliminate HIV and viral hepatitis infections.
#44 Revealing viral hepatitis epidemiology in the Democratic Republic of Congo: insights from yellow fever surveillance reanalysis | Tropical Medicine and Health | Full Text
https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-025-00687-8
Viral hepatitis is a major cause of acute febrile jaundice in the DRC with notable geographic and seasonal trends. National yellow fever surveillance is a valuable resource for understanding hepatitis epidemiology, though careful interpretation is necessary. Tailored interventions are required for mitigating the burden of viral hepatitis in each province. […] This study demonstrated that utilizing residual samples from the national yellow fever surveillance system is a valuable tool not only for determining prevalence but also for gaining comprehensive insights into the demographic and geographical characteristics of viral hepatitis A, B, C, and E. […] Overall, viral hepatitis is a major cause of acute febrile jaundice in the DRC, constituting 35.4% of our tested cases. HAV was the most common, followed by HBV, HCV and HEV.
#45 Revealing viral hepatitis epidemiology in the Democratic Republic of Congo: insights from yellow fever surveillance reanalysis | Tropical Medicine and Health | Full Text
https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-025-00687-8
Viral hepatitis is a major cause of acute febrile jaundice in the DRC with notable geographic and seasonal trends. National yellow fever surveillance is a valuable resource for understanding hepatitis epidemiology, though careful interpretation is necessary. Tailored interventions are required for mitigating the burden of viral hepatitis in each province. […] This study demonstrated that utilizing residual samples from the national yellow fever surveillance system is a valuable tool not only for determining prevalence but also for gaining comprehensive insights into the demographic and geographical characteristics of viral hepatitis A, B, C, and E. […] Overall, viral hepatitis is a major cause of acute febrile jaundice in the DRC, constituting 35.4% of our tested cases. HAV was the most common, followed by HBV, HCV and HEV.
#46 2 Surveillance | Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C | The National Academies Press
https://nap.nationalacademies.org/read/12793/chapter/4
The recommendations for surveillance based on the committees findings focus on the development of a model designed to improve the quality and accuracy of information by developing systems to collect, analyze, and disseminate data on acute and chronic HBV and HCV infections. The recommendations call for a two-part system: core surveillance activities, building the capacity of state and local health departments to conduct standard disease surveillance on newly diagnosed acute and chronic HBV and HCV infections, and targeted surveillance to obtain data on specific populations that are not represented fully in the collection of core surveillance data. […] Surveillance data are used in a variety of ways by a broad base of state health-department staff, researchers, clinicians, policy-makers, and private industry. Federal and state health-department surveillance systems provide population-based information that can be used to improve the publics health.
#47 2 Surveillance | Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C | The National Academies Press
https://nap.nationalacademies.org/read/12793/chapter/4
The recommendations for surveillance based on the committees findings focus on the development of a model designed to improve the quality and accuracy of information by developing systems to collect, analyze, and disseminate data on acute and chronic HBV and HCV infections. The recommendations call for a two-part system: core surveillance activities, building the capacity of state and local health departments to conduct standard disease surveillance on newly diagnosed acute and chronic HBV and HCV infections, and targeted surveillance to obtain data on specific populations that are not represented fully in the collection of core surveillance data. […] Surveillance data are used in a variety of ways by a broad base of state health-department staff, researchers, clinicians, policy-makers, and private industry. Federal and state health-department surveillance systems provide population-based information that can be used to improve the publics health.
#48 2 Surveillance | Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C | The National Academies Press
https://nap.nationalacademies.org/read/12793/chapter/4
The recommendations for surveillance based on the committees findings focus on the development of a model designed to improve the quality and accuracy of information by developing systems to collect, analyze, and disseminate data on acute and chronic HBV and HCV infections. The recommendations call for a two-part system: core surveillance activities, building the capacity of state and local health departments to conduct standard disease surveillance on newly diagnosed acute and chronic HBV and HCV infections, and targeted surveillance to obtain data on specific populations that are not represented fully in the collection of core surveillance data. […] Surveillance data are used in a variety of ways by a broad base of state health-department staff, researchers, clinicians, policy-makers, and private industry. Federal and state health-department surveillance systems provide population-based information that can be used to improve the publics health.
#49 Using a hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu provinces to improve data quality and assess program effectiveness, China, 2015 | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05265-3
Monitoring hepatitis B surveillance data is important for evaluating progress towards global hepatitis B elimination goals. Accurate classification of acute and chronic hepatitis infections is essential for assessing program effectiveness. […] We identified discrepancies in the accuracy of HBV case-reporting in the project hospitals. Onsite training on the use of anti-HBc IgM testing as well as on HBV case definitions and reporting procedures are needed to accurately assess program effectiveness and ensure case-patients are referred to appropriate treatment and care. Routine surveillance evaluations such as this can be useful for improving data quality and monitoring program effectiveness. […] Our evaluation identified discrepancies in the classification of HBV cases reported to NNDRSonly 60% of chronic HBV cases and 7% of acute HBV cases were reported correctly to NNDRS. Most misclassifications involved patients with chronic HBV or HBV carriers or patients without the required diagnostic information who were reported as having an acute infection. Misclassification varied by province, hospital grade, and ward type. Additionally, only a few patients received anti-HBc IgM laboratory tests for differentiating acute and chronic infections as recommended. These discrepancies can be addressed through training, possible revisions to reporting procedures, and development of feedback mechanisms to hospital staff. Our project highlights the importance of routine surveillance evaluations for assessing data quality and monitoring program effectiveness. […] Our findings support the use of similar evaluations in other locations as a possible complement to resource-intensive HBV sero-surveys.
#50 Using a hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu provinces to improve data quality and assess program effectiveness, China, 2015 | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05265-3
Monitoring hepatitis B surveillance data is important for evaluating progress towards global hepatitis B elimination goals. Accurate classification of acute and chronic hepatitis infections is essential for assessing program effectiveness. […] We identified discrepancies in the accuracy of HBV case-reporting in the project hospitals. Onsite training on the use of anti-HBc IgM testing as well as on HBV case definitions and reporting procedures are needed to accurately assess program effectiveness and ensure case-patients are referred to appropriate treatment and care. Routine surveillance evaluations such as this can be useful for improving data quality and monitoring program effectiveness. […] Our evaluation identified discrepancies in the classification of HBV cases reported to NNDRSonly 60% of chronic HBV cases and 7% of acute HBV cases were reported correctly to NNDRS. Most misclassifications involved patients with chronic HBV or HBV carriers or patients without the required diagnostic information who were reported as having an acute infection. Misclassification varied by province, hospital grade, and ward type. Additionally, only a few patients received anti-HBc IgM laboratory tests for differentiating acute and chronic infections as recommended. These discrepancies can be addressed through training, possible revisions to reporting procedures, and development of feedback mechanisms to hospital staff. Our project highlights the importance of routine surveillance evaluations for assessing data quality and monitoring program effectiveness. […] Our findings support the use of similar evaluations in other locations as a possible complement to resource-intensive HBV sero-surveys.
#51 National Viral Hepatitis Surveillance Programme – National Centre for Disease Control (NCDC)
https://ncdc.mohfw.gov.in/national-viral-hepatitis-surveillance-programme/
The National Centre for Disease Control is the nodal agency for the implementation of the scheme The national program on Surveillance of Viral Hepatitis. This central sector scheme is an ongoing scheme under the 12th FYP. The Standing Finance Committee (SFC) has approved the continuation of the on-going scheme for the FY 2017-2020. Ten sites have been identified which will be responsible for implementing the program in the initial two years. […] To establish laboratory network for laboratory based surveillance of viral hepatitis in different geographical locations of India. […] To ascertain the prevalence of different types of viral hepatitis in different zones of the country. […] To provide laboratory support for outbreak investigation of hepatitis through established network of laboratories.
#52 National Viral Hepatitis Surveillance Programme – National Centre for Disease Control (NCDC)
https://ncdc.mohfw.gov.in/national-viral-hepatitis-surveillance-programme/
The National Centre for Disease Control is the nodal agency for the implementation of the scheme The national program on Surveillance of Viral Hepatitis. This central sector scheme is an ongoing scheme under the 12th FYP. The Standing Finance Committee (SFC) has approved the continuation of the on-going scheme for the FY 2017-2020. Ten sites have been identified which will be responsible for implementing the program in the initial two years. […] To establish laboratory network for laboratory based surveillance of viral hepatitis in different geographical locations of India. […] To ascertain the prevalence of different types of viral hepatitis in different zones of the country. […] To provide laboratory support for outbreak investigation of hepatitis through established network of laboratories.
#53 National Viral Hepatitis Surveillance Programme – National Centre for Disease Control (NCDC)
https://ncdc.mohfw.gov.in/national-viral-hepatitis-surveillance-programme/
The National Centre for Disease Control is the nodal agency for the implementation of the scheme The national program on Surveillance of Viral Hepatitis. This central sector scheme is an ongoing scheme under the 12th FYP. The Standing Finance Committee (SFC) has approved the continuation of the on-going scheme for the FY 2017-2020. Ten sites have been identified which will be responsible for implementing the program in the initial two years. […] To establish laboratory network for laboratory based surveillance of viral hepatitis in different geographical locations of India. […] To ascertain the prevalence of different types of viral hepatitis in different zones of the country. […] To provide laboratory support for outbreak investigation of hepatitis through established network of laboratories.
#54 National Viral Hepatitis Surveillance Programme – National Centre for Disease Control (NCDC)
https://ncdc.mohfw.gov.in/national-viral-hepatitis-surveillance-programme/
Establishment of laboratory based surveillance for viral hepatitis in the country for collection of data. Development of testing and surveillance guidelines and its dissemination. […] A network of laboratories with quality testing for hepatitis markers will be established covering the entire country. […] Training of manpower/health care providers in 10 regional labs including NCDC i.e. the reference lab. […] Development of IEC for providers and community. […] Establishment of baseline data for hepatitis to see the impact.
#55 2020 Viral Hepatitis Surveillance Report | NASTAD
https://nastad.org/blog/2020-viral-hepatitis-surveillance-report
Reported cases of acute hepatitis B virus (HBV) declined by 30% compared to 2019, but the reduction is likely due to the challenges posed by the COVID-19 pandemic. […] In 2022, there was a 15% increase in the rate of reported cases of acute hepatitis C virus (HCV), largely driven by increases in injection drug use. […] The 2020 surveillance report also included the first-ever Health Equity Takeaways section, which features data analysis and reporting on inequities in viral hepatitis disease burden and mortality. […] The rate of chronic HBV cases is 12x higher in Asian and Pacific Islander (API) persons than among non-Hispanic White persons, and the rate of HBV-associated deaths is highest in API populations. […] People who inject drugs continue to bear the burden of acute HCV infection: among the 32% of reported acute HCV cases that included risk information for injection drug use, 66% reported it.
#56 2020 Viral Hepatitis Surveillance Report | NASTAD
https://nastad.org/blog/2020-viral-hepatitis-surveillance-report
The rate of HCV-associated deaths is highest in American Indian/Alaska Native persons and non-Hispanic White persons. […] Additionally, the 2020 progress report shows that many epidemiological targets set by the 2025 DVH Strategic Plan and the Department of Health and Human Services (HHS) Viral Hepatitis National Strategic Plan for 2021-2025 were not met. […] The impact of the COVID-19 pandemic on the overall hepatitis provider network detailed in the 2020 surveillance and progress reports signal an increased urgency to shore up outbreak detection and response capacity at state and local health department hepatitis programs and prioritize interventions that center health equity and focus on vulnerable populations, especially Asian and Pacific Islanders, American Indians and Alaska Natives, non-Hispanic Blacks/African Americans, and people who inject drugs.
#57 Surveillance – Hepatitis and Liver Cancer – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK220037/
Given that both hepatitis B and hepatitis C infections are largely asymptomatic, most people do not receive a diagnosis until the infection is chronic. […] For disease-surveillance purposes, it can be challenging for health departments to obtain the complete laboratory results that are necessary to classify a chronic hepatitis B case according to CDCs case definitions. […] Current public-health surveillance systems for hepatitis B and hepatitis C are poorly developed and are inconsistent among jurisdictions. […] The inability of health departments to track all diagnosed cases also seriously undermines case-management and prevention efforts. […] CDC has funded seven enhanced projects through the Viral Hepatitis Surveillance Emerging Infections Programs (EIPs). […] The projects focus on surveillance for hepatitis A, hepatitis B, and hepatitis C, they all take different approaches, including multiple approaches in individual jurisdictions.
#58 Using a hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu provinces to improve data quality and assess program effectiveness, China, 2015 | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05265-3
Monitoring hepatitis B surveillance data is important for evaluating progress towards global hepatitis B elimination goals. Accurate classification of acute and chronic hepatitis infections is essential for assessing program effectiveness. […] We identified discrepancies in the accuracy of HBV case-reporting in the project hospitals. Onsite training on the use of anti-HBc IgM testing as well as on HBV case definitions and reporting procedures are needed to accurately assess program effectiveness and ensure case-patients are referred to appropriate treatment and care. Routine surveillance evaluations such as this can be useful for improving data quality and monitoring program effectiveness. […] Our evaluation identified discrepancies in the classification of HBV cases reported to NNDRSonly 60% of chronic HBV cases and 7% of acute HBV cases were reported correctly to NNDRS. Most misclassifications involved patients with chronic HBV or HBV carriers or patients without the required diagnostic information who were reported as having an acute infection. Misclassification varied by province, hospital grade, and ward type. Additionally, only a few patients received anti-HBc IgM laboratory tests for differentiating acute and chronic infections as recommended. These discrepancies can be addressed through training, possible revisions to reporting procedures, and development of feedback mechanisms to hospital staff. Our project highlights the importance of routine surveillance evaluations for assessing data quality and monitoring program effectiveness. […] Our findings support the use of similar evaluations in other locations as a possible complement to resource-intensive HBV sero-surveys.
#59 Hepatitis C Surveillance
https://portal.ct.gov/DPH/AIDS–Chronic-Diseases/Surveillance/Hepatitis-C-Surveillance
The Connecticut Department of Public Health (DPH) conducts surveillance for hepatitis C virus (HCV). Public health surveillance is defined as the ongoing, systematic collection of health data to: […] Monitor and clarify the epidemiology of reportable diseases […] Inform public health policy to identify priorities and strategies […] Document the impact of public health interventions and track progress towards specific goals […] Identify infected persons who may benefit from public health intervention and medical care […] Identify contacts of infected persons to refer for testing and/or post exposure prophylaxis […] Identify and interrupt disease transmission. […] Both medical providers and laboratories provide surveillance information to DPH and local health departments. Hepatitis C-related laboratory test results are reported by the laboratories and medical providers complete and submit a PD-23 Case Report Form. […] For additional Connecticut HCV surveillance data, please visit the Hepatitis C Statistics web page.