HEPATITIS C

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HEPATITIS C
Can We Get The Real Numbers?
Alice Williams-Root PHN Sutter County Public
Health
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Why Do We Need the Real Numbers?

• Determine the scope and characteristics of the
  epidemic
• Evaluate disease progression and treatment
  successes
• Provide accurate California data to CDC
• Direct resources and prevention efforts where
  needed
• Document need for funding and services!

3
What is the Current System for Reporting
Hepatitis C?

• Confidential Morbidity Report (CMR)
• No mandated laboratory reporting
• Under-reporting and inconsistent reporting by
  physicians and providers

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Dual Reporting System
Specimen
Test Result
PHYSICIAN - HEALTH CARE PROVIDER Over 80
diseases and conditions reportable
LABORATORY 25 reportable positive lab tests
(hepatitis C not currently included)
Local Health Department
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Why Dont We Have the Real Numbers?

• Physician reporting incomplete and under-reported
• Interpretation of test results
• Inconsistent reporting practices across
  California
• Duplication of reports to the state

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Why is Reporting Complicated

• Acute vs chronic
• Need lab and clinical information
• Acute infection is rarely diagnosed
• Most cases reported are chronic
• False positive screening tests
• High cost of confirmatory tests
• Multitude of lab tests for HCV

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Solution Change to Lab Reporting

• CCLHO recommend to DHS that Hepatitis C be added
  to laboratory reportable list
• What lab tests to be reported?
• all positive antibody tests, or just confirmed
  tests
• Benefits
• Can usually be automated
• More complete
• More accurate

8
How Can the Change be Made?

• Modification of the Health and Safety Code
  Section 120130 by DHS, after consultation with
  the California Conference of Local Health
  Officers.

9
Whats Happening Now?

• CACDC subcommittee on hepatitis C reporting
• CADC Hepatitis C Work Group recommended lab
  reporting of HCV to CACDC Executive Committee
• CACDC President will present report/recommendation
  s to CCLHO CD Committee

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Current Changes/Issues

• Web CMR unique patient ID
• Confidential case registry
• De-duplication of case reports
• Data maintenance
• Person based CMR

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SUMMARY

• Statewide moving toward improved data along
  several lines
• Laboratory reporting
• Web CMR
• Electronic lab reporting
• State registry
• This will take some time
• Goal is to Get the Real Numbers