0920-1353 Outbreak Summary Report Form

Health Department Processes to Identify and Report Acute Viral Hepatitis Cases

Participating Health Department

Health Department
Contact Name
Contact Position
Contact E-mail Address

Hepatitis B reporting

1. (a) Are negative hepatitis B surface antigen (sAg) results currently reportable in your jurisdiction?

☐ Yes, all negative lab results are received by the health department (complete reporting)

☐ Yes, some negative lab results are received by the health department (incomplete reporting)

☐ No

(b) If yes, what was the first full reporting year that negative hepatitis B sAg lab results were available in your jurisdiction? ____________

2. (a) Of all the newly reported hepatitis B cases (acute and chronic) ≤40 years reported in 2019, what proportion had an unknown anti-HBC IgM result?

☐ None

☐ <25%

☐ 25%-<50%

☐ 50%-<75%

☐ ≥75%

2. Among those cases that had an unknown anti-HBc IgM result (in question 2a), what proportion were investigated?

☐ None

☐ <25%

☐ 25%-<50%

☐ 50%-<75%

☐ ≥75%

Hepatitis C reporting

3. (a) Are negative hepatitis C antibody (anti-HCV) results currently reportable in your jurisdiction?

☐ Yes, all negative lab results are received by the health department (complete reporting)

☐ Yes, some negative lab results are received by the health department (incomplete reporting)

☐ No

(b) If yes, what was the first full reporting year that negative anti-HCV lab results were available in your jurisdiction? ____________

4. (a) Are negative / undetectable hepatitis C RNA (HCV RNA) results currently reportable in your jurisdiction?

☐ Yes, all negative lab results are received by the health department (complete reporting)

☐ Yes, some negative lab results are received by the health department (incomplete reporting)

☐ No

(b) If yes, what was the first full reporting year that negative HCV RNA lab results were available in your jurisdiction? ____________

5. Among all newly reported hepatitis C cases (acute and chronic) aged ≤40 years reported in 2019, what proportion of cases were investigated by a public health department?

☐ None

☐ <25%

☐ 25%-<50%

☐ 50%-<75%

☐ ≥75%

Quantifying under-ascertainment and under-reporting

6. (a) Of all of the hepatitis A, acute hepatitis B, and acute hepatitis C infections that you believe (or have estimated) occurred in your jurisdiction in 2019, what proportion do you believe were: 1) reported to the state or local health department in your jurisdiction, and 2) a notification was sent to CDC?

Confirmed Hepatitis A		Confirmed Hepatitis B, acute		Confirmed Hepatitis C, acute
Reported to your jurisdiction	CDC was notified	Reported to your jurisdiction	CDC was notified	Reported to your jurisdiction	CDC was notified
☐ <25%	☐ <25%	☐ <25%	☐ <25%	☐ <25%	☐ <25%
☐ 25%-<50%	☐ 25%-<50%	☐ 25%-<50%	☐ 25%-<50%	☐ 25%-<50%	☐ 25%-<50%
☐ 50%-<75%	☐ 50%-<75%	☐ 50%-<75%	☐ 50%-<75%	☐ 50%-<75%	☐ 50%-<75%
☐ ≥75%	☐ ≥75%	☐ ≥75%	☐ ≥75%	☐ ≥75%	☐ ≥75%

2. Please provide a brief justification for the answer you selected for each acute viral hepatitis infection in Question 6a.

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