Abstract
BackgroundMonitoring 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.MethodsWe evaluated hepatitis B case-reporting at six hospitals in Fujian, Hainan and Gansu provinces in 2015 to assess the accuracy of case classification. We linked National Notifiable Disease Reporting System (NNDRS) HBV case-reports with hospital information systems and extracted information on age, gender, admission ward and viral hepatitis diagnosis from medical records. To assess accuracy, we compared NNDRS reported case-classifications with the national HBV case definitions. Multivariable logistic regression was used to identify factors associated with misclassification.ResultsOf the 1420 HBV cases reported to NNDRS, 23 (6.5%) of the 352 acute reports and 648 (60.7%) of the 1068 chronic reports were correctly classified. Of the remaining, 318 (22.4%) were misclassified and 431 (30.4%) could not be classified due to the lack of supporting information. Based on the multivariable analysis, HBV cases reported from Hainan (aOR = 1.8; 95% CI: 1.3–2.4) and Gansu (aOR = 12.7; 95% CI: 7.7–20.1) along with reports from grade 2 hospitals (aOR = 1.6; 95% CI:1.2–2.2) and those from non-HBV related departments (aOR = 5.3; 95% CI: 4.1–7.0) were independently associated with being ‘misclassified’ in NNDRS.ConclusionsWe 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.
Highlights
Monitoring hepatitis B surveillance data is important for evaluating progress towards global hepatitis B elimination goals
We evaluated the accuracy of hepatitis B virus infections (HBV) surveillance data reported to National Notifiable Disease Reporting System (NNDRS) from hospitals in three geographically and demographically diverse provinces and identified factors that may affect the accuracy of these reports
We selected one grade 2 and one grade 3 hospitals for a total of six project hospitals using the following criteria: 1) the hospital had an advanced laboratory information system (LIS) with access to HBsAg test results; 2) the hospital had an electronic hospital information system (HIS) that can link the Laboratory information system (LIS) to the inpatient medical record number; and 3) in 2015, the hospital reported a greater number of hepatitis B cases compared to the hospital-based provincial mean
Summary
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. 257 million persons have chronic hepatitis B virus infections (HBV) and nearly 900,000 HBV-related deaths occur annually [1]. To address this disease burden, the World Health Organization (WHO) outlined a new strategy for viral hepatitis elimination, focusing on a 90% reduction of new chronic viral hepatitis B cases by 2030 [2]. An estimated 90 million individuals of whom the majority are older than 30 years of age [6], are HBV surface antigen positive (HBsAg+) and at risk of developing cirrhosis and liver cancer [7, 8]. Persons who are HBsAg+ can transmit HBV to susceptible persons
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