Case Definition: HEPATITIS C Maria del Rosario, MD, MPH WVDHHR/BPH/IDEP IDEP Training - February 2008

Objectives To describe the important aspects of reporting hepatitis c. To discuss how a hepatitis c is ascertained.

What is reportable by law*? Health care providers and facilities to report Acute Hepatitis C case/s within 1 week of diagnosis. Report should include the following laboratory results: Hepatitis A serology Hepatitis B serology Transaminase (ALT, AST) Bilirubin Laboratories to report the following results within 1 week of diagnosis: Hepatitis C/other non-A non-B – virologic or serologic *Law is found at http://www.wvdhhr.org/idep/PDFs/IDEP/Reportable%20Diseases_%20Conditions_%20Events_07.pdf

ACUTE HEPATITIS C: Case definition Clinical description Acute illness with discrete onset of signs/symptoms consistent with acute viral hepatitis (e.g. anorexia, abdominal discomfort, nausea, vomiting), AND Jaundice or serum ALT levels >400 IU/L Laboratory criteria One or more of the following: Anti-HCV screening-test-positive with a signal to cut-off ratio predictive of a true positive, or HCV RIBA positive, or NAT for HCV RNA positive AND IgM antibody to hepatitis A virus (IgM anti-HAV) negative IgM antibody to hepatitis B core antigen (IgM anti-HBc) negative

ACUTE HEPATITIS C: Case Classification CONFIRMED: Meets clinical case definition, AND Laboratory confirmed, AND Not known to have chronic hepatitis C

PAST or PRESENT HEPATITIS C INFECTION: (Chronic) CASE DEFINITION Clinical description Most are asymptomatic. Some have chronic liver disease (cirrhosis, cancer). Laboratory criteria Anti-HCV positive (repeat reactive) by EIA, verified by an additional more specific assay (e.g. RIBA for anti-HCV or nucleic acid testing for HCV RNA), OR HCV RIBA positive, OR Nucleic acid test for HCV RNA positive, OR Anti-HCV positive (repeat reactive) by EIA with a signal to cut-off ratio >= 3.8

PAST or PRESENT HEPATITIS C INFECTION: (Chronic) Case Classification PROBABLE: a case that is anti-HCV positive (repeat reactive) by EIA, AND has ALT (or SGPT) values above the upper limit of normal, BUT anti-HCV EIA result has not been verified by an additional more specific assay or the signal to cutoff ratio is unknown CONFIRMED: laboratory confirmed, AND does not meet the case definition for acute hepatitis C

Exercise: Hep C Laboratory USA What are the next steps? Test Result Name: Greene, Berry Age: 46 years old Collection Date: Sept. 04, 2007 Report Date: Sept. 10, 2007 Type of Test: Hepatitis panel Test Result Hep A Ab, total negative Hep B surface Ag negative Hep B core Ab, IgM negative Hep C Ab Reactive s/co: 4.888 What are the next steps?

Exercise: Hep C STEPS: Fax report to IDEP (IDEP maintains a hepatitis c registry) What information do you need to ascertain a case? clinical information laboratory information

Exercise: Hep C Additional information from PCP: Patient complained of abdominal pain, nausea, loss/decrease appetite, unsure if jaundice ALT = 1025 (reference: 40) Hep C RIBA = positive

Exercise:

Exercise

Exercise Complete the investigation.

Source: MMWR, February 7, 2003; Vol. 52(RR-3)

What to do next? Past Hepatitis C Infection ascertained Acute Hepatitis C ascertained Complete yellow card, educate (if resources allow) Investigate Report in WVEDSS Send lab report and yellow card to IDEP

What’s new for 2008: IDEP: weekly disease upload to CDC For new* acute hep c case: when IDEP receives information on a case suspecting acute hepatitis C, a case will be opened in WVEDSS and assigned to respective CHD (instead of sending a letter to investigate). For new* chronic hep c case: FYI letter from IDEP will continue. *new implies case is not in surveillance system (e.g. registry, WVEDSS, NETSS)

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