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

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

3. 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

4. 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

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

6. 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

7. 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

8. 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?

9. 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

10. 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

11. Exercise:

12. Exercise

13. Exercise
Complete the investigation.

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

15. 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

16. 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)

17. Reference