Strategic Plan: Implementation and Recommendations

Surveillance & Research Focus Area

Viral Hepatitis Surveillance

Surveillance is the ongoing and systematic collection, analysis and interpretation of health data for the purposes of planning, implementing and evaluating public health programs. The goals of viral hepatitis surveillance are to measure the burden of disease; determine risk factors; identify outbreaks; monitor trends; evaluate control measures, interventions and programs; and identify infected persons for medical referral, education and counseling.

A primary surveillance goal for New York State is the development of an enhanced surveillance system, which is able to generate accurate viral hepatitis data to support primary and secondary prevention, education, and medical management.

Challenges to viral hepatitis surveillance in New York State include:

  • Lack of resources at the local level to follow-up on laboratory reports of markers of viral hepatitis infection,
  • Lack of physician education regarding the need to screen patients for viral hepatitis, interpretation of diagnostic test results, differences between acute and chronic infection, and case reporting requirements,
  • Lack of laboratory diagnostic testing to distinguish between acute and chronic infection for hepatitis C,
  • Incomplete and inaccurate case information repor ted, and
  • Underreporting of viral hepatitis infections.

Strategies identified to overcome these challenges include:

  • Improve viral hepatitis reporting and follow-up through the development of provider education programs, which include information regarding clinical management, case contact management, education, counseling, and the importance and responsibility of reporting,
  • Assist LHDs with surveillance activities by developing detailed viral hepatitis surveillance guidelines, funding epidemiology surveillance officers, improving electronic reporting systems, and integrating case tracking systems within existing surveillance systems,
  • Collect and disseminate the highest quality data possible by determining the completeness and accuracy of baseline data, working with laboratories to report complete case information with hepatitis test results, developing standardized data quality-monitoring tools, and periodically distributing data quality summary reports to LHDs, and
  • Ensure that analysis capabilities meet all stake-holders' needs by analyzing case report information and disseminating periodic reports to stakeholders.

Viral Hepatitis Research

A primary research goal for New York State is the promotion of research activities that will assist with decreasing the incidence of viral hepatitis and benefit those infected with chronic hepatitis.

Two distinct areas of research that will help meet the goal of reducing disease incidence and benefiting chronically infected persons include:

  • Epidemiological research to close gaps in the current literature regarding behaviors that increase the risk of transmission of viral hepatitis and effective prevention activities specific to New York State residents and
  • Medical management research to assess health care services available to those infected, including the identification of persons in need of but not receiving treatment, and the barriers that prevent treatment. Continuing research into the effectiveness of treatment for viral hepatitis, measured by sustained viral response, is needed as new treatments are developed. A system to track persons being treated to evaluate treatment outcomes of specific populations is also needed.

Long Term Goal # 1: New York State should have an enhanced surveillance system that will generate accurate data on hepatitis to support primary and secondary prevention, education and medical management.

Strategy # 1:

Improve viral hepatitis reporting and follow-up.

Action Plans

  • During year one, NYSDOH should:
    • Develop provider education programs on clinical management, contact management, education, counseling, and reporting,
    • Disseminate viral hepatitis surveillance guidelines to LHDs,
    • Adopt CDC hepatitis C testing algorithm, and
    • Add hepatitis role to NYSDOH Communications Directory.
  • During year two, NYSDOH should work with Clinical Laboratory Evaluation Program (CLEP) to draft hepatitis C testing regulations.
  • During years one through five, NYSDOH should:
    • Explore the need for additional epidemiologists,
    • Define roles and responsibilities of those conducting surveillance at all levels (state, regional, and local),
    • Increase electronic reporting and improve data quality, and
    • Work with CDC and NYSDOH information technology staff to enhance reporting system with a tracking component.

Strategy # 2:

Collect and disseminate the highest quality data possible.

Action Plans

  • During year one, NYSDOH should:
    • Assess completeness and accuracy of base-line hepatitis case repo t data and
    • Distribute NYSDOH letter instructing laboratories to provide patient and provider information on all laboratory test results.
  • During year two, NYSDOH should develop a standard data quality-monitoring tool.
  • During years three through five, NYSDOH should distribute periodic reports on data quality to LHDs.

Strategy # 3:

Ensure analysis capabilities meet all stakeholders' needs.

Action Plans

  • During years one through five, NYSDOH should:
    • Disseminate periodic epidemiologic reports to stakeholders,
    • Analyze case report data for development and evaluation of prevention activities, and
    • Provide periodic data analysis of case reports including disease incidence and trends over time.
  • During years three through five, NYSDOH should develop and implement patient tracking reports for LHDs.

Long Term Goal # 2: New York State should promote research activities that will assist with decreasing the incidence of viral hepatitis and benefit those with chronic hepatitis.

Strategy # 1:

Conduct epidemiologic research.

Action Plans

  • During year one, NYSDOH should conduct research to assess hepatitis A and B vaccination coverage and identify high-risk groups and barriers to vaccination.
  • During year two, NYSDOH should conduct patient education studies to determine the most effective education methodology.
  • During year three, NYSDOH should conduct targeted prevalence studies for hepatitis B and C.
  • During year four, NYSDOH should conduct mortality studies to assess the mortality rate among those infected with HBV and HCV.
  • During year five, NYSDOH should pursue studies to assess the risk of hepatitis C transmission associated with tattooing, body piercing, electrolysis, sex, and nosocomial transmission.

Strategy # 2:

Conduct research related to health services and clinical science.

Action Plans

  • During year one, NYSDOH should conduct provider studies to assess the medical management of those infected with viral hepatitis.
  • During year two, NYSDOH should conduct research to identify populations not receiving treatment for HBV and HCV, and identify the barriers.
  • During year three, NYSDOH should conduct research studies on HCV treatment outcomes looking at sustained viral response.