Chronic Viral Hepatitis Registry

Information for Health Care Providers

Background

• Viral hepatitis, especially hepatitis B virus infection (HBV), has been identified as a significant concern for San Francisco residents.
• Over the past 2 decades, San Francisco has had persistently higher rates of acute HBV compared with rates in the Bay Area, California, and the USA as a whole.  See the San Francisco Department of Public Health Communicable Disease Report).
• Many San Francisco residents were born in countries with high HBV endemicity (East Asia in particular) and are therefore at increased risk for chronic HBV infection.  In 2004-05 a local SFDPH community outreach program found that 10% of over 1,200 San Francisans of Asian/Pacific Islander origin tested positive for hepatitis B surface antigen (SF Medicine 2006).  A recent CDC prevalence study found that as many as 15% of New York City residents born in East Asia had evidence of chronic HBV (MMWR 2006). 
• Chronic HBV infection results in significant morbidity and mortality.  As many as 25% of those with chronic HBV will die prematurely of cirrhosis of the liver or hepatocellular carcinoma (MMWR 2005).  In patients with chronic HBV, periodic screening for hepatocellular cancer with liver ultrasound and alfa-fetoprotein testing may be of benefit (Physician's Guide).
• Chronic HBV is often treatable.  Several FDA-approved medications are effective in suppressing viral replication in patients with chronic HBV (AASLD 2007).
• HBV disease is preventable by safe, effective vaccines.  Vaccination of susceptible contacts (e.g. family members, sexual partners) reduces transmission of the disease and is a key feature of the strategy to eliminate transmission of HBV in the U.S. (MMWR 2005).

Specific Objectives of the Registry

• To estimate the prevalence of chronic HBV among San Francisco residents.
• To obtain data on HBV risk factors, demographics, testing, and other patient attributes among those with chronic HBV.
• To analyze registry data in order to identify missed opportunities for HBV screening and prevention in San Francisco communities. 

Funding

• Funding is provided by the U.S. Centers for Disease Control & Prevention (CDC), Division of Viral Hepatitis.

Registry Data

• MMWR 2007; 56(18):446-448.  Characteristics of Persons with Chronic Hepatitis B --- San Francisco, California, 2006.

• Reprinted in JAMA 2007; 298(2):167-68. Characteristics of Persons with Chronic Hepatitis B --- San Francisco, California, 2006.

Data Sources- Role of Clinical Laboratories

• New regulations making certain positive HCV tests laboratory-reportable to the local health department were enacted in June, 2007.
  
• Laboratories are now required by the CA Code of Regulations, Title 17 Section 2505 to report positive results of both HBV and HCV tests to SFDPH.
  
• In addition to test results, labs are required to report patient identifiers (e.g. name, DOB, gender, medical record no.) and provider identifiers (e.g. name, facility).
• SFDPH reviews the test reports, organizes them by person in an electronic database, and removes duplicates.
• CDC criteria are applied to test results used to identify persons with chronic viral hepatitis.
• Hepatitis B Virus Infection, Chronic:  see the current case definition (2007) and the prior case definition (2003)
• Hepatitis C Virus Infection, Past or Present: see the current case definition (2005).

Data Sources- Role of San Francisco Health Care Providers

• When SF residents meet CDC criteria for chronic HBV, SFDPH contacts the provider for information unavailable from laboratory reports alone. 
  
• A simple, one-page data collection form is sent to the health care provider who ordered the most recent positive HBV test.  
  
• The data collection form asks about HBV risk factors, demographics, and other patient attributes. See sample data collection form.
• Providers complete the form and return it by fax to (415) 554-2878 at the SF Dept Public Health. 
  
• SFDPH maintains the confidentiality of all patient data.

• Providers are required by the CA Code of Regulations, Title 17 Section 2500 to report cases of viral hepatitis, including chronic HBV and HCV, to SFDPH. 
  
• See instructions for reporting.

Data Sources- Role of San Francisco Residents

• In 2007-2008 SFDPH will complete telephone interviews with SF residents with chronic hepatitis B identified via the registry database. 
  
• The interviews are brief (15 minutes) and are conducted in the interviewee's native language, whenever possible.
• Information is gathered about household and intimate contacts at risk for HBV acquisition and about what practices are used to prevent disease transmission.
• Interviewers are trained to educate patients about preventing HBV spread and about monitoring for liver disease and liver cancer.
• Written materials are mailed to interviewees at the close of the interview to reinforce the preventive care messages.

Project Team

• Patricia Shiono, PhD; Project Director
  
• Sue Shallow, MPH - Chronic Viral Hepatitis Registry Epidemiologist
• Ishmael Bihl, Supervisor, Communicable Disease Control Unit
  
• Amy Nishimura, MPH - Disease Control Investigator
• Martina Li - Research Assistant
• David M Stier, MD - Medical Epidemiologist
  
• Sandra Huang, MD - Director, Communicable Disease Control Unit
  

For More Information

• See Frequently Asked Questions
• Contact Sue Shallow MPH, Project Epidemiologist.  Tel: (415) 554-2737 Email: sue.shallow@sfdph.org
• Project Fax Line (415) 554-2878