Table 3.

Surveillance activities needed to describe the epidemiology of viral hepatitis, including hepatitis B and hepatitis C.

Parameter	Activities that contribute to surveillance for viral hepatitis
	Surveillance for acute hepatitis that reflect new infections		Surveillance for chronic, prevalent hepatitis		Surveillance for sequelae
Activities	Syndromic surveillance in the general population; Event-based surveillancea	Enhanced case reporting (with in vitro diagnosis and collection of information on risk factors) countrywide or in sentinel sitesb	Case reporting from laboratories or health care facilities	Regular biomarker surveys	Combination of data from cancer registries, death certificates, and testing of cirrhosis and HCCc patients for HBVd and HCVe infection
Population under surveillance	Persons presenting with acute hepatitis in health care facilities (discrete onset of symptoms)	Persons presenting with acute hepatitis in health care facilities (discrete onset of symptoms)	Persons without acute symptoms tested in health care facilities/laboratories	Person without acute symptoms tested during population surveys	Persons diagnosed with cirrhosis and HCC
Usual implementer	Communicable disease surveillance	Communicable disease surveillance (if countrywide); hepatitis program (if sentinel sites)	Communicable disease surveillance and/or hepatitis program	Hepatitis program in coordination with the other actors implementing biomarker surveys	Hepatitis program collating data from various different sources, including vital registration
Case definitions to use (see Table 4)	Presumptive case of acute hepatitis	Confirmed case of acute hepatitis (by type)	Chronic HBV and HCV infection; serological evidence of past or present HCV infection	Chronic HBV and HCV infection; serological evidence of past or present HCV infection	Cases of HCC or cirrhosis with chronic HBV or HCV infection
Objective of the surveillance activity	Detect outbreaks	Describe trends in type-specific acute hepatitisf and identify risk factors	Estimate the proportion of chronically infected persons who have been identified	Estimate the burden of chronic infections; model incidence trends	Estimate the incidence of HCC and cirrhosis

^aIn vitro diagnosis needs to be organized on a sample of cases when an outbreak is reported.

^bHigh-quality data (ie, reliable in vitro diagnosis and good information on risk factors) from a smaller number of tertiary centers is preferable and more efficient than poor-quality data from many sites.

^cHCC: hepatocellular carcinoma.

^dHBV: hepatitis B virus.

^eHCV: hepatitis C virus.

^fSurveillance for acute hepatitis cannot be used directly to quantify new infections. The reported number of cases of acute hepatitis needs to be adjusted for the large proportion of asymptomatic cases and underreporting.