hepatitis surveillance units, where they exist, often receive no dedicated federal funding for this activity. Others may receive funding directly from their state or city, or they may be integrated into or receive funding from other programs or units that receive federal funding from CDC programs whose missions are related to epidemiology or viral hepatitis. The CDC programs include the Immunization Services Division (related to perinatal hepatitis B), the Epidemiology and Laboratory Capacity for Infectious Diseases program (acute hepatitis B), EIPs, and the DVH. Funding may also be available through private organizations or foundations. Some surveillance units receive funding from multiple sources. Each funding source may require different activities and may provide varied guidance on the receiving unit’s activities. The recent survey of AVHPCs conducted by NASTAD found that fewer than one-fourth of the 43 responding jurisdictions reported receiving funding for surveillance for either chronic HBV or chronic HCV infection (NASTAD, 2009).

Program Design

Variability among jurisdictions is also due to a wide array of program structures. In a 2006 survey, 33% of the 52 hepatitis C coordinators funded by CDC reported being in their jurisdictions’ communicable-diseases or epidemiology programs, 25% in HIV–STD programs, 14% in HIV programs, and the remainder in the immunization or STD programs (CDC, 2006). The hepatitis C coordinators’ locations within public health departments may or may not correspond with the health department program responsible for conducting surveillance, which can lead to reduced involvement and oversight by the coordinator of viral hepatitis surveillance activities.

In a later survey of the (renamed) AVHPCs by CDC in April 2009, only 32 states reported having state viral-hepatitis plans. Of the 32, 29 included surveillance as a component. However, fewer than two-thirds of the program coordinators reported being able to implement the surveillance components. The reasons listed for not implementing plan components were lack of staff and lack of funding (CDC, 2009h).

Reporting Systems and Requirements

Reporting of surveillance data to CDC by state and territorial health departments is voluntary, and in general little federal funding is provided for HBV and HCV surveillance activities (Klein et al., 2008). Chronic hepatitis B is reportable in 42 states, but only 38 states conduct surveillance and maintain systems, and only 20 report cases to CDC (George, 2004). Chronic hepatitis C is reportable in 40 states, but only 20 report cases to CDC (George, 2004). CDC collects data from states that report



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