Chronic hepatitis B surveillance in Victoria, 1998-2008: Instituting a 21st century approach to an old disease

Objective: To describe the epidemiology and assess the quality of the Victorian chronic hepatitis B (CHB) surveillance data in light of revised recommendations for the management of people with CHB infection published by the Centers for Disease Control (CDC). Methods: Records of confirmed non-acute hepatitis B cases notified from 1998-2008 were extracted from the Victorian Notifiable Infectious Diseases Surveillance database. Age-standardised notification rates were calculated using population data from the Australian Bureau of Statistics. Descriptive epidemiological analyses were conducted on demographic fields and notifications were assessed for identity of notifier and completeness, especially for country of birth data as prioritised by the CDC. Results: There were 19,024 notifications of CHB from 1998-2008. The annual agestandardised notification rates ranged from 28-38 per 100,000 population, with an upward trend from 2006. Country of birth information reflected the heterogeneity of HBV prevalence worldwide. A decreasing trend of doctor notifications resulted in poor completeness of risk factor fields such as Indigenous status (37%) and country of birth (27%). Conclusion: This analysis highlighted the burden of CHB in Victorians born in high prevalence countries; however a true estimate of this burden was limited by the high proportion of incomplete notifications. Implications: Improving the information collected from notifications will improve surveillance for CHB and ability to target appropriate responses. We suggest a pilot of enhanced surveillance to meet revised standards from CDC.