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Indiana State Department of Health

ISDH Home > Public Health Protection & Laboratory Services > Epidemiology Resource Center (ERC) > Surveillance and Investigation > Infectious Disease Epidemiology > Newsletters > Indiana Epidemiology Archived Newsletters > Epi_Newsletter_June_2006-Page1 Hepatitis C Case Surveillance

Indiana Epidemiology Newsletter
June 2006

Mike Wilkinson, B.S.
Hepatitis C Epidemiologist

The Indiana State Department of Health (ISDH) is expanding hepatitis C surveillance to identify risk factors for infection and to more effectively target education and prevention. Currently, only acute cases are reportable. The ISDH is requesting that local health departments (LHD) report all chronic hepatitis C cases as well.

The ISDH is expanding hepatitis C surveillance to include chronic cases for several reasons. First, because chronic cases are not currently reportable, we have no conclusive data on chronic hepatitis C cases in Indiana. Second, the vast majority of hepatitis C cases are chronic. Third, surveillance of chronic cases will allow for better determination of the scope of hepatitis C prevalence and, hence, the burden of infection in Indiana. Finally, surveillance of chronic cases will allow for the identification of new risk factors and more targeted education and prevention efforts.

The ISDH will mail copies of lab reports and completed Confidential Reports of Communicable Disease forms (State Form #43823) to LHDs with a cover letter requesting follow-up. The hepatitis C case investigation form is available online at Public health nurses should complete the form as thoroughly as possible on newly identified acute and chronic hepatitis C cases and fax the form to 317.233.9271. Faxing the form will transmit the data directly into the hepatitis C database. For that reason, the ISDH requests that hard copies of completed investigation forms not be mailed. The ISDH Field Epidemiologists can provide assistance with case investigation and form completion.

Several LHDs have inquired about what should be faxed to the new database number (317.233.9271) and what should be faxed to the regular number (317.234.2812).

  • Only the new 6-page investigation form should be faxed to the new database number, 317.233.9271.
  • All other forms, including lab forms and Confidential Report of Communicable Disease forms, should be faxed to 317.234.2812.
  • Only one investigation needs to be completed per case. Any follow-up labs or reports received at the LHD after the case investigation has been completed should be faxed to 317.234.2812.

The ISDH requests that LHDs with large Department of Correction (DOC) facilities in their jurisdictions maintain lab reports on those cases. The ISDH is currently developing the protocol for follow-up of DOC cases.

The ISDH acknowledges the increased workload required to investigate chronic cases and appreciates the support for this surveillance initiative. Enhanced reporting and surveillance can help effectively target intervention and education for better control of hepatitis C. Health officials expect the number of hepatitis C cases to increase given the aging baby boomer population, popularity of tattoos*, growing prison population, and continued intravenous drug use. Indiana is among the three states that have taken this initiative, and Indiana can serve as an example to the rest of the country on methods to help control this silent epidemic.

If you have any questions regarding hepatitis C surveillance and reporting, please contact Mike Wilkinson at 317.234.2827 or

Hepatitis C Acute Case Definition (must meet all of the following):

  • Discrete onset of symptoms, such as GI symptoms, dark urine, pale stool, and fatigue;
  • Jaundice or elevated liver enzymes (serum levels must be 7 times upper limit of normal);
  • Laboratory criteria:
    • HCV antibody positive by EIA with signal to cut off ratio ≥ 3.8 OR
    • Positive anti-HCV antibody test confirmed by RIBA OR
    • HCV RNA positive
    • Patient must also be negative for hepatitis A and hepatitis B virus

>80% of acute hepatitis C cases will not resolve or clear virus in six months.

Hepatitis C Chronic Case Definition:

  • Have had HCV antibodies six months or longer
  • Laboratory criteria:
    • HCV antibody positive by EIA with signal to cut off ratio ≥ 3.8 OR
    • Positive anti-HCV antibody test confirmed by RIBA OR
    • HCV RNA positive

>most are asymptomatic
>liver enzymes may be normal
>antibody and perhaps RNA will be positive

*Tattoos pose a risk for those who go to facilities where sanitary practices are not practiced, such as not replacing ink pots appropriately or not using sterilized needles.

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