N.H. among few with no mandate to report hepatitis C
| By JIM HADDADIN jhaddadin@fosters.com |
Sunday, June 3, 2012
EXETER — When he announced last week that an outbreak of hepatitis C at Exeter Hospital is the first of its kind in New Hampshire, the state's top public health official included one noteworthy caveat.
Exeter Hospital was forced to temporarily halt operations at its cardiac catheterization laboratory last month after discovering four cases of hepatitis C with a possible link to the lab.
Discussing the development at a press conference on Thursday, May 31, Public Health Director Dr. Jose Montero said it's impossible to judge with certainty whether the situation at Exeter Hospital is unprecedented in New Hampshire.
That's because unlike a majority of other states, New Hampshire does not require hospitals, labs and medical clinics to report new cases of hepatitis C.
States have autonomy to set their own regulations for disease reporting, and the list of reportable diseases differs across the country, according to the Centers for Disease Control and Prevention.
New Hampshire law specifies about 75 reportable diseases, including tetanus, mumps, rabies and some sexually transmitted diseases.
The virtue of collecting disease data is that it can be used to spot trends, detect unusual clusters and measure the effectiveness of prevention efforts. Notifications also help local health officials identify people at risk of infection.
When the New Hampshire Department of Health and Human Services learns of a new case of measles, for example, staffers interview the family of the patient, contact physicians and reach out to the patient's classmates.
But when it comes to hepatitis C, New Hampshire has among the most lax reporting requirements in the country, according to both Montero and information from the Council of State and Territorial Epidemiologists.
In 2010, CSTE conducted a survey of state epidemiologists to learn how each state handles disease reporting.
The results showed 46 states require all medical clinics, hospitals and laboratories to report acute cases of hepatitis C to local health officials.
Of the remaining four states, California and Alaska exempt only hospitals from the requirement. North Carolina exempts hospitals and laboratories, but requires reporting from clinics.
However, New Hampshire is an outlier. It doesn't require any medical provider to provide information about new hepatitis C cases unless an outbreak is confirmed.
Under state law, any "outbreak, cluster of illness, or unusual occurrence of disease" that poses a public health concern must be reported to the state within 24 hours.
One of the reasons hepatitis C hasn't been categorized as a reportable disease in New Hampshire is the added administrative burden and cost of taking in reports, Montero said. Another is the fact that the effectiveness of hepatitis C monitoring remains in dispute.
Since many people who are infected with the virus develop symptoms only weeks, or years, after contracting the virus, Montero said it can be tricky to pinpoint when or how someone contracted hepatitis C.
However, monitoring individual cases could have benefits. Montero said the state could be missing opportunities to target prevention efforts, like outreach around safe needle use.
In Massachusetts, Maine and Vermont, hepatitis C reporting is already mandatory.
Sheila Pinette, director of the Maine Centers for Disease Control and Prevention, said a dedicated staff member is assigned to investigate new cases of hepatitis and STDs.
When the state receives a report of a diagnosis, state officials make contact with the patient's primary care physician and investigate any potential risk posed by the disease.
That includes interviewing the patient about past sexual partners and recommending for the patient to get tested for HIV, since the condition often coexists with hepatitis C.
Vermont State Epidemiologist Patsy Kelso said hepatitis C is one of the most commonly reported viral diseases in the state, and requires "a good deal of effort" on the part of state health officials.
Vermont does not follow up with each patient diagnosed with hepatitis C, but Kelso said staffers try to identify patients who are younger than 25 or older than 65.
People younger than 25 are more likely to have been infected recently, and can help to identify points from which the disease is being spread, Kelso said.
For the past several months, New Hampshire public health officials have been holding discussions about whether to add hepatitis C and a number of other diseases to the list of reportable diseases as part of a regular review, Montero said.
If the Division of Public Health Services recommends placing hepatitis C on the reportable diseases list, the proposal would also need approval from a committee of lawmakers.
"We are reviewing that specific point over the next several months," Montero said, "and certainly outbreaks like this offer more information on what we are doing and may trigger a different decision."
http://www.fosters.com/apps/pbcs.dll/article?AID=/20120603/GJNEWS_01/706039911/-1/FOSNEWS
Home Delivery
Exeter Hospital was forced to temporarily halt operations at its cardiac catheterization laboratory last month after discovering four cases of hepatitis C with a possible link to the lab.
Discussing the development at a press conference on Thursday, May 31, Public Health Director Dr. Jose Montero said it's impossible to judge with certainty whether the situation at Exeter Hospital is unprecedented in New Hampshire.
That's because unlike a majority of other states, New Hampshire does not require hospitals, labs and medical clinics to report new cases of hepatitis C.
States have autonomy to set their own regulations for disease reporting, and the list of reportable diseases differs across the country, according to the Centers for Disease Control and Prevention.
New Hampshire law specifies about 75 reportable diseases, including tetanus, mumps, rabies and some sexually transmitted diseases.
The virtue of collecting disease data is that it can be used to spot trends, detect unusual clusters and measure the effectiveness of prevention efforts. Notifications also help local health officials identify people at risk of infection.
When the New Hampshire Department of Health and Human Services learns of a new case of measles, for example, staffers interview the family of the patient, contact physicians and reach out to the patient's classmates.
But when it comes to hepatitis C, New Hampshire has among the most lax reporting requirements in the country, according to both Montero and information from the Council of State and Territorial Epidemiologists.
In 2010, CSTE conducted a survey of state epidemiologists to learn how each state handles disease reporting.
The results showed 46 states require all medical clinics, hospitals and laboratories to report acute cases of hepatitis C to local health officials.
Of the remaining four states, California and Alaska exempt only hospitals from the requirement. North Carolina exempts hospitals and laboratories, but requires reporting from clinics.
However, New Hampshire is an outlier. It doesn't require any medical provider to provide information about new hepatitis C cases unless an outbreak is confirmed.
Under state law, any "outbreak, cluster of illness, or unusual occurrence of disease" that poses a public health concern must be reported to the state within 24 hours.
One of the reasons hepatitis C hasn't been categorized as a reportable disease in New Hampshire is the added administrative burden and cost of taking in reports, Montero said. Another is the fact that the effectiveness of hepatitis C monitoring remains in dispute.
Since many people who are infected with the virus develop symptoms only weeks, or years, after contracting the virus, Montero said it can be tricky to pinpoint when or how someone contracted hepatitis C.
However, monitoring individual cases could have benefits. Montero said the state could be missing opportunities to target prevention efforts, like outreach around safe needle use.
In Massachusetts, Maine and Vermont, hepatitis C reporting is already mandatory.
Sheila Pinette, director of the Maine Centers for Disease Control and Prevention, said a dedicated staff member is assigned to investigate new cases of hepatitis and STDs.
When the state receives a report of a diagnosis, state officials make contact with the patient's primary care physician and investigate any potential risk posed by the disease.
That includes interviewing the patient about past sexual partners and recommending for the patient to get tested for HIV, since the condition often coexists with hepatitis C.
Vermont State Epidemiologist Patsy Kelso said hepatitis C is one of the most commonly reported viral diseases in the state, and requires "a good deal of effort" on the part of state health officials.
Vermont does not follow up with each patient diagnosed with hepatitis C, but Kelso said staffers try to identify patients who are younger than 25 or older than 65.
People younger than 25 are more likely to have been infected recently, and can help to identify points from which the disease is being spread, Kelso said.
For the past several months, New Hampshire public health officials have been holding discussions about whether to add hepatitis C and a number of other diseases to the list of reportable diseases as part of a regular review, Montero said.
If the Division of Public Health Services recommends placing hepatitis C on the reportable diseases list, the proposal would also need approval from a committee of lawmakers.
"We are reviewing that specific point over the next several months," Montero said, "and certainly outbreaks like this offer more information on what we are doing and may trigger a different decision."
http://www.fosters.com/apps/pbcs.dll/article?AID=/20120603/GJNEWS_01/706039911/-1/FOSNEWS
Home Delivery
No comments:
Post a Comment