2011 HEPATITIS CASE DEFINITIONS (B & C)

Hepatitis B, Acute

CSTE Position Statement Number: 10-ID-11

Clinical definition

An acute illness with:

a) discrete onset of symptoms 

                  AND 

b) jaundice or serum aminotransferase levels (ALT) >200 IU/L

 

Laboratory criteria for diagnosis:

a)     • IgM antibody to hepatitis B core antigen (anti-HBc) positive

                     OR

         hepatitis B surface antigen (HBsAg) positive

                     AND

b) IgM anti-HAV negative (if done)

 

Case classification

Confirmed: A case that meets the clinical case definition, is laboratory confirmed, AND is not known to have chronic hepatitis B.

 

Hepatitis B, Chronic

 

 

CSTE Position Statement Number: 10-ID-10

Clinical Evidence

No symptoms are required. Persons with chronic HBV infection may have no evidence of liver disease or may have a spectrum of disease ranging from chronic hepatitis to cirrhosis or liver cancer.

Laboratory criteria for diagnosis

a)      •    IgM antibodies to hepatitis B core antigen (IgM anti-HBc) negative AND

         •    A positive result on one of the following tests: hepatitis B surface antigen (HBsAg),

               hepatitis B e antigen (HBeAg), or hepatitis B virus (HBV) DNA

                  OR

b)        •  HBsAg positive or HBV DNA positive or HBeAg positive two times at least 6 months

               apart (Any combination of these tests performed 6 months apart is acceptable)

 

Case classification

Confirmed: a case that meets either of the above laboratory criteria for diagnosis

Probable: a person with a single HBsAg positive or HBV DNA positive or HBeAg positive lab result and does not meet the case definition for acute hepatitis B.

Comment

Multiple laboratory tests indicative of chronic HBV infection may be performed simultaneously on the same patient specimen as part of a “hepatitis panel.” Testing performed in this manner may lead to seemingly discordant results, e.g., HBsAg-negative AND HBV DNA-positive. For the purposes of this case definition, any positive result among the three laboratory tests mentioned above is acceptable, regardless of other testing results. Negative HBeAg results and HBV DNA levels below positive cutoff level do not confirm the absence of HBV infection.

 

Hepatitis C, Acute

 

 

CSTE Position Statement Number: 10-ID-08

Clinical Presentation

An acute illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., anorexia, abdominal discomfort, nausea, vomiting)

            AND, either

a) jaundice/dark urine

            OR 

b) serum alanine aminotransferase (ALT) levels >400 IU/L.

 

Laboratory criteria for diagnosis

One or more of the following three criteria:

a)         Antibodies to hepatitis C virus (anti-HCV) screening-test-positive with a signal to cut-off

            ratio predictive of a true positive as determined for the particular assay as defined CDC.

            (URL for the signal to cut-off ratios: http://www.cdc.gov/ncidod/diseases/hepatitis/c/sc_ratios.htm)

                  OR

b)          Hepatitis C Virus Recombinant Immunoblot Assay (HCV RIBA) positive

                  OR


c)           Nucleic Acid Test (NAT) for HCV RNA positive (including genotype)

                  AND, meets the following two criteria:

                •  IgM antibody to hepatitis A virus (IgM anti-HAV) negative

                        AND
                • 
IgM antibody to hepatitis B core antigen (IgM anti-HBc) negative

Case classification:

Confirmed: a case that meets the clinical case definition, is laboratory confirmed, and is not known to have chronic hepatitis C.

 

Hepatitis C, past or present

 

 

CSTE Position Statement Number: 10-ID-09

Clinical Case Definition

No symptoms are required. Most HCV-infected persons are asymptomatic; however, many have chronic liver disease, which can range from mild to severe.

Laboratory criteria for diagnosis

One or more of the following four criteria:

a)               Anti–HCV positive (repeatedly reactive) by enzyme immunoassay (EIA) verified by

                  at least one additional more specific assay

                           OR

b)               HCV RIBA (recombinant immunoblot assay) positive

                           OR

c)               Nucleic Acid Test (NAT) positive for HCV RNA (including genotype)

                           OR

d)               Antibodies to hepatitis C virus (anti-HCV) screening-test-positive with a signal to

                  cut-off ratio predictive of a true positive as determined for the particular assay and

                  posted by CDC. (http://www.cdc.gov/ncidod/diseases/hepatitis/c/sc_ratios.htm)

Case classification

Confirmed: a case that is laboratory confirmed and does not meet the case definition for acute hepatitis C.

Probable: a case that is anti-HCV positive (repeat reactive) by EIA and has alanine aminotransferase (ALT or SGPT) values above the upper limit of normal, but the anti-HCV EIA result has not been verified by an additional more specific assay or the signal to cut-off ratio is unknown.