Acute Hepatitis B in the State of Virginia (1995-1998)

Acute Hepatitis B (HBV) is a very serious infection leading to numerous chronic as well as other deadly liver conditions. Putting a halt to the incidence of acute HBV will directly effect those cases that become prevalent (chronic) throughout society. Thus the purpose of this research paper is to illustrate the results of a descriptive analysis of the acute hepatitis B cases reported in 1995-1998 by both the Virginia Department of Health (VDH) and Hospital Admission data provided in the Virginia Health Information (VHI) database. Methods throughout this project will follow procedures utilized within a descriptive analysis. For instance, annual incidence rates for acute HBV will be determined over a 4 year period. These rates will further be dissected to calculate region-, race-, gender-, and age-specific rates with regards to the incidence of acute HBV. Furthermore, risk ratios will be calculated to illustrate the risk of acute HBV with regards to the characteristics listed above. Overall, this project will attempt to identify a trend in acute HBV during the years 1995-1998 in the State of Virginia.

With regards to the VDH data, overall incidence of acute HBV in the state of Virginia increased 1995-1996 and then decreased 1997-1998. Fortunately, 1998 had the lowest incidence over the study period. Incidence specific by region showed that Eastern Virginia had the highest incidence over the study period while Northwest Virginia obtained the lowest incidence. Furthermore, the majority of the cases reported to the VDH were black (except in 1995), male, and between the age of 30-59 years. Similar results were obtained regarding the incidence of hospitalization of acute HBV, in which cases were extracted from the VHI database. With regards to overall incidence for the State of Virginia: incidence increased slightly during 1995-1996, dropped dramatically in 1997, and increased slightly in 1998. 1997 had the lowest incidence over the study period. Looking specifically at incidence by region, Eastern Virginia had the highest incidence while Northwest Virginia had the lowest which matches that in the VDH data. The majority of admissions of acute HBV were black, male (except in 1995), and between the age of 30-59 years.

When comparing both the VDH and VHI data, the VHI hospitalization incidence rates of acute HBV were consistently higher than the incidence rates calculated from the VDH data. For instance for the incidence rate of acute HBV for the entire State of Virginia was at most 3.5 times higher. When looking at incidence rates specifically by regions, the greatest difference was seen in Central Virginia (1995) where VDH reported a rate of 2.69/ 100,000 while VHI reported a rate of 17.42/ 100,000. Similar differences were seen in the race-, sex-specific incidence rates. Even though enormous differences were seen in the incidence rates, still risk factors (being black and male) were constant in both reporting systems.

Several implications exist regarding this descriptive study. First, underreporting plays a major factor in VDH much less cases of acute HBV than VHI. Most of the problem appears because of the passive reporting system in place by the health department. However, underreporting is also present because of possible miscoding by hospitals. Several recommendations are proposed to decrease the incidence of acute HBV in Virginia. For instance, increase availability of the HBV vaccine, educate the general public regarding spread and prevention (especially in pregnant women), and promulgate further study to document laboratory results and acute status of hospitalized cases.

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