JMIR Publications

ABSTRACT

Background:

In 2012, the country of Georgia established an electronic integrated disease surveillance system (EIDSS) for acute hepatitis B virus (HBV) infection. All medical facilities must report laboratory-confirmed acute HBV cases to the regional public health centres (PHCs) within 24 hours, which are subsequently registered in EIDSS.

Objective:

To evaluate the acute hepatitis B surveillance system in Georgia in order to identify areas for improvement and develop recommendations that enhance its capacity to inform prevention and response efforts, supporting the elimination of viral hepatitis.

Methods:

For the evaluation of acute HBV surveillance system from 2015 to2020, we used the US Centers for Disease Control and Prevention updated guidelines. We assessed data completeness by calculating the percentage of missing values for key variables. We assessed simplicity, acceptability and flexibility by describing surveillance processes and by surveying PHC epidemiologists. We evaluated representativeness by comparing cases registered in EIDSS with cases registered in hospital discharges. We assessed timeliness by calculating the number of days from the date of diagnosis to the date of notification in EIDSS. We calculated the positive predictive value (PPV) as the proportion of cases notified during 2018-2020 having documentation of confirmatory tests in their medical records, meeting the confirmed case definition.

Results:

During 2015–2020, 270 cases of acute viral hepatitis B were reported to EIDSS. All notified cases were HBsAg positive. However, only 53% of the 19 key variables were complete. Hepatitis B test results were missing in most reported cases, despite 82% being classified as "confirmed". Simplicity and acceptability of the system were affected by 30% of respondents experiencing challenges with the EIDSS reporting form. The system had limited flexibility due to cumbersome procedures to implement any changes. Representativeness was limited, as only 41% of confirmed cases recorded in the hospital discharge database were reported to EIDSS. The average notification delay was 72 hours. Among 104 cases notified in 2018-2020, 66 met the case definition, leading to PPV of 63%.

Conclusions:

The surveillance system for acute HBV infection was timely although only 51% of cases were reported within the 24-hour notification target. The system was not representative and did not correctly ascertain cases. We recommend reconsidering the statutory notification time of 24 hours, revising notification forms and providing clear guidelines for data entry, and reporting of all test results needed for adequate case classification to enhance data completeness and reliability of case classification.