Hepatitis, Viral, Acute 1996 Case Definition

NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.

Clinical Description

An acute illness with a) discrete onset of symptoms and b) jaundice or elevated serum aminotransferase levels.

Laboratory Criteria For Diagnosis

Hepatitis A: Immunoglobulin M antibody to hepatitis A virus (IgM anti-HAV) positive
Hepatitis B:
- IgM antibody to hepatitis B core antigen (anti-HBc) positive or hepatitis B surface antigen (HBsAg) positive
- IgM anti-HAV negative (if done)
Hepatitis C:
- Serum aminotransferase levels greater than 2.5 times the upper limit of normal, AND
- IgM anti-HAV negative, AND
- IgM anti-HBc negative (if done) or HBsAg negative, AND
- Antibody to hepatitis C virus (anti-HCV) positive, verified by a supplemental test
Non-A, Non-B Hepatitis:
- Serum aminotransferase levels greater than 2.5 times the upper limit of normal, AND
- IgM anti-HAV negative, AND
- IgM anti-HBc negative (if done) or HBsAg negative, AND
- Anti-HCV negative (if done)
Delta Hepatitis*: HBsAg or IgM anti-HBc positive and antibody to hepatitis delta virus positive

Case Classification

Confirmed

A case that meets the clinical case definition and is laboratory confirmed or, for hepatitis A, a case that meets the clinical case definition and occurs in a person who has an epidemiologic link with a person who has laboratory-confirmed hepatitis A (i.e., household or sexual contact with an infected person during the 15-50 days before the onset of symptoms)

Comments

Persons who have chronic hepatitis or persons identified as HBsAg positive or anti-HCV positive should not be reported as having acute viral hepatitis unless they have evidence of an acute illness compatible with viral hepatitis (with the exception of perinatal hepatitis B infection). (See Hepatitis B, Perinatal)
Up to 20% of acute hepatitis C cases will be anti-HCV negative when reported and will be classified as non-A, non-B hepatitis because some (5%-10%) have not yet seroconverted and others (5%-10%) remain negative even with prolonged follow-up.¹
Available serologic tests for anti-HCV do not distinguish between acute and chronic or past infection. Thus, other causes of acute hepatitis should be excluded for anti-HCV positive patients who have an acute illness compatible with viral hepatitis.

* Delta hepatitis is not a nationally notifiable disease.

References

Kuo G, Choo Q-L, Alter HJ, Gitnick GL, Redeker AG, Purcell RH, Miyamura T, Dienstag JL, Alter MJ, Stevens CE, et al. An Assay for Cirulating Antibodies to a Major Etiologic Virus of Human Non-A, Non-B Hepatitis. Science 1989;244(4902):362-4

Related Case Definition(s)

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Last Reviewed: April 16, 2021

Source: Office of Public Health Data, Surveillance, and Technology