Title: Evaluation of the acute hepatitis B surveillance system in the country of Georgia, 2015-2020 (Preprint)

• DOI: 10.2196/preprints.72888
• Publication Date: 2025-02-24T16:55:07Z
• Authors: Lika Karichashvili; Ketevan Galdavadze; Khatuna Zakhashvili; Maia Tsereteli; Ekaterine Ruadze; Sophia Surguladze; Pawel Stefanoff

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 cases notified in 2015-2020, we used the Centres 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% 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 106 cases notified in 2018-2020, 67 met the case definition, leading to PPV 63%.

CONCLUSIONS The surveillance system for acute HBV infection was timely but 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.