| Course | NR 586NP Population Health and Epidemiology for Advanced Nursing Practice |
|---|---|
| Week | 4 |
| Paper type | Surveillance data review |
| Length | About 1,140 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, nurse practitioner core |
| Updated | October 2026 |
Free sample paper for NR 586NP Week 4
Surveillance Data Review: Newly Reported Chronic Hepatitis C in Hollis County, 2019 to 2025, and Why a 61% Rise in Reports Is Mostly a Rise in Testing
Student Name
College of Nursing, Chamberlain University
NR 586NP: Population Health and Epidemiology for Advanced Nursing Practice
Instructor Name
Month Day, Year
Surveillance Data Review: Newly Reported Chronic Hepatitis C in Hollis County, 2019 to 2025, and Why a 61% Rise in Reports Is Mostly a Rise in Testing
The System Before the Numbers
Hepatitis C is a notifiable condition in the state. Laboratories must report positive antibody results and all RNA results, positive and negative, to the state health department's electronic surveillance system; most do so automatically through electronic laboratory reporting. Clinicians must also report cases they diagnose. The department's staff classify each report using the national case definition in force: since 2020, a confirmed chronic case requires a positive RNA test, while an antibody-positive result alone without RNA is not counted as confirmed. The system was built to find cases for follow-up and to count them for planning; it was not designed to measure how many people are infected, only how many are found.
The Extract, Described Exactly
Geography: Hollis County residents, by address at the time of report.
Period: calendar years 2019 to 2025; 2025 provisional for October to December, extracted on 15 January 2026.
Measure: newly reported confirmed chronic hepatitis C cases (first report ever for that person), with annual rates per 100,000 using census mid-year estimates.
Case definition: the 2020 national definition for all years; reports from 2019 were reclassified by the department under the same definition, so the series is consistent.
Testing volume: the number of hepatitis C antibody tests reported from county residents each year, available since 2021, when the state began requiring negative results.
The Trend
| Year | New chronic reports | Mid-year population | Rate per 100,000 | Antibody tests reported | Antibody positivity |
|---|---|---|---|---|---|
| 2019 | 88 | 38,900 | 226.2 | not available | not available |
| 2020 | 61 | 38,800 | 157.2 | not available | not available |
| 2021 | 97 | 38,700 | 250.6 | 1,540 | 8.1% |
| 2022 | 118 | 38,500 | 306.5 | 3,210 | 6.0% |
| 2023 | 131 | 38,400 | 341.1 | 4,060 | 5.4% |
| 2024 | 139 | 38,300 | 362.9 | 4,710 | 5.1% |
| 2025 (provisional) | 142 | 38,200 | 371.7 | 4,980 | 4.9% |
Reports rose from 88 in 2019 to 142 in 2025, a rise of 61%; the rate rose from 226 to 372 per 100,000.
Two Explanations for Every Rise
2020 fall. Reports fell by about a third. A real fall in infection is unlikely in one year. The more likely explanation is that clinic visits and routine testing dropped when the pandemic first closed clinics and kept patients home.
2021 rebound. Reports returned above the 2019 level. Infections missed in 2020 may have been found in 2021. The CDC's April 2020 advice that every adult be tested once in their lifetime (Schillie et al., 2020) also began to change practice.
2022 to 2025 rise. Two explanations sit side by side. More infection: the county's overdose deaths remain high, and injection drug use drives new infections in the region (Zibbell et al., 2018). More testing: the health center began screening every adult in January 2022, the jail began testing at intake in 2024 and a regional laboratory began reporting electronically in March 2023. Antibody tests reported tripled between 2021 and 2025, from 1,540 to 4,980, while positivity fell from 8.1% to 4.9%.
The falling positivity is the key. If infection were rising and testing stayed the same, positivity would rise. Instead, the department is testing many more people, including many at low risk, and finding a smaller share positive. The rise in reports is therefore mostly a rise in testing. Some of it may still be real, and the acute case series, which counts recent infections, is the better place to look.
The Acute Series
Acute cases were 6, 4, 7, 8, 11, 10 and 9 for 2019 to 2025. These are small numbers that move by chance. Acute cases also depend on testing: a case can be classed as acute only if a recent negative test exists, so more repeat testing at the syringe program creates more acute cases. The series does not show a clear rise or fall.
Provisional Means Incomplete
The 2025 figure is provisional for the last quarter. In earlier years, the final count for each year was about 6% to 10% higher than the count extracted in mid-January, because some laboratory and clinician reports arrive weeks late and some cases are reclassified. The final 2025 figure is likely to be around 150 to 156, not 142. Reading the small rise from 2024 to 2025 as a leveling off would be premature until the final count is in.
Denominator Changes
The county population fell by about 700 between 2019 and 2025, a decline of under 2%. That alone raises rates slightly, by about the same proportion, but explains very little of the change.
The Cases That Never Arrived
The system counts only infections that are tested and reported. It misses residents who are never tested, which includes many people who use drugs by injection and never meet a service; residents tested at out-of-state facilities, which report to their own state; and people who had an antibody test without a follow-up RNA test, who cannot be confirmed. The health center's own data show that 7 of 197 antibody-positive patients in 2025 had no RNA result, usually because the sample was insufficient. The true number of residents with current infection is therefore higher than the reports suggest, and the increase in reports is partly the system catching up with infections that already existed.
How Testing Volume Was Used
Testing counts are a denominator for the reports, though not a population denominator. Dividing reports by tests gives a crude yield: in 2021, 97 new chronic reports came from 1,540 antibody tests, about 6.3 per 100 tests; in 2025, 142 from 4,980, about 2.9 per 100 tests. The yield more than halved. This crude measure has limits, because one person may be tested more than once and some reports arise from tests done outside the county, but the direction is clear. Friis and Sellers (2021) describe the effect of case-finding on reported incidence, and this series shows it at the scale of one county.
What a Reader Should Take From the Trend
The county is finding far more hepatitis C than it did five years ago, mainly because it is looking harder. That is good news for diagnosis. It does not, on its own, show that infection is spreading faster. Two things would help: the final 2025 count, and a few more years of the acute series with stable testing at the syringe program.
Limits
The testing series begins only in 2021. The population figures are estimates. The data are composite and stand in for what a county's surveillance staff would provide.
References
Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett Learning.
Schillie, S., Wester, C., Osborne, M., Wesolowski, L., & Ryerson, A. B. (2020). CDC recommendations for hepatitis C screening among adults: United States, 2020. MMWR Recommendations and Reports, 69(2), 1-17. https://doi.org/10.15585/mmwr.rr6902a1
Zibbell, J. E., Asher, A. K., Patel, R. C., Kupronis, B., Iqbal, K., Ward, J. W., & Holtzman, D. (2018). Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. American Journal of Public Health, 108(2), 175-181. https://doi.org/10.2105/AJPH.2017.304132
Reading the NR 586NP Week 4 instructions
The Week 4 review opens on the system: what it was built to detect, who must report and by what route, because a trend cannot be read without knowing how the numbers arrive. Describe the extract precisely, including geography, period, measure and the case definition in force. Then read the trend carefully, putting a second explanation beside every rise: wider testing, a changed definition, a laboratory newly reporting or a shifting denominator. Mark recent points as provisional. Most rubrics mark down calling a rise an outbreak when testing changed, reading the last weeks as a decline when they are still filling in, a review with no case definition and a narrated graph.
How this NR 586NP Week 4 example is built
The sample explains that laboratories report positive antibody and all RNA results electronically and that a confirmed chronic case needs a positive RNA test under the 2020 definition. The extract is defined by residence, years, measure and reclassification. A table gives reports, population, rates, antibody tests and positivity from 2019 to 2025. Each period gets two explanations, and falling positivity is used to weigh them. A section computes a crude yield per 100 tests. The acute series is read for chance and testing effects. Provisional counts, the small population change and missing cases are covered, followed by what to take from the trend. Margin notes point out where the definition and the testing explanation earn their rows.
Reading the NR 586NP Week 4 grading rubric
The heavy loss is calling a rise an outbreak when the testing changed, and this review shows testing tripled while positivity fell. Reading the final points as real change when they are still filling in costs the next share, so the 2025 count is marked provisional with an expected final range. A review with no case definition leaves every comparison undefended, while this one states the definition and confirms earlier years were reclassified. A narrated graph that never interprets loses a row; every period here is interpreted. Counts with no denominator and a population change left unmentioned lose smaller marks, and both are addressed.
NR 586NP Week 4 help: mistakes that cost points
The commonest NR 586NP Week 4 problem is a review that sees rising numbers and concludes the disease is spreading. Another is treating the latest weeks or months as complete. Many reviews never state the case definition or check whether it changed. Some describe the shape of a line without interpreting it. Testing volume is often ignored. Few reviews ask which cases never reach the system. Start with how reports arrive, set a testing explanation beside every rise and use positivity or yield to weigh the two. If your condition differs, send the series and what you know about reporting, and a sample review can read it the same way.
Get a NR 586NP Week 4 example written to your instructions
Send the assignment instructions, the rubric and the surveillance data your classroom pointed you toward, and a custom example review is written to your parameters and delivered inside 24-48h, the first one free. If your section names a particular system or a date range, include it and the example works from that.
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NR 586NP Week 4 questions, answered
What does surveillance data actually support saying?
It supports statements about reported cases and about changes in reporting, and it supports hypotheses about disease. The gap between those is the whole subject. A finished review pitches its conclusions at the level the system can carry, then names what would be needed to say more, usually active case finding or a survey that does not depend on people presenting for care.
Is passive reporting worth analyzing if it misses so much?
Yes, because it misses steadily. A system capturing a fraction of cases can still show direction reliably as long as the fraction stays roughly constant, and the analysis turns on whether anything disturbed it: a new test, a publicity campaign, a definition change, a laboratory joining or leaving. Stability of ascertainment is the assumption to examine out loud.
How does clinical experience help in this week?
It tells you where the leaks are. A practitioner knows which presentations get tested and which get treated empirically, which reports are filed at the end of a long clinic and which are not, and which patients avoid the encounter entirely. That knowledge belongs in the under ascertainment section, written as reasoning about the reporting pathway rather than as a personal story.
Where can I find a free NR 586NP Week 4 sample paper?
The full surveillance data review of seven years of county hepatitis C reports, with testing volume and positivity, is published on this page.
Why is the rise mostly testing in the NR 586NP Week 4 review?
Antibody tests tripled from 1,540 to 4,980 while positivity fell from 8.1% to 4.9%, which is what more testing among lower-risk people looks like.