Hepatitis B Birth Dose: A Self-Study Module for the Maternal and Child Health Nurse

Transcription

1 Hepatitis B Birth Dose: A Self-Study Module for the Maternal and Child Health Nurse With a special feature on frequently asked questions about vaccines

2 Purpose: The purpose of this activity is to expand the participants knowledge of the Hepatitis B birth dose vaccine and to answer frequently asked questions about vaccines. Participants will be able to educate expectant and newly delivered mothers along with significant others. Desired outcome: To increase the number of newborns receiving the birth dose of the hepatitis B vaccine in the hospital by increasing the knowledge of hospital staff and healthcare professionals. Target Audience: This program is intended for maternal and child health nurses. Objectives: 1. Discuss the rationale of the hepatitis B birth dose vaccine. 2. Identify the appropriate treatment of newborns born to both hepatitis B surface Antigen (HBsAg) positive and HBsAg negative mothers. 3. Answer questions frequently asked by parents regarding both the hepatitis B vaccine and vaccinations in general. Continuing Education Certificate Requirements: 1.5 contact hours will be awarded for this program to participants. Central Jersey Family Health Consortium is an approved provider of continuing nursing education by the New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation. Provider number P92-8/ Provider approval is valid through August 31, This program is valid from December 1, 2014 through August 31, All answer sheets and evaluations must be received on or before August 31, To receive a contact hour certificate participants must: Read the self-study module (all powerpoint slides, fact sheets and brochure) Complete the post-test and achieve a score of at least 75% Complete the evaluation form Disclosures: The planners and faculty have nothing to disclose. There is no commercial support for this presentation. ii

3 Since 1992 the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the Centers for Disease Control and Prevention (CDC) have recommended a three pronged approach to prevent hepatitis B infection in newborns: Routine administration of a birth dose of a hepatitis b vaccine to all newborns Identifying all pregnant HBsAg positive women Ensuring that all newborns born to HBsAg women receive prophylaxis The NJ Department Of Health, Vaccine Preventable Disease Program implemented the Perinatal Hepatitis B Prevention Program in 1993, based on recommendations from CDC, ACIP, the AAP, and the American College of Obstetricians and Gynecologists (ACOG) for prevention of perinatal HBV infection. The goal of the program is to identify all pregnant HBsAg positive women to ensure that the newborn receives prophylaxis and/or the hepatitis B vaccine birth dose. According to the 2012 national immunization survey, only 52.6% of newborns in NJ were receiving the birth dose of hepatitis B vaccine compared to the national average of 71.6%. NJ ranks 49 th out of 50 states in birth dose vaccination coverage. *HBsAG A surface antigen of the hepatitis B virus which indicates a current Hep B infection *Antigen: any substance which provokes an adaptive immune response 1

4 HBV is primarily transmitted through direct contact with blood, semen, or vaginal secretions from an infected person, sexual contact, contaminated needles, syringes, and needle sticks. HBV can be spread at birth (mom is infected), from bites from infected person, by touching open sores or cuts, sharing toothbrushes, and contaminated ear piercing needles. 2

5 Hepatitis B is a serious liver infection caused by the Hepatitis B Virus (HBV). It is the most prevalent chronic infection disease in the world, with estimates of 350 million people infected. In the US, it is estimated that 1.2 million people are infected. The younger the child is at the time he is infected, the greater his risk for developing chronic infection. Infants who are infected at birth have a 90% chance of becoming chronically infected with HBV. Adults who contract the disease most often do not develop chronic hepatitis B and may also be asymptomatic. Only 5 10% of adults will develop chronic infection. If the mother or someone who she lives with was born in Africa, Alaska, Eastern Europe, Middle East, S. America, S. Asia or Western Pacific the mother & her child are at a higher risk of becoming infected with hepatitis B. Reference: NJ Department of Health, Perinatal Hepatitis B Prevention Program (2013). Protect All Babies At Birth With Hepatitis B Vaccine. Centers for Disease Control and Prevention: 3

6 According to the 2010 census, there were 725,000 Asians living in NJ. Hepatitis B disease affects 1 in 12 Asian Americans. 4

7 On two annual surveys conducted by the Immunization Action Coalition covering the period from July 1999 to October 2002, state and local hepatitis coordinators reported more than 500 medical errors regarding perinatal hepatitis B prevention. Example on Dec 13, 1999 a previously healthy 3 month old infant of Southeast Asian descent was brought to the hospital and admitted with a 5 day history of fever, diarrhea and jaundice. Hepatitis B serology was ordered and revealed that the infant was HBsAg positive. Liver enzymes were also elevated, the mother was tested & found to be HBsAg +. The baby was diagnosed with hepatic failure d/t HBV. On Dec 16 th she was transferred to another hospital for possible liver transplant. After transfer, the infant developed seizures and her condition rapidly deteriorated. She died on Dec 17 th. Investigation into this case revealed that the mother had tested positive for HBsAg during her pregnancy but the test result was communicated incorrectly. To reduce errors, NJ Department of Health recommends that a copy of the original laboratory report be provided to the birthing hospital. The hospital should verify that the correct test was performed and the testing date was during the current pregnancy. 5

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9 Encouraging the birth dose will provide early protection to infants at risk of infection after the perinatal period. The birth dose will prevent perinatal transmission of the virus in 70 90% of infants born to HBsAg positive mothers. Research has shown that the Hepatitis B vaccine alone, without the Hepatitis B immunoglobulin (HBIG), is effective in preventing perinatal infection. In areas where cost makes the use of HBIG* impractical only the vaccine is used. The cost of the three shot vaccine series range from $75 to $165 for children, but prices may vary. Infants up to 18 months old and even sometimes older children may receive the vaccine free of charge from most local public health clinics. *(HBIG a human immune globulin that is used to prevent the development of hepatitis B) 7

10 The birth dose is a single antigen hepatitis B vaccine, 0.5ml IM. Reference: Immunization Action Coalition. Sample Text for Developing Admission Orders in Newborn Units for the Hepatitis B Vaccine Birth Dose. Centers for Disease Control and Prevention Hepatitis B Information for Health Care Professionals 8

11 0.5ml hepatitis B vaccine IM 0.5ml HBIG For Newborns Weighing More Than 2 KG: If the newborn must be discharged before the result of the mother s HBsAG testing is known, document the parent s contact info, obtain the name, address & phone number of the newborn s healthcare provider. Notify the mother s and newborn s healthcare provider that the mother s HBsAG test result is pending. There is little benefit to administering HBIG if the newborn is more than 7 days old. 9

12 0.5ml HBIG & 0.5ml Hep B Vaccine 10

13 In accordance with NJAC 8:43G19.2, NJ hospital licensing standards, hospitals must ensure that all pregnant women admitted to the hospital with unknown or undocumented HBsAg results are tested & if appropriate the newborn receives prophylaxis. 11

14 New Jersey Administrative Code requires reporting positive cases to the local health department. 12

15 The goal of Healthy NJ 2020 is to have 75% of infants receive the birth dose of the Hepatitis B vaccine. National quality forum has adopted the birth dose as a measure of hospital quality. 13

16 Today s parents and expectant parents have many questions about the safety and necessity of vaccinations. Many are hesitant to have their children immunized. Some fear that the rise in autism over the last few decades is due to vaccinations. Much of the current day misconceptions were initially fueled by a British gastroenterologist/medical researcher, Andrew Wakefield, who produced a research paper claiming that there was a link between the measles, mumps, rubella vaccine (MMR) and autism. Although the paper and author(s) were discredited publically and in the scientific community, the doubts were already planted and there was a rise in the number of parents refusing to have their children immunized. An article by Gerber and Offit (2009) explored three parental concerns that were based on hypotheses that were not supported by the scientific community: one was the link between MMR and autism, another was that a preservative in some vaccines was toxic to the central nervous system and the last one was the administration of multiple vaccines overwhelms the immune system. Despite the fact that research and expert review of the literature* subsequent to 2009, have not supported these hypotheses, many parents and even some health care professionals promote these misconceptions. New parents, most of whom were vaccinated as children, do not remember or had not been born when many of the diseases such as polio, measles, mumps, rubella, and pertussis were widespread. In addition their children were not immune. They do not know of the fears parents had that their child would get polio, and the big relief the parents had when the polio vaccine was finally available. Many people are not aware of the current day reemergence of pertussis and measles. The current recommendation for pregnant women is to receive the pertussis and measles vaccines during the pregnancy and the recommendation for the father of the baby, grandparents and other people taking care of the baby is to have their immunizations up to date. *For a list of recent scientific studies and information related to these topics please go to websites for Every Child By Two ( the American Academy of Pediatrics ( and the Centers for Disease Control and Prevention ( and Vaccine Recommendations of the ACIP( recs/index.html?s_cid=cs_748) 14

17 Dispelling the Myths NO. Immunizations do not cause autism. There was one study done in Great Britain that reported a connection between the MMR vaccine and autism. This study has been retracted and was proven to have been false. The link between immunizations and autism has been reviewed by many experts including the National Academy of Sciences Institute of Medicine. They concluded that there is no available link between MMR vaccine and autism. There are more than 20 published articles that refute the connection. Giving many immunizations at once cannot overload the baby s immune system. Separating the amount of immunizations in an office visit leaves the child possibly susceptible to serious diseases while waiting to receive all the doses. Every day, a healthy baby s immune system successfully fights off millions of antigens, the parts of germs that cause the body s immune system to go to work. The antigens in vaccines come from the germs themselves, but the germs are weakened or killed so that they cannot cause serious illness. Vaccines contain only a tiny fraction of the antigens that babies encounter every day in their environment, even if they receive several vaccines on one day. Thirty years ago, children received a total of 7 vaccines and the total number of bacterial and viral proteins contained in them was about 3,000. Children now receive 14 different vaccines and the total number of proteins is only about 150. The new vaccines are purer and safer. Most published scientific studies do not support a causal relationship between hepatitis B vaccination and MS or other demyelinating diseases. Examples of this scientific evidence can be found on the CDC s website. 15

18 Vaccines protect our children from at least 14 serious diseases. Last year alone, vaccines prevented 14 million infections and 33,000 deaths in the U.S. Yes. Vaccines are safe. Today, we have the ability to protect our babies from at least 14 serious diseases thanks to vaccines. This is why they are recommended by three professional groups dedicated to the safety of children ( the Center for Disease Control, American Academy of Pediatrics, and the American Academy of Family Medicine). Vaccines are approved and licensed by the FDA, continually monitored and reviewed for safety, and are held to the highest standard of safety. Today, we can protect children younger than 2 years of age from 14 potentially serious diseases with vaccines. Every dose of a vaccine is important because they all protect against infectious diseases that are threats today. These diseases can be especially serious for infants and very young children. Parents may not have heard of some of today s vaccines or the serious diseases they prevent. For example, Haemophilus influenza type b (Hib) vaccine prevents a serious bacterial infection that was a leading cause of mental retardation before the vaccine began to be used. Pneumoccocal vaccine prevents today s leading cause of bacterial meningitis. 16

19 A child is more likely to be seriously injured by one of the diseases the immunizations are trying to prevent than by any vaccine. Thimerosal is a mercury containing compound that prevents the growth of dangerous bacteria and fungus. It is used as a preservative in the flu vaccines in to prevent contamination in the multi dose vial when individual doses are drawn from it. Receiving a vaccine contaminated with bacteria can be deadly. Mercury can be toxic to the nervous system. When the US Food and Drug Administration mandated that the amount of mercury in all food and drugs be identified, concern grew that infants could get mercury poisoning. Despite the lack of evidence that infants received harmful quantities of thimerosal, it was removed from vaccines given to young infants. (Gerber and Offit, 2009) Today, except for some flu vaccines in multi dose vials, no recommended childhood vaccines contain thimerosal as a preservative. It is not safe to delay or use an alternative schedule for vaccination administration. It is important to protect babies as soon as it is safe. The schedule was created by doctors, scientists and researchers working together with the CDC. Infants and young children who follow immunization schedules that spread out shots or leave out shots are at risk of developing diseases during the time that shots are delayed. Following the recommended immunization schedule protects infants and children by providing immunity early in life, before they are exposed to potentially life threatening diseases. 17

20 Many parents don t realize that approximately 66% of childhood transmission of HBV occurs in infants whose mothers are HBV negative but who are exposed postnatally from another family member or caretaker with chronic HBV infection or who are inadvertently exposed outside the home. Some parents and healthcare professionals mistakenly think this vaccine is given at birth for a sexually acquired infection that might be contracted later in life; but the most important reason for the vaccine is to prevent HBV infection early in life. 18

21 Frequently Asked Questions Regarding Vaccines and Vaccinations 1. Why are immunizations so important? Vaccines protect our children from at least 14 serious diseases. Last year alone, vaccines prevented 14 million infections and 33,000 deaths in the U.S. 2. Are vaccines safe? Yes. Vaccines are safe. Today, we have the ability to protect our babies from at least 14 serious diseases thanks to vaccines. This is why they are recommended by three professional groups dedicated to the safety of children ( the Center for Disease Control, American Academy of Pediatrics, and the American Academy of Family Medicine). Vaccines are approved and licensed by the FDA, continually monitored and reviewed for safety, and are held to the highest standard of safety. Get vaccine information from trusted sources, such as: VoicesforVaccines.org Immunize.org Vaccinateyourbaby.org 3. Do immunizations cause autism? NO. Immunizations do not cause autism. There was one study done in Great Britain that reported a connection between the MMR vaccine and autism. This study has been retracted and was proven to have been false. The link between immunizations and autism has been reviewed by many experts including the National Academy of Sciences Institute of Medicine. They concluded that there is no available link between MMR vaccine and autism. There are more than 20 published articles that refute the connection. 4. Why does my baby receive so many vaccinations? Today, we can protect children younger than 2 years of age from 14 potentially serious diseases with vaccines. Every dose of a vaccine is important because they all protect against infectious diseases that are threats today. These diseases can be especially serious for infants and very young children. Parents may not have heard of some of today s vaccines or the serious diseases they prevent. 19

22 For example, Haemophilus influenza type b (Hib) vaccine prevents a serious bacterial infection that was a leading cause of mental retardation before the vaccine began to be used. Pneumoccocal vaccine prevents today s leading cause of bacterial meningitis. 5. Is it safe to give multiple immunizations at once? Giving too many immunizations at once cannot overload the baby s immune system. Separating the amount of immunizations in an office visit leaves the child possibly susceptible to serious diseases while waiting to receive all the doses. Every day, a healthy baby s immune system successfully fights off millions of antigens- the parts of germs that cause the body s immune system to go to work. The antigens in vaccines come from the germs themselves, but the germs are weakened or killed so that they cannot cause serious illness. Vaccines contain only a tiny fraction of the antigens that babies encounter every day in their environment, even if they receive several vaccines on one day. Thirty years ago children received a total of 7 vaccines and the total number of bacterial and viral proteins contained in them was about 3,000. Children now receive 14 different vaccines and the total number of proteins is only about 150. The new vaccines are purer and safer. 6. Do vaccines have side effects? A child is more likely to be seriously injured by one of the diseases the immunizations are trying to prevent than by any vaccine. 7. Are preservatives such as mercury and thimerosal needed in vaccines? Thimerosal is a mercury containing compound that prevents the growth of dangerous bacteria and fungus. It is used as a preservative for flu vaccines in multi-dose vials, to keep the vaccine free from contamination. When each new needle is inserted into the multi-dose vial, it is possible for microbes to get into the vial. The preservative, thimerosal, prevents contamination in the multi-dose vial when individual doses are drawn from it. Receiving a vaccine contaminated with bacteria can be deadly. Today, except for some flu vaccines in multi-dose vials, no recommended childhood vaccines contain thimerosal as a preservative. 8. Is it safe to delay vaccines or use an alternative schedule? It is not safe to delay or use an alternative schedule. It is important to protect babies as soon as it is safe. The schedule was created by doctors, scientists and researchers working together with the CDC. Infants and young children who follow immunization schedules that spread out shots- or leave out shots- are at risk of developing diseases during the time that shots are delayed. Following the recommended immunization schedule protects infants and children by providing immunity early in life, before they are exposed to potentially life-threatening diseases. 20

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