Perinatal Hepatitis b Prevention Purpose 2 The primary goal of the Perinatal Hepatitis b Prevention Program (PHBPP) is to identify all pregnant women who are infected with hepatitis b and prevent perinatal transmission of the virus. 1
3 The NYSDOH PHBPP is funded by the Centers for Disease Control (CDC) Immunizations and Vaccine for Children (VFC) 317 Cooperative Agreement. The fifty seven county health departments are an integral part of the NYSDOH PHBPP. NYS Public health law 2500 e 4 Serologic test for hepatitis b surface antigen (HBsAg) for every pregnancy. HBsAg test result prominent in pregnant woman s medical record. Report HBsAg + test results of all mothers of newborn children to the PHBPP. If the mother or infant tested positive for HBsAg the infant shall be offered hepatitis b vaccine and hepatitis b immune globulin within 12 hours of birth or whenever the infant is stable. Follow up hepatitis vaccine series in accordance with the CDC schedule. 2
Identification of HBsAg+ pregnant women 5 The LHD receives all HBsAg positive test results through Electronic Clinical Laboratory reporting System (ECLRS). If the case is a female of child bearing age (10 to 55 years) the local health department investigates to determine if the woman is pregnant. If pregnant, the LHD contacts the prenatal health care provider to confirm the HBsAg status of the pregnant woman and assure the positive HBsAg is clearly documented in her medical record. The LHD completes all perinatal hepatitis B investigations through the Clinical Disease Electronic Surveillance System (CDESS) within 15 days. 6 CDC estimates less than half of hepatitis B surface antigen (HBsAg)-positive pregnant women are identified. One Solution: Four major commercial laboratories have successfully implemented methods to clearly indicate pregnancy status of HBsAg-positive women when available. 3
New York State 7 NYS 2014 data: 287 newborns enrolled in the PHBPP in the 57 NYS counties, excluding NYC Range 0 to 46 PHBPP cases per county Case Manage The LHD should contact the HBsAg positive woman to, Provide information and education; a home visit is preferable. Both verbal and written information should include an overview of hepatitis B infection, importance of timely vaccination and PVST for her newborn, preventing the transmission of hepatitis B, other. 8 Identify, counsel, test, and vaccinate all household, sexual, and needlesharing contacts as indicated. Offer Hep B vaccine to all household, sexual, and needle sharing contacts. The LHD perinatal hepatitis B coordinator is responsible to documenting all counseling, testing and vaccination of susceptible contacts. 4
Newborn prophylaxis The LHD contacts the delivery hospital to alert the staff of the positive HBsAg status and due date and ensures that the hospital has best practices in place that are consistent with CDC recommendations and NYS public health law 2500-e to administer hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth. 9 Hospitals must notify the county health department within 24 hours for all HBsAg + pregnant women. Maternal HbsAg status is reported on the newborn screen form. Follow up is required on all positive, unknown, and missing information. New York State 10 99% of 279 infants born in 2014 and enrolled in the PHBPP received Hepatits b vaccine and HBIG within one calendar day of birth 5
Vaccinate The LHD works with the infant s physician to assure the 3-dose hepatitis B vaccine series and post-vaccination serologic testing (PVST) is completed, consistent with CDC recommendations. 11 The LHD reports the details of the child's follow up care in CDESS within 30 days for each CDC recommended hepatitis b vaccine and PVST. New York State 12 2014 birth cohort, 219 infants or 78.5% received hepatitis b vaccine and HBIG within 1 calendar day of birth and completed the hepatitis b series by 8 months of age (decrease from 84% 2013 birth cohort). 255 infants or 91% by 12 months of age (decrease from 92%). 6
New Post Vaccination Serologic Testing (PVST ) guidance PVST of Infants Born to Hepatitis b-infected Mothers should be, ordered at age 9 12 months, or 1 2 months after the final dose of the vaccine series, if the series is delayed. PVST should not be drawn before 9 months of age. 13 NYS Data 14 65% of infants in the birth cohort who completed PVST by the end of the reporting period, this is an increase from 62.8% in 2014. 7
Birth Dose 15 Encourage area birthing hospitals to maintain CDC and NYSDOH best practice recommendations to administer the hepatitis B birth dose to all newborns within 12 hours of birth and achieve a 90 % universal birth dose coverage for all newborns. New York State 2015 NYS excluding NYC 116,236 births Birth dose rate for 89 birth hospitals, outside of NYC, ranges from 39% to 96%, with a state wide average of 83.8% 32 hospitals achieved 90% birth dose rate or higher 59 hospitals ordered hepatitis b vaccine through the PHBPP in 2014 16 8
Community Education 17 Organizations that focus on prenatal, postpartum, and pediatric care. Social service agencies /institutions/faith based organizations, etc. that provide services to high-risk populations. Persons who are immigrants, refugees, asylum seekers, and internationally adopted born in Asia, the Pacific Islands, Africa, and other regions with high endemicity of HBV infection. Resources 18 NYSDOH https://www.health.ny.gov/diseases/communicable/hepati tis/hepatitis_b/perinatal/ Center for Disease Control http://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html Immunization Action Coalition http://www.immunize.org/birthdose/ 9
19 Assessment, Feedback, Incentives, exchange (AFIX) Program Purpose 20 The AFIX program is a research supported continuous quality improvement process to increase and sustain high immunization coverage rates and incorporate evidence based immunization practices at the immunization provider level. 10
Goal 21 The NYS DOH Bureau of Immunization goal, consistent with the Healthy People 2020 objective, is to meet or exceed a 80% immunization coverage level state wide for 19 35 month old children with the 4:3:1:3:3:1:4 series. AFIX Components 22 Assessment Feedback Incentives exchange 11
AFIX Visits Prioritized to providers with low 4:3:1:3:3:1:4 immunization rates. Half (50%) of all AFIX visits must be performed at practices in the bottom quartile for 4:3:1:3:3:1:4 rates. 23 Prioritize the remaining AFIX visits based on: The highest volume providers with the lowest 4:3:1:3:3:1:4: and/or adolescent immunization rates. Newly enrolled VFC providers. Practices that have new staff involved in the VFC. 24 The reviewer must complete all documentation in the AFIX Online Tool. For assistance, contact your Regional office contact or the AFIX Coordinator, Carolyn Perry, at (518) 473-4437 Carolyn.perry@health.ny.gov 12
Resources 25 Online Tool training video & user guide are on PAPA (AFIX Program AFIX2016 Training video) Site visit toolkit-coming soon Childhood report card Adolescent report card The Pink Book-The AFIX Approach Resources 26 NYSDOH AFIX https://www.health.ny.gov/prevention/immuni zation/providers/afix/ CDC AFIX http://www.cdc.gov/vaccines/programs/afix/i ndex.html?s_cid=cs_748 13