Perinatal Hepatitis B Prevention Program Presented by: Carolyn Perry, RN, BSN 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. 4 ACIP Recommendations New or Updated Universal hepatitis B (HepB) vaccination within 24 hours of birth for medically stable infants weighing 2,000 grams. Testing HBsAg-positive pregnant women for hepatitis B virus (HBV) DNA. Post vaccination serologic testing for infants whose mother s HBsAg status remains unknown indefinitely (e.g., when a parent or person with lawful custody surrenders an infant confidentially shortly after birth). Single-dose revaccination for infants born to HBsAg-positive women not responding to the initial vaccine series. Removal of permissive language for delaying the birth dose until after hospital discharge. The MMWR containing the new ACIP Hepatitis B Recommendations available at the link listed below: https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm?s_cid=rr6701a1_w 2
Safely Surrender Infants with HBsAg status unknown mothers Recommendation - all safe surrender infants should be followed by the PHBPP, complete the hepatitis B vaccine series, and obtain PVST. 5 6 NYS Public Health Law 2500-e 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 of an 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. 3
7 Identification of HBsAg+ pregnant women 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. 8 Changes to CDC/CSTE Case Definitions of Communicable Diseases, Effective 2017 Hepatitis B, Perinatal Infection 2017 Includes in the clinical criteria a specific age range for the patient ( 24 months) Updates laboratory criteria to include any of the following: o Positive hepatitis B surface antigen (HBsAg) test (only if at least 4 weeks after last dose of Hep B vaccine) o Positive hepatitis B e antigen (HBeAg) test o Detectable HBV DNA 4
Adds Born to Hepatitis B virus infected mother (i.e., mother positive for HBsAg, HBeAg, or HBV DNA) as epidemiologic linkage criteria. Updates confirmed case classification to include specific age ranges for the patient and time frames for positive testing. Adds a probable case classification for patients whose mother s hepatitis B status is unknown, using the same age ranges for the patient and time frames for positive testing. Clarifies that a patient whose mother is known to not be infected with hepatitis B virus will refer to the case definition for acute Hepatitis B. 9 Immunization Action Plan (IAP) Performance Measure 10 80% of Hepatitis B (HBsAg, HBeAg, HBV-DNA) positive test results that are received through ECLRS for females 10-55 years of age have had their pregnancy status determined. 5
March 19, 2018 11 IAP Performance Measure At least 90% of HBsAg positive, missing, or unknown results that are reported on a newborn screen and hepatitis B (HBsAg, HBeAg, and/or HBV-DNA) positive results reported for women age 10 to 55 had an investigation completed (dismissed or case creation) within 30 days. March 19, 2018 12 IAP Performance Measure At least 90% of PHBPP cases receive education. 6
IAP Performance Measure 13 At least 80% of CDESS PHBPP infant tracking records completed (hepatitis B vaccine series and PVST consistent with CDC guidance or moved) by 15 months of age. March 19, 2018 14 IAP Performance Measure At least 75% of PHBPP cases have contact investigations reported in CDESS at the time of case completion or closeout. 7
Update-CDESS Redesign Complete Infant s Information. 15 Complete Mother s information. Contact investigation(s). On CDESS-Perinatal webinar, is available. Please click the link to view: Perinatal. Update Birth Hospital Policy Provides publicly-purchased hepatitis B vaccine to participating NYS birth hospitals, at no cost to the hospital, to support the universal birth dose for all newborns in their hospital. 16 Hospitals agree to comply with all PHBPP Birth Hospital Initiative requirements and NYS legal requirements for the prevention of perinatal hepatitis B transmission. 8
17 Hospitals NYS upstate Region # of Hospitals Approved Pending Not Interested Total Capital District 13 9 4 0 13 Central District 19 13 3 2 18 MARO 31 8 4 5 17 Western 22 13 4 2 19 Total Hospitals 85 43 15 9 67 IAP Performance Measure 18 100% of birth hospitals are notified of their birth dose rate annually. 9
Updates PHBPP Hospital On-site Monitoring Visit The criteria to conduct an on-site visit includes, but is not limited to: 1) A newborn who is born to a mother with a positive or unknown hepatitis B surface antigen (HBsAg) and did not receive immunoprophylaxis. 19 2) The HBsAg result is reported in error on the newborn screen. For example, the HBsAg result is reported as unknown or negative but the mother is HBsAg positive or the newborn screen is reported as positive but the mother is HBsAg negative. 3) The hospital s birth dose rate is below the state average. PHBPP Hospital REPORT FORM New York State 20 NYS 2016 data: 281 newborns enrolled in the PHBPP in the 57 NYS counties, excluding NYC. Range 1 to 56 PHBPP cases per county. 10
New York State 21 98% of 281 infants born in 2016 and enrolled in the PHBPP received Hepatitis B vaccine and HBIG within one calendar day of birth. New York State 2016 birth cohort, 248 infants or 88% received Hepatitis B vaccine and HBIG within 1 calendar day of birth and completed the Hepatitis B series by 8 months of age. 263 infants or 94% received Hepatitis B vaccine and HBIG within 1 calendar day of birth and completed the Hepatitis B series by 12 months of age. 22 11
New York State 23 79% of infants in the 2016 birth cohort completed PVST by the end of the reporting period. 24 Post Vaccination Serologic Testing (PVST ) Guidance PVST (hepatitis B surface antigen [HBsAg] and hepatitis B surface antibody [anti-hbs]) 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. 12
IAP Performance Measure LHD Staff Training & Resources Task: PHBPP staff will review, NYS PHBPP manual. The CDC pink book, Chapter 10: Hepatitis B. NYS public health law 2500e and regulations. CDESS Help Documents-User Guides-Perinatal Hepatitis B. Participate in ongoing quarterly NYSDOH CO-RO-LHD conference calls, webinars, and training. Resources Central Office and Regional Office Staff Performance Measure - LHD accurately tracks and reports trainings completed by staff. 25 IAP Performance Measure 26 Conducted at least one education and / or professional training session annually. 13
Professional Training 27 Engage hospital staff (meetings, grand rounds) to encourage, PHBPP Birth Hospital Initiative. CDC and NYSDOH best practice recommendations to administer the hepatitis B birth dose to all newborns within 12 hours of birth and achieve at least a 90% universal birth dose coverage. Engage Community Providers to encourage, CDC and NYS PHBPP best practice recommendations. Community Education 28 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. 14
Resources NYSDOH https://www.health.ny.gov/diseases/communicable/he patitis/hepatitis_b/perinatal/ Center for Disease Control http://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html https://www.cdc.gov/vaccines/programs/perinatalhepb/index.html 29 30 Resources-Immunization Action Coalition IAC's ACIP Recommendations web page (sortable by date or vaccine) IAC's Diseases and Vaccines: Hepatitis B web page IAC's print materials about hepatitis B for healthcare professionals IAC's print materials about hepatitis B for patients Give birth to the end of Hep B web page on immunize.org MMWR main page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements Free MMWR electronic subscription 15
31 Resources-Immunization Action Coalition Give birth to the end of Hep B web page on immunize.org Fact sheet about the birth dose honor roll: Do you qualify for the Hepatitis B Birth Dose Honor Roll? If so, apply today. Fact sheet about the importance of the hepatitis B vaccine birth dose: Give birth to the end of Hep B. Hepatitis B Birth Dose Honor Roll web page 84-page guidebook, Hepatitis B: What Hospitals Need to Do to Protect Newborns, which contains a wide range of resources to help birthing institutions establish, implement, and optimize their hepatitis B vaccine birth dose policies Give birth to the end of Hep B slide set, includes script (43 slides) 16