STATE TDAP VACCINE PROGRAM CDPH provides free Tdap vaccine for local public health departments. This vaccine then is distributed to clinics through out county. Vaccine to be specifically given to: Woman during 27-36 weeks of pregnancy Household members of pregnant women Household members of infants <1 year of age To request Tdap vaccine supply contact: Melissa Thun, RN Immunization PHN supervisor Masha Djuric, RN State Tdap program coordinator
OVERVIEW OF PERINATAL HEPATITIS B PREVENTION PROGRAM Masha Djuric, RN, PHN Immunization Program Epidemiology and Immunization Services Branch Health and Human Services Agency County of San Diego
HEPATITIS B FACTS There are 350 million people worldwide chronically infected with hepatitis B, the leading cause of liver cancer. Majority of those with chronic infection acquired it from mother-to-child transmission at birth or during early childhood. About 1 million people die from Hepatitis B every year, but it is entirely preventable through vaccinations and protective shots given at birth.
CHRONIC HEPATITIS B FACTS Global public health problem: An estimated 1.2 million people living with Chronic Hepatitis B infection in the United States. Can lead to liver cancer: Approximately 15% to 25% of people with chronic Hepatitis B develop serious liver damage, including liver cancer. Currently living with Hepatitis B: Millions of people currently living with chronic Hepatitis B were infected as infants or during early childhood. These infections occurred before the vaccine was available and widely used. Silent disease: Chronic Hepatitis B is often silent and many people can go decades without symptoms. Most don t know it: Up to two-thirds of Americans living with chronic Hepatitis B do not know they are infected.
HEPATITIS B
PREVALENCE OF HEPATITIS B
PREVALENCE OF HEPATITIS B
PERINATAL HEPATITIS B FACTS Without postexposure immunoprophylaxis, about 70-95% of infants born to HBV-infected mothers will develop chronic HBV infection, approximately onefourth of whom will eventually die from chronic liver disease. Perinatal HBV transmission can be prevented by identifying HBV-infected (Hepatitis B surface antigen - positive) pregnant women and providing Hepatitis B immune globulin and Hepatitis B vaccine to their infants within 12 hours of birth.
PERINATAL HEPATITIS B
NATIONAL GUIDELINES Preventing perinatal HBV transmission is an integral part of the national strategy to eliminate Hepatitis B in the United States. National guidelines call for the following: Universal screening of pregnant women for HBsAg during each pregnancy Case management of HBsAg positive mothers and their infants Provision of immunoprophylaxis for infants born to infected mothers, including Hepatitis B vaccine and Hepatitis B immune globulin Routine vaccination of all infants with the Hepatitis B vaccine series, with the first dose administered at birth
CA PERINATAL HEPATITIS B PREVENTION PROGRAM National Program In 1989 Hepatitis B infection became a condition reportable to California Department of Public Health (CDPH). The California Perinatal Hepatitis B Prevention Program (CA PHBPP) is managed by the CDPH. The program was established in 1991 to provide resources and technical support to local health departments (LHD) for perinatal hepatitis B prevention and to provide surveillance for perinatal hepatitis B cases.
CALIFORNIA PHBPP GOALS The goals of the CA PHBPP include: Prenatal testing of pregnant women for HBsAg to identify infected mothers. Appropriate immunoprophylaxis for infants born to these mothers and post vaccination serologic testing. Outreach and education for infected women and their contacts, birth hospitals, prenatal care providers and pediatricians. Referrals for serologic tests and immunizations for susceptible household contacts.
SD COUNTY PHBPP ACTIVITIES State funding of local programs supports these activities: Case management of pregnant infected women and their infants. Education of medical providers, birth hospitals, and hepatitis B infected pregnant women and their close contacts. Coordination with birth hospitals to promote implementation of national perinatal Hepatitis B prevention recommendations.
PHBPP OUTREACH
PHBPP PROCESS HBV+ labs reported to PHD via fax, email or WebCMR lab reporting PHN identifies females of childbearing age (14-45) Administrator identifies if female is pregnant Pregnant female is enrolled into PHBPP and PHN starts case management Contact with community health partners: Administrator requesting information from lab ordering providers. Info requested: pregnancy status, if YES EDD, delivery hospital, demographics, ethnicity, insurance info, gravida?
PHBPP PROCESS CONTINUES PHN contacts pregnant female and introduces PHBPP and provides education Administrator contacts birth hospital and hospital notifies us when baby is born PHN contacts baby s pediatrician and starts following HB vaccine and PVS progress Child PVS tested and if immune (HBsAb +) Case is closed by administrator. Info requested: Date and time of birth and d&t HBIG and 1 st HB vaccine, weight at birth, sex and name of infant. Info requested: Date of 2 nd, 3 rd or 4 th HB vaccines. Results of post vaccination serology (PVS). Goal: HBsAg (-) negative, HBsAb (+) positive if NOT: Repeat HB vaccination series and PVS.
PROPHYLAXIS Two types of products are available for prophylaxis against Hepatitis B infection: Hepatitis B Immune Globulin (HBIG) provides temporary protection (i.e., three to six months) and is used as passive immunization for discrete, identifiable percutaneous or mucosal exposures and for perinatal exposure within 12 hours of birth. Hepatitis B vaccine, which provides long-term protection against HBV infection, is recommended for pre-exposure and post-exposure prophylaxis.
PEP ERRORS Postexposure Prophylaxis Errors Birth hospitals are responsible for administering Hepatitis B postexposure immunoprophylaxis (PEP) to all infants born to mothers who are infected with Hepatitis B. PEP errors identified by LHD are reported to CDPH and CDPH reports to The Joint Commission. Failure to provide PEP increases the infant s risk of acquiring hepatitis B infection, which can lead to fulminant or chronic hepatitis and early death.
COMMON PEP ERRORS HBIG given >12 hours Misinterpretation of lab reports Transcription of lab reports or lapses in reporting Mother didn t have Prenatal care and was never tested for HBsAg and hospital fails to test mother post delivery.
POST VACCINATION SEROLOGY Per CDPH Perinatal Hepatitis B Guidelines for Pediatric Care Providers: All infants born to HBsAg positive women should be tested 1-2 months after having received their third dose of hepatitis B vaccine, but not before 9 months of age. Required tests: Hepatitis B Surface Antigen (HBsAg) Hepatitis B Surface Antibody (Anti-HBS)
STATISTICS AT A GLANCE In year 2014 3,500+ (estimate) HB+ labs reported to EISB 753 clinics/doctor offices contacted with an average of 63 per month 192 new cases opened with an average of 16 per month 159 babies were born to chronic HBV mothers 145 cases closed and these include cases opened previous years 112 PVS obtained in which the babies were immune (Anti-HBsAb+) 2 cases were closed after receiving 2 nd round of HB series 3 PEP errors were identified and reported to CDPH 0 cases of HBsAg+ conversion in SD County in 2014 1.2% state wide conversion rate
LOCAL CONTACT INFORMATION Carmen Phruksukarn PHBPP Administrator 619-692-5542 or Carmen.Phruksukarn@sdcounty.ca.gov Florencia Sisterson, RN PHBPP Coordinator 619-692-8691 or Florencia.Sisterson@sdcounty.ca.gov Heidi Unruh, RN PHBPP case management 619-692-8670 or Heidi.Unruh@sdcounty.ca.gov Masha Djuric, RN PHBPP case management 619-542-4121 or Maria.Djuric@sdcounty.ca.gov Melissa Thun, RN Immunization PHN Supervisor
RESOURCES CDC - http://www.cdc.gov/hepatitis/resources/index.htm CDPH - http://www.cdph.ca.gov/healthinfo/discond/pages/perinatalhepatitis BPrevention.aspx SDIZ - http://www.sdiz.org Hep B Moms - http://hepbmoms.org/projects.html Asian Liver Center - http://liver.stanford.edu/ PHBPP Coordinator List - http://www.cdc.gov/hepatitis/partners/perihepbcoord.htm CA PHDPP Coordinators Handbook - http://www.cdph.ca.gov/healthinfo/discond/ Documents/PHPPCoordinator'sHandbook2-23-09.pdf MMWR 12/2005, A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States - http://www.cdc.gov/mmwr/pdf/rr/rr5416.pdf
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