Perinatal Hepatitis B Prevention Program

1
Perinatal Hepatitis B Prevention Program

• Overview and Goals
• Julie Anderson, BSN, RN
• Perinatal Hepatitis B Presentation
• Brazos County Health Department

2
Six Responsibilities of Perinatal Hepatitis B
Prevention Program
Assure identification of ALL HBsAg positive women
and their infants
Assure all exposed infants receive HBIG and 1st
dose of hep. B vaccine w/in 12 hours of birth
Prevention ofPerinatal Hepatitis B Transmiss
ion

Assurecompletion of 3 doses of hepatitis B
vaccine and post vaccination testing of exposed
infants
Assure that all susceptible household and sexual
contacts are vaccinated
Conduct active surveillance, quality assurance,
and outreach to improve program
3
Hepatitis B Virus

• Caused by a double-stranded DNA virus Incubation
  period of 45-160 days
  
• Can survive 30 days on surfaces
• Causes acute and chronic HBV infection
• Humans are the only host

4
Serologic Markers of Hepatitis B

• There are three well defined antigens associated
  with Hep B
  
• HBcAg
• HBeAg
• HBsAg viral antigen measured most routinely in
  blood. It is the earliest serologic marker to
  appear before onset of infection.

5
Perinatal Transmission

• If the mother is positive for hepatitis B surface
  antigen (HBsAg) and HbeAg, the risk of perinatal
  transmission is 70-90.

6
Perinatal Transmission

• Up to 25 of infants infected during the
  perinatal period will die in adulthood of chronic
  liver disease.

7
How to prevent perinatal HepB transmission

• Identify HBsAg-positive pregnant women through
  serologic screening.
  
• Provide prophylaxis for infant born to
  HBsAg-positive women.
  
• Provide the birth dose of hepatitis B vaccine to
  ALL infants.

8
Screening Pregnant Women

• Texas Law requires all pregnant women be screened
  for HBsAg during an early prenatal visit and at
  the time of delivery for each pregnancy.
  
• (Texas Administrative Code Title 25, Part 1
  Chapter 97, subchapter F 97.135)

9
Hospital Responsibility

• Screen all pregnant women for HBsAg at delivery
  for each pregnancy
  
• Report all HBsAg-positive women to the Brazos
  County Health Department or Texas Department of
  State Health Services (DSHS).
  
• Administer the hepatitis B vaccine at birth ALL
  newborns.

10
Hospital Responsibility

• Administer the Hep B vaccine birth dose and HBIG
  within 12 hours of birth to infants born to
  
• HBsAg-positive mothers
• Mothers of unknown HBsAg status
• Administer the Hep B vaccine birth dose to ALL
  newborns before hospital discharge.

11
Hospitals Prophylaxis of Premature Infants

• HBsAg positive women or unknown HBV status
• Initiate prophylaxis at birth
• If birth weight vaccine is not counted
  
• Infant will need 4 doses of Hep B vaccine
• Initiate second dose of hepatitis B vaccine at 1
  month of age (chronological)
  
• HBsAg-negative women
• Delay first dose of Hep B vaccine until one
  month of age (chronological).

12
Recommendations

• Document maternal HBsAg in both maternal and
  infant records.
  
• Include a hard copy of HBsAg lab results in
  hospital records.
  
• Establish a specific written policy for perinatal
  hepatitis B prevention.
  
• Establish universal hepatitis B vaccine birth
  dose policy.
  

13
Reporting

• Once HBsAg positive lab results are reported we
  provide
  
• Educational and consultative services
• Provide completion of the hepatitis B vaccine
  series.
  
• Provides post-vaccination testing.
• Provides vaccination of household and sexual
  contacts of HBsAg-positive women.
  

14
Prevention Outcome

• Increase life expectancy
• Increases quality of life
• Reduced health care cost
• Hepatitis B vaccine series cost 27.00
• New liver costs1,000,000

15
How Are We Doing?

• Only 64 of pregnant women were screened for
  HBsAg in the hospital at the time of delivery.
  
• (statistic based on quality assurance review of
  the top 66 birthing hospitals in Texas)

16
Reporting Forms

• Reporting forms are available at
• http//www.TexasPerinatalHepB.org
• http//www.brazoshealth.org

17
Summary

• The overall goal of our program is twofold
  identify the pregnant women who are hepatitis B
  surface antigen positive and to prophylax their
  infants appropriately.

18
Contact Information

• Brazos County Health Department
• Perinatal Hepatitis B Prevention Program
• 201 North Texas Avenue
• Bryan, Texas 77803
• Phone [phone]
• Fax [phone]
• www.brazoshealth.org