linda.vrtis@metrokc.gov or 206-296-4777 Public Health-Seattle & King County Implementation of a Mandatory Reporting Requirement in King County Linda Vrtis, PHN Public Health-Seattle & King County Communicable Disease Control, Epidemiology & Immunization linda.vrtis@metrokc.gov or 206-296-4777

Public Health-Seattle & King County Background Large city/county health department King County Population: 1.76 million Perinatal Hepatitis B Prevention Program (PHBPP) staff One administrative staff member (75% time) One Public Health Nurse (25% time) Over 60% of enrollees in the Washington State PHBPP are King County residents In 1994, 0.4% of women who delivered babies in Washington State hospitals were HBsAg-positive

Public Health-Seattle & King County Background Mandatory (physician-based) reporting of all cases of hepatitis B virus (HBV) infection implemented in Washington State in December 2000 Prior to becoming mandatory reporting compliance difficult to establish & maintain 1996 -1999 < 64% of Washington State minimum expected births to HBsAg+ women were identified

Public Health-Seattle & King County Objectives Present the number of reports: chronic HBV infection HBsAg-positive pregnant women births to HBsAg-positive women Compare timeliness of pre-delivery reporting of HBsAg+ pregnant women prior to and after implementation of mandatory reporting

Public Health-Seattle & King County Objectives (con’t) Discuss interventions to increase awareness of program to increase timeliness of reporting one-on-one telephone contact with program coordinator and health care providers targeted letters to health care providers failing to report cases in a timely fashion educational presentations for health care providers

Public Health-Seattle & King County Methods Reports were compared for 2000 and 2001 persons with chronic HBV infection HBsAg-positive pregnant women Number of births per year to eligible women 1995-2001 Number and percent of women reported & delivered in the same year were compared by year of report 1995-2001

Public Health-Seattle & King County Results 1996 to 2000 received 200 to 400 new chronic HBV reports per year 2001 and 2002 received 629 and 585 new reports of chronic HBV infection, respectively Number of births to HBsAg+ women reported increasing: 147 in 2000, 150 in 2001 and 185 in 2002 Number of reported HBsAg+ pregnant women increasing: 150 in 2000, 189 in 2001 and 202 in 2002

Public Health-Seattle & King County Results (con’t) Pre-delivery reporting of eligible women increased: 1995 to 2000 an average of 37% of women were reported pre-delivery (range 32% to 43% per year) in 2001 51.5% of women were reported prior to delivery

Public Health-Seattle & King County *Rate per 1,000 live births

Public Health-Seattle & King County *No PHBPP coordinator for 75% of 1998

Public Health-Seattle & King County

Public Health-Seattle & King County Other Measures to Increase Compliance with Reporting-Current Presentations given on PHBPP: Perinatal Nurses Consortium (bi-annual) As requested Letters: targeted health care providers not reporting in a timely fashion to parents and health care providers stating recommendations for: primary vaccination series management of premature infants management of infants without adequate immunity after primary vaccination series

Public Health-Seattle & King County Other Measures to Increase Compliance with Reporting-Current One-on-one telephone contact with health care providers to discuss program components and management of perinatally-exposed infants general resource for providers Fact Sheet Materials on Internet site http://www.metrokc.gov/health/prevent/, then select “Hepatitis B”

Public Health-Seattle & King County Other Measures to Increase Compliance with Reporting-Future Revision of the Washington State PHBPP manual with targeted sections for: Hospital maternal and child staff OB/GYN, pediatric, and family practice providers Parents & families Presentations on PHBPP program components for hospital maternal and child unit staff

Public Health-Seattle & King County Other Measures to Increase Compliance with Reporting-Future Letters and certificates of appreciation upon completion of follow-up serologic testing: health care providers mothers Letters to clinic office managers requesting a consistent (preferably clinician) contact responsible for reporting

Public Health-Seattle & King County Conclusions Mandatory reporting of chronic HBV increases: number of reports number of program-eligible women identified timeliness of reporting of HBsAg+ pregnant women Low-intervention & low-cost methods: help inform health care providers about the program may improve compliance with timely reporting

Public Health-Seattle & King County Acknowledgements Shelly McKeirnan, RN, MPH, Epidemiologist Communicable Disease Control/Epidemiology Public Health-Seattle & King County Chas DeBolt, RN, MPH, Epidemiologist