Hepatitis B Vaccine Birth Dose Promotion & Policy Evaluation National Immunization Conference - 2009 5/31/2018 Hepatitis B Vaccine Birth Dose Promotion & Policy Evaluation Ohri LK, Eslinger C, Stapp K, Chatterjee A, Christensen C, Hrdy M Immunization Task Force – Metro Omaha Immunization Task Force – Metro Omaha Immunization Task Force - Metro Omaha

Immunization Task Force Metro Omaha National Immunization Conference - 2009 5/31/2018 Immunization Task Force Metro Omaha Began in 1991 by Children’s Hospital and Douglas County Health Department (along with other partners) - in response to identified low immunization rates and measles outbreaks Paid part time staff in early years (CDC funds) Volunteer only since ~2003 Currently represents approximately 27 different organizations and agencies, with approximately 68 individual members. Organizational Structure: - Steering Committee - Professional Liaison Committee - Community Liaison Committee - Legislative / Advocacy Committee Parent organization to the Nebraska Immunization Registry Coalition (NE-IRC) Examples of Activities: Health Fairs - Screening; Assessment; Education; Promotion Vacci-Fax newsletter, eventually distributed electronically across state Speaker’s Bureau (episodically over years) – Professional (with CE provided) and some Lay programs as well Successful Legislative Advocacy (Immunization Registry; Vaccine school mandates; opposition to Thimerosal legislation) Annual Flu campaign to Metro Daycares (School promotion added in 2008) + general promotion (Bus signs + Marquee advertising, etc) Annual Governor’s Proclamation of August Immunization month Immunize Nebraska Conference – Since 2004 (This program is the major source of funds raised for Task Force activities) Participation on 317 Coalition 5-6 national presentations and posters at the National Immunization Conference and National Immunization Coalition meetings 2 publications in Nebraska Pediatrician journal Assistance to two additional regional immunization coalitions in start up and development of by-laws Immunization Task Force - Metro Omaha

National Immunization Conference - 2009 5/31/2018 Background Hepatitis B Birth Dose (HBBD) Project: 2002 Survey 25% of Nebraska birthing hospitals had a policy to offer hepatitis B vaccine to all newborns prior to discharge NIS – Nebraska infants (born 1/2003 – 6/2005) 13% received hepatitis B vaccine within 24 hrs Chatterjee A, Yasmin T, Vanderbur LE, Ohri LK. Hepatitis B: Maternal screening and infant immunization policies in Nebraska hospitals. Nebraska Pediatrician Winter 2004/2005; 1, 6, 9-11. CDC. Newborn Hepatitis B Vaccination Coverage Among Children Born January 2003--June 2005 --- United States. MMWR Weekly 2008; 57(30):825-828. Immunization Task Force - Metro Omaha

Promotion Efforts – Metro Omaha National Immunization Conference - 2009 5/31/2018 Promotion Efforts – Metro Omaha Grand Rounds presentation at Children’s Hospital Recognized Expert – Thomas Saari, MD, PID, FAAP Provision of educational materials to medical and birthing unit staff Utilization of physician colleague advocate to promote hepatitis B birth dose (HBBD) to birthing unit medical staff Direct educational presentations by ITF’s pediatric infectious disease consultant Birthing unit staff and physicians Thomas N. Saari, FAAP, U. WI – Author of: Neonatal Vaccination in the United States: Implementation of the Hepatitis B Birthdose - http://www.hhs.gov/nvpo/meetings/neonatal/Saari.pdf Immunization of Preterm and Low Birth Weight Infants. Pediatrics, July 2003, Vol. 112(1):193-8 – URL: http://pediatrics.aappublications.org/cgi/content/full/112/1/193 Immunization Task Force - Metro Omaha

National Immunization Conference - 2009 5/31/2018 Tipping Point Efforts between 2004 and 2006 eventually achieved establishment of HBBD policies at all 7 metro birthing facilities Pharmacy chart review study at hospital with high use birthing unit: 11/2005 – 11/50 (22%) received HBBD (4/11 within 12 hrs) 9/2006 - 50/50 (100%) received HBBD (49/50 within 12 hrs) Immunization Task Force - Metro Omaha

National Immunization Conference - 2009 5/31/2018 State-wide Effort Request for assistance from NE H & HS Immunization Program personnel Promotion and Assessment Project initiated Birthing facility mailing list provided from state Promotional PowerPoint created Resource materials identified Survey post card developed Immunization Task Force - Metro Omaha

Promotion Effort (June 2007) National Immunization Conference - 2009 5/31/2018 Promotion Effort (June 2007) Packets mailed to: Manager of Birthing Unit Hospital CEO Promotional materials: PowerPoint handout – Offer to mail CD per request Saari report on HBBD in Preterm/LBW infants Policy implementation resources Reports on infant Hep B cases / Legal risks Immunization Task Force - Metro Omaha

National Immunization Conference - 2009 5/31/2018 Survey Questions Does your hospital currently have a policy to administer the hepatitis B vaccine birth dose to all newborns prior to discharge? If so, is hepatitis B vaccination a part of your newborn standing orders? Immunization Task Force - Metro Omaha

Telephone Follow-up (November 2007) National Immunization Conference - 2009 5/31/2018 Telephone Follow-up (November 2007) Facilities not responding to postcard survey Facilities indicating no policy on postcard Birthing unit nursing staff member Standardized question set / Problem solving assistance offered: Perceived reasons for lack of policy Offer to provide additional resource materials Actual policies / standing orders not obtained Immunization Task Force - Metro Omaha

National Immunization Conference - 2009 5/31/2018 Survey Results 94% (58/62) response rate, by mail and/or follow- up telephone call 40 (65%) had a policy to administer hepatitis B birth dose vaccine in place, along with standing orders for administration 18 (29%) - No policy / standing orders 4 (6%) - No response / Status unknown Six (~10%) hospitals reported change to a HBBD policy in the follow-up telephone survey after indicating no policy on the initial postcard survey. No way of telling why these facilities changed their policy (some may have been at some point in process of change when first interviewed) Immunization Task Force - Metro Omaha

Estimated Impact (Newborn access) National Immunization Conference - 2009 5/31/2018 Estimated Impact (Newborn access) Based on Nebraska vital statistics report on births occurring annually 2004 – 2006 in counties where hospitals located: 4 hospitals with unknown status - < 1% annual NE births 18 hospitals with no policy – 8-9% annual NE births Therefore, estimated that ~ 90% of NE infants now born in hospitals with HBBD policy Immunization Task Force - Metro Omaha

Barriers to Implementation National Immunization Conference - 2009 5/31/2018 Barriers to Implementation Economic – 5 respondents - Free dose typically obtained at public health at 1-2 mo Considered low risk / unnecessary – 4 Concern over loss of records – 3 Physician preference – 3 Perceived unnecessary; high clinic compliance – 2 Only a few deliveries; so considered unnecessary - 2 Better reimbursement in clinic – 2 “Extra” dose (4 vs 3) considered unnecessary - 1 Immunization Task Force - Metro Omaha

National Immunization Conference - 2009 5/31/2018 “Mop Up” Activities Report published in Nebraska Pediatrician This NIC presentation Plans for “telehealth” presentations Follow-up promotion / survey of facilities Id / confirm current status Promote conversion if policy not in place (share study reports) – Unit manager AND CEO Plans to extend campaign to education and promotion re Tdap for family members before or at time of delivery Immunization Task Force - Metro Omaha

The Little Engine that Could! National Immunization Conference - 2009 5/31/2018 The Little Engine that Could! Immunization Task Force - Metro Omaha