1. 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 or

2. 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

3. 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
< 64% of Washington State minimum expected births to HBsAg+ women were identified

4. 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

5. 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

6. 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
Number and percent of women reported & delivered in the same year were compared by year of report

7. 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

8. 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 % of women were reported prior to delivery

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

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

11. Public Health-Seattle & King County

12. 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

13. 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
then select “Hepatitis B”

14. 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

15. 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

16. 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

17. 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