1. Perinatal Hepatitis B Prevention Program (PHBPP) Pat Fineis 517-335-9443 05/02/03

2. The PHBPP 1991 Michigan’s program –To prevent perinatal transmission of hepatitis B virus to infants exposed at birth –To identify hepatitis B surface antigen (HBsAg) positive women Prenatally Delivery

3. The PHBPP (2) –To assure the infants born to them receive Hepatitis B immune globulin (HBIG) and A dose of hepatitis B vaccine Two more doses of hepatitis B vaccine Post vaccination serology –To identify, test and treat the household and sexual contacts of these women

4. The PHBPP (3) Free HBIG and hepatitis B vaccine Free hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) testing –Infants born to HBsAg (+) women –Susceptible household –Susceptible sexual contacts

5. LHD/State Verify HBsAg (+) status in pregnant women by hard copy lab –Follow-up with pregnant woman Confirm that she is aware of her status and what it means to be HBsAg (+) Identify household/sexual contacts (name, dob, status)

6. LHD/State (2) Determine what follow-up care is needed –For her –For her infant –For her household/sexual contacts Provide services and help set up appointments if necessary Contact hospital and pediatric provider Share between departments/intake form

7. Laboratory Report all HBsAg results to ordering physician Report all HBsAg (+) results to local health department within 24 hours

8. Prenatal care provider Test every pregnant woman during every pregnancy for HBsAg If HBsAg (-) and are high risk women, test again late in pregnancy

9. Prenatal care provider (2) If HBsAg (+) report to local health department within 24 hours Contact delivering hospital –Send prenatal information to labor/delivery –Send hard copy lab

10. Hospital Verify HBsAg status of pregnant woman Or test her stat –If HBsAg (+) Give HBIG and hepatitis B vaccine within 12 hours of birth Report to LHD within 24 hours Provide educational materials Contact pediatric provider

11. Private Provider If caring for an infant born to an HBsAg (+) woman –Give 2 nd dose at 1 month of age –Give 3rd dose at 6 months of age –Test for HBsAg and hepatitis B surface antibody (anti-HBs) 3-9 months after last dose –Complete case report form or call LHD/State

12. Private Provider (2) –Continue to provide educational materials to the family –Identify and test all household and sexual contacts

14. Death

15. A Tragedy Baby girl Born September 2, 1999 Died December 17, 1999 Cause of death: acute hepatitis B infection

16. Why Did This Tragedy Occur? Birth dose was not given Mom tested HBsAg (+) prenatally Prenatal care provider –Reported it to the hospital as HBsAg (-) –Did not report the HBsAg (+) to the LHD –Did not send a hard copy of the HBsAg test results to the hospital

17. What Can We Do? Identify and review all HBsAg (+) results for women of childbearing years –First time reported –Reported before (ask the patient/doc if she is pregnant)? Make sure there are policies in place and information is shared between departments

18. What Else Can We Do? Continue to provide education on HBsAg reporting –Prenatal care providers –Hospitals –Laboratories –Private doctors Ensure compliance

19. Six Responsibilities of Perinatal Hepatitis B Prevention Programs Assure identification of ALL HBsAg positive women and their infants Assure all exposed infants receive HBIG and 1 st dose of hep. B vaccine w/in 12 hours of birth Prevention of Perinatal Hepatitis B Transmission Conduct active surveillance, quality assurance, and outreach to improve program Assure completion of 3 doses of hepatitis B vaccine and post vaccination testing of exposed infants Assure that all susceptible household and sexual contacts are vaccinated

20. PHBPP Contacts Christi Downing Pat Fineis Sallie Pray (SE MI) Therese McGratty 517-335-8122 517-335-9855 fax 517-335-9443 or 800-964-4487 517-335-9855 fax 313-456-4432 313-456-4428 fax 313-456-4431 313-456-4428 fax