Post on 15-Dec-2015
transcript
Case Identification for the Missouri Perinatal Hepatitis B Prevention Program
Libby Landrum, RN, MSNViral Hepatitis Prevention Manager
Bureau HIV, STD, and Hepatitis Missouri Department of Health and Senior
Services
Hepatitis B Reporting in Missouri
Hepatitis B virus is a reportable condition in Missouri
Missouri is a dual reporting state
Mandated reporters:• laboratories• healthcare providers
Methods of Reporting Hepatitis B
Laboratories report hepatitis Bpaper reports (mailed or faxed)electronic reports (electronic transfer)
Healthcare providers report hepatitis B
paper reports (mailed or faxed)• communicable disease case report (CD-1)• copy of original laboratory reports
Processing Hepatitis B Reports
Positive hepatitis tests are submitted to:
Department of Health and Senior Services or Local Public Health Agencies
Health department staff:review and interpret the test resultsassign the appropriate hepatitis condition status according to the current CDC case definitionsenter case information into the electronic state disease registry
Types of Case Identification
Prospective Identification: identification of an HBsAg-positive pregnant womanRetrospective Identification: identification of an infant born to an HBsAg-positive pregnant woman
Case Identification in Missouri
Missouri ~ 130 infants identified per year CDC Missouri estimates (156-258)
Missouri Identification of Infants Born to Hepatitis B-infected Women By Year
0
20
40
60
80
100
120
140
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Nu
mb
er
of
Infa
nts
Id
en
tifi
ed
Prospective Identification Retrospective Identification Total Infants Born to HBV-infected Women
Review of HBsAg+ Women
Positive hepatitis tests for females age 11 to 55 years
earmarked for pregnancy status determination
Entered using a specialized disease condition category in the state disease registry
hepatitis B pregnancy condition
• pregnancy condition• “suspect” status remains open
(until pregnancy status is determined)
Determining Pregnancy Status
Determination of pregnancy statusassigned case manager • contacts submitting healthcare provider• documents pregnancy status on lab
report
Not pregnantpregnancy condition
– “suspect status” changed to “no case”– appropriate hepatitis B condition entered
(acute or chronic)– case investigated as usual– case closed
Opening a Case
When pregnancy is verifiedhepatitis B pregnancy condition is changed from a “suspect” to “confirmed” in the state disease registry pregnant HBsAg-positive woman is enrolled into case managementappropriate public health agency case manager notifiedappropriate case manager follows case to completion
Retrospective Case Identification
Notifications of infants born to women with maternal risk factor of hepatitis B
memorandum of agreement with the Bureau of Viral Records• monthly report of births to mothers with
hepatitis B as a maternal risk factor
Transfer of infant born in another state Notification by healthcare provider or service provider familiar with our programs
Examples of Retrospective Identification
Case investigation on a new HBsAg-positive pregnant woman finds an unreported infant born prior to current pregnancyLocal public health agency identifies an unreported infant though a clinic visit or service provisionCase investigator discovers retrospective infant during a case contact investigation
Relationships with Partners
Case Managers and Program Staff
Local public health agencies • electronic notification• fax case information
Healthcare providers• consultation• technical assistance• education• interventions
Relationships with Partners (cont’d)
Birthing Hospitals, Healthcare Providers, and Local Public Health Agencies
birthing hospital site visitsmedical record reviewshepatitis B prevention education and recommendationsregional trainings• “One is Too Many” workshops• hepatitis viral markers interpretation• disease, prevention and treatment
Annual Educational Letters Physicians
MD/DO• Family Practice• Pediatrics• Obstetrics
Nurse PractitionersPediatricsFamily PracticeObstetrics
MidwivesLocal Public Health
Communicable Disease Nurses
2008 Updates
State Case Manager/Quality Assurance Coordinator now contacts physicians Verifies pregnancy statusAssigns appropriate pregnancy condition status in state disease registry
expedites case follow-up decreases unreported casesincreases prospective identification of infants at risk
Case Example
A pregnant woman without prenatal care presented in emergency care to deliverThe hospital has standing orders to test pregnant women of unknown HBsAg status upon admission for Labor and Delivery
Case Example (cont’d)
The HBsAg test results were reported back within 10 hours of the infant’s deliveryWoman tested HBsAg-positiveThe newborn nursery staff administered HBIG and the 1st dose of monovalent hepatitis B vaccine within 12 hours of birth
Case Example (cont’d)
Newborn nursery nurse reported case to infection control officer
Infection control officer reported infant to Perinatal Hepatitis B Prevention Case Manager as a retrospective case
Case Outcome
Follow-up case management initiatedInfant received appropriate and timely immunoprophylaxisPost-vaccination serology testing indicated the infant was HBsAg-negative and anti-HBs >10mIU/mL (immune)
Critical Lessons Learned
Important to establish relationships
birthing hospital staff• labor and delivery physicians and nurses• newborn nursery nurses• infection control nurses
local obstetric providerslocal pediatricianslocal family practice providers
Partner Relationship Building
Provide education and materialsRespect other’s time and efforts Keep the goal of hepatitis B prevention a frequent topic of conversation
Questions?