Universal birth dose hepatitis b a safety net
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Universal Birth Dose Hepatitis B: A Safety Net. Pat Fineis Michigan Department of Community Health. Overview. History of Michigan’s Universal Hepatitis B Vaccination Program Case example and responses to tragedy

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Universal birth dose hepatitis b a safety net

Universal Birth Dose Hepatitis B: A Safety Net

Pat Fineis

Michigan Department of Community Health


Overview

Overview

  • History of Michigan’s Universal Hepatitis B Vaccination Program

  • Case example and responses to tragedy

  • Process of adding hepatitis B (hep B) administration information to birth certificate and immunization registry

  • Evaluation tools and methods to increase hep B birth dose coverage levels

  • Barriers to implement birth dose

  • Hospital enrollment process


Michigan s history

Michigan’s History

  • 1991 Universal Hepatitis B Vaccination Program began

    • Goal: offer hep B vaccine to all birthing hospitals for all infants

      • Michigan’s birth cohort

        • 132,000 (1991)

        • 128,000 (2007)

      • Visited and provided education to all birthing hospitals (102)


Hepatitis b birth dose is postponed

Hepatitis B Birth Dose is Postponed

  • July – September 1999

    • Thimerosal statement released

    • Recommendation:

      • Postpone birth dose until 2 - 6 months of age if infant born to hepatitis B surface antigen (HBsAg)-negative woman

      • Give birth dose to infants born to HBsAg-positive and unknown HBsAg status women


Case example

Case Example

  • Mother

    • 15 y.o. HBsAg-positive Laotian female

    • 10 prenatal visits

    • Lab and prenatal care provider (PCP) did not report HBsAg-positive result to local health department (LHD)

    • PCP reported HBsAg result as negative on prenatal record sent to delivery hospital

  • Infant

    • Healthy baby girl born (38 wks gestation)

    • Mom’s HBsAg status also noted as HBsAg-negative in baby’s chart

    • Due to recommendation to delay birth dose, no hep B vaccine was given


Case example cont d

Case Example (cont’d)

  • 2 months of age

    • 1st dose of hep B vaccine

  • 3 months of age

    • Ill with fever, diarrhea, jaundice

  • 5 days after onset of symptoms

    • Diagnosed with HBV infection and acute liver failure

  • 8 days after becoming ill

    • Infant dies


Response to situation

Response to Situation

  • Presented case study in newsletters and conferences

  • Visited 102 birthing hospitals

    • Provided new CDC recommendations

    • Reinforced state law

    • Recommended original lab report with prenatal record to birthing hospital


Method to assess efforts

Method to Assess Efforts

  • Conducted hospital surveys

    • 1999

      • 82 of 102 (80%) had written policies and standing orders to give hep B birth dose

    • 2001

      • 92 of 102 (90%) had written polices and standing orders

  • Identified need for an assessment tool to measure hep B birth dose


Adding hepatitis b to electronic birth certificate ebc 1999 2000

Adding Hepatitis B to Electronic Birth Certificate (EBC), 1999-2000

  • Meetings with records manager and data entry staff

  • Goal:

    • Documentation of hep B vaccine dose on EBC

    • Box created to include hep B vaccine administration

      • Yes or No field

      • Date vaccine given (month/day/year)


Ebc hepatitis b birth dose

EBC - Hepatitis B Birth Dose


Adding hepatitis b birth dose to immunization registry 2000 2001

Adding Hepatitis B Birth Dose to Immunization Registry, 2000-2001

  • Identified need to capture hep B birth dose through the immunization registry

  • Meetings with immunization registry coordinator and technology staff - Michigan Care Improvement Registry (MCIR)

  • Goal:

    • Create a process to obtain the birth dose data

    • Develop process to download EBC birth dose data into MCIR


Monitoring hep b birth dose 2002

Monitoring Hep B Birth Dose, 2002

  • Began monitoring the birth dose coverage levels

  • Developed reports based on the information entered into Michigan Care Improvement Registry (MCIR)

    • County

    • Birthing hospital

      • Number of births

      • Number of doses given within 4 days of life

      • Percentages of births/number of doses

  • Discovered only 72% of Michigan’s babies were receiving hep B birth dose


Issues and barriers

Issues and Barriers

  • Lag time of 2 – 3 weeks to get birth dose data into MCIR

  • Downloading problems

    • Electronic systems not compatible

    • Billing data conflicts

    • Some hospitals batching data

  • Documentation problems

    • EBC didn’t include hep B

    • Neonatal Intensive Care Unit (NICU) not documenting

  • Education and training were needed


Publicizing hepatitis b birth dose 2000

Publicizing Hepatitis B Birth Dose, 2000

  • Published results in Immunization Newsletter by hospital name (>10,000 readers)

    • Reinstating/implementing written policies and standing orders to OFFER birth dose to all infants (based on survey results)

    • 82 of 102 (80%) hospitals had policies in place to offer hep B to all newborns

  • Generated many calls

    • Discussed hospital process

      • Reporting birth dose information to state

      • Documenting birth dose on EBC (yes and date)

  • Continued to update and publish list quarterly


Publicizing hepatitis b birth dose 2002

Publicizing Hepatitis B Birth Dose, 2002

  • Published article that listed hospitals by name

    • Written policies and standing orders to offer hep B vaccine to ALL newborns

      AND

    • Birth dose coverage levels > 90% (based on MCIR data)

      • 32 of 102 hospitals named (31%)

  • Caused concern among hospitals and prompted

    • More calls

    • Hospitals to re-evaluate their systems

    • State to verify birth data


Ongoing activities

Ongoing Activities

  • Presentations

  • Created and distributed program manual

  • Conduct hospital surveys

    • Identify/update contacts

  • Listserv for hospital and LHD contacts

    • Provide updates on policy/procedure information

    • Provide program manual updates annually

    • Distribute hep B birth dose coverage level reports semi-annually

  • Direct contact (phone call, e-mail or site visit)


Hepatitis b birth dose coverage levels mcir

Hepatitis B Birth Dose Coverage Levels - MCIR

  • MCIR hep B birth dose coverage levels (within 4 days of life)

    • 76% in 2004

    • 78% in 2005

    • 80% in 2006

    • 81% in 2007


Hepatitis b birth dose coverage levels nis

Hepatitis B Birth Dose Coverage Levels - NIS

  • Hep B birth dose coverage levels from the National Immunization Survey (NIS) are within 2 days of life

  • 2006 Michigan ranks 3rd highest in nation

    • National: 48.8% + 1.1

    • Michigan: 78.3% + 5.0

    • Detroit, MI: 81.7% + 5.6


New ebc hepatitis b birth dose and hbig reporting 2007

New EBC - Hepatitis B Birth Dose and HBIG Reporting, 2007

  • Created new web based electronic birth certificate (EBC) worksheet

  • HBIG was added

  • New EBC now includes:

    • Hep B vaccine

    • HBIG


New ebc fields

New EBC Fields


Universal hepatitis b vaccination program 2003

Universal Hepatitis B Vaccination Program, 2003

  • Continuous need to evaluate and improve methods

  • Developed Enrollment Form with MI’s Vaccines for Children (VFC) Program which requires hospitals:

    • Minimal paperwork

    • Complete profile table

      • Total annual number of births who were:

        • Enrolled in Medicaid

        • Uninsured

        • American Indian/Alaska Native

        • Underinsured/Fully insured/Private Pay


Funding of universal program

Funding of Universal Program

  • Develop annual population estimates to determine annual allocation of federal funds

    • Michigan’s birth cohort x $9.50 = ($1,200,000)

    • Estimate 46% are VFC eligible (enrolled in Medicaid, uninsured, American Indian, Alaska Native, and those underinsured served at FQHC/RHC)

    • 54% served by 317/state funding (insured, underinsured) = ($648,000)


Hospital enrollment process

Hospital Enrollment Process

  • Hospital eligibility information based on:

    • Registry data (preferred)

    • Billing data

    • Tally Sheets

    • Prior year’s ordering data

    • Doses administered report

  • Shipping information (site days/hours of operation)

  • Forms due to state by February 15th


Recruiting hospitals to program

Recruiting Hospitals to Program

  • VFC provides a list of hospitals not enrolled

  • Call LHD to determine if there are specific issues/corrective action plans

  • Contact hospital pharmacy manager/director to discuss:

    • Barriers

    • Universal Program

    • Recommendations

    • Ease of obtaining hep B vaccine

    • Cost savings


Assessing enrollment process

Assessing Enrollment Process

  • 2004

    • 54 of 95 birthing hospitals enrolled (57%)

  • 2005

    • Identified barriers

      • Too much paperwork

      • Didn’t know about process or program

      • Purchased their own vaccine

    • Worked to increase participation

      • 2005: 86 of 95 (91%) enrolled

      • 2006: 88 of 95 (93%) enrolled

      • 2007: 92 of 94 (98%) enrolled


Summary

Summary

  • Ensure hospitals have written policies and standing orders

  • Consider establishing a Universal Program and enroll hospitals

  • Encourage hospitals to give hep B birth dose to all infants

  • Provide feedback to counties and hospitals on birth dose coverage levels

  • Continue to provide education and materials


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