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Health Protection input to the antenatal hepatitis B screening programme. N Irvine June 2011. Policy/standards/guidelines. HSS(MD)43/2010 Infectious diseases in pregnancy screening programme: standards and handbook for laboratories (National Screening Committee)

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health protection input to the antenatal hepatitis b screening programme

Health Protection input to the antenatal hepatitis B screening programme

N Irvine

June 2011

policy standards guidelines
Policy/standards/guidelines
  • HSS(MD)43/2010 Infectious diseases in pregnancy screening programme: standards and handbook for laboratories (National Screening Committee)
  • Appointment with hepatitis B specialist within 6 weeks of issue of positive result
  • Maternal consent for baby to be vaccinated
  • Care during pregnancy
  • Considerations for intrapartum care (maternal status, neonatal vaccination needs, avoid fetal blood sampling/ fetal scalp electrodes)
  • Postnatal dose within 24 hours of birth
  • Arrangements for completion of the vaccination schedule
  • Process to ensure subsequent doses
current northern ireland process 1
Current Northern Ireland process (1)
  • NIBTS: testing and notification of results to Obstetrician, GP, PHA
  • Trusts: testing, counselling, referral to specialist, referral to GUM, vaccination at birth, serology testing at 12/12
  • PHA: further communication of results according to area protocol, telephone and written follow up with GP re:
    • - Referral to GUM and hepatitis B specialist if not already actioned
    • - Screening/vaccination household contacts
current northern ireland process 2
Current Northern Ireland process (2)
  • NIBTS: testing and notification of results, advice re neonatal vaccination schedule, provision of vaccine/HBIG to hospitals (and D2,3 to primary care)

Follow up vaccination

  • Mixture of Trust and primary care provision
  • All processes are (or are moving to) being Trust managed
  • PHA: monitoring via Child Health System, follow up of orphan NIBTS reports, alerting Trusts to delayed doses/serology
vaccination schedule and rationale
Vaccination schedule and rationale
  • Risk of perinatal transmission (without intervention) is high
  • 73-88% born to HBeAg positive
  • 7-14% born to HBeAg negative
  • 90% of infected babies will have chronic infection
  • Almost all infections are asymptomatic in infancy (so need to test with HBsAg)
  • Effectiveness of timely vaccination is 72-92%
  • 0, 1 and 2 months
  • Booster at 12/12
  • HBIG further 50% reduction in highest risk infants
slide7
HBIG
  • Offered in addition to vaccine to babies born to higher risk mothers:
  • HBeAg positive
  • Anti-HBe negative
  • Acute hepatitis B in pregnancy
  • High viral load if measured
  • Infants with very low birthweight
follow up of babies
Follow up of babies
  • Many published audits
  • Coverage variable, often low completion rates
  • Often very low proportion with documented follow up serology
babies born in northern ireland calendar year 2008
Babies born in Northern Ireland, calendar year 2008
  • Movements out of N Ireland; English not first language
ongoing work re infant vaccination
Ongoing work re infant vaccination
  • Regional group comprising Trust leads and ANC coordinators, RVL, CHS and PHA
  • Standard serology request form
  • COVER-style statistics and detail feedback to Trusts
  • 5 year booster reminders
  • Regionally agreed CHS flag