Provider Education Tuscarawas County Health Department Perinatal Hepatitis B Prevention Program Purpose To increase understanding of current healthcare provider recommendations for preventing perinatal hepatitis B transmission ID: 933894
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Perinatal Hepatitis B Prevention Provider Education
Tuscarawas County Health DepartmentPerinatal Hepatitis B Prevention Program
Slide2Purpose
To increase understanding of current healthcare provider recommendations for preventing perinatal hepatitis B transmissionTo ensure there are no missed opportunities for testing and follow-up of all pregnant females and infants at high-risk for perinatal hepatitis B
Slide3What is Hepatitis B?
Liver disease resulting from infection with hepatitis B virusSpread through blood, semen, or other bodily fluids from infected personTransmission occurs through:Direct contact with blood from infected person
Sex with infected personBirth from infected mother to newborn infant (c-section and vaginal delivery)
Slide4Why Prevent Perinatal Transmission of Hepatitis B?Approx. 40%
of infants born to hepatitis B virus (HBV) infected mothers will develop chronic infection if not given postexposure immunoprophylaxis ¼
of whom will die from chronic liver disease (cirrhosis, end-stage liver disease, liver cancer)
Slide5Best Practices in Prevention of Perinatal Transmission
The first step in preventing perinatal transmission of hepatitis B is to test every pregnant female for the virus using the
hepatitis B surface antigen test (HBsAg) with every pregnancy.Things to remember…Test in the first trimester, if possible
Test regardless of past testing status
HBsAg
Slide6The Next Steps
https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm
This CDC algorithm, which can be found at the link below, is a great resource to use for pregnant women after obtaining their prenatal HBsAg results. We will now go through each step.
Slide7HBsAg NegativeAfter obtaining a negative HBsAg result, assess if the pregnant patient is at high risk for acquiring HBV infectionNo = no further action needed
Yes = consider vaccinating during pregnancy/postpartum and repeat HBsAg test when admitted for delivery
Slide8HBsAg PositiveAll HBsAg positive pregnant women must be immediately reported
to the Perinatal Hepatitis B Prevention Program (PHBPP) for the jurisdiction in which they reside to initiate case management services.Women residing in Tuscarawas County can be reported to the Tuscarawas County Health Department by calling 330-343-5555 ext. 132 or by faxing a report to 330-343-1601 at Attn: Communicable Disease Nurse.Providers with access to the Ohio Disease Reporting System (ODRS) can also report to the Ohio Department of Health PHBPP through ODRS.Also,
household and sexual contacts need identified for recommendation to be screened for HBV infection by their primary care provider.
Slide9HBsAg PositivePregnant women testing HBsAg positive will need additional testing
including,Hepatitis B e-antigen (HBeAg)Hepatitis B virus DNA concentration (HBV DNA)Liver function testing with at least the alanine aminotransferase test (ALT)
Slide10HBsAg PositiveReview the results of additional testing. If any of the following are present, refer to a specialist immediately during pregnancy
HBeAg positiveHBV DNA >20,000 IU/mL
ALT ≥19 IU/LIf none are present, refer patient for care during the postpartum period
Slide11Patient EducationAll pregnant women need educated about 1st dose of hepatitis B vaccination administered at birth to their newborn.
HBsAg-positive pregnant women need educated about the administration of both the hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours after birth and the need to take their infant to the pediatrician to finish the 3-dose vaccine series.
Slide12https://www.cdc.gov/hepatitis/partners/perinatal/perihepb-education.htm
Resources for PatientsThe CDC’s website provides many great resources for patients, including this audio-visual slide set found at the URL link below. This slide set is a great tool for
women with hepatitis B infection to educate on hepatitis B and the steps to prevent transmission to their baby. It is available in 6 different languages that can also be printed off for handouts.
Slide13https://www.cdc.gov/knowhepatitisb/PDFs/Infographic-Perinatal.pdf
Resources for Patients
This front and back CDC handout is a great visual resource for
all pregnant patients
, no matter their HBsAg test results. It briefly discusses both the disease and vaccine. The PDF document for printing can be found at the link below.
Slide14https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm
Resources for PatientsAdditional patient handouts can be found at the CDC website link below. After opening the link, scroll down to Patient Education Tools
to open the PDF documents for printing. Both documents shown on this slide are front and back. Other languages are available, including Spanish.
Please note the light blue colored page is a great resource for pregnant patients who have tested
HBsAg positive
to discuss the preventative measures needed at birth using the HBIG shot and first dose of vaccine within the first 12 hours after birth.
Slide15Delivery HospitalsGuidelines and algorithms are available on the CDC website link below for delivery hospitalsProcedural algorithms for preventing perinatal hepatitis B transmission at delivery when the maternal HBsAg test results are
available and when they are unavailableThe Immunization Action Coalition (IAC) has guidance for developing standing orders in labor and delivery and newborn units for preventing perinatal transmission of hepatitis B
https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm
Slide16THANK YOU!!!
POST-TEST
SURVEYThank you for taking time to complete this training.
Please be sure to complete both the post-test and the survey by clicking the buttons below.Please be sure to include your contact information on the post-test so we can contact you to fill out a training verification form for ODH.If you have any questions or concerns, please feel free to contact the Tuscarawas County Health Department. Contact information can be found on the next slide.
Slide17Chelsea Martin, BSN RNPublic Health Nurse/Communicable Disease NurseTuscarawas County Health Department
897 East Iron Ave, Dover, OH 44622Phone: 330-343-5555 ext. 132Fax: 330-343-1601cmartin@tchdnow.org
Contact Information
Slide18ResourcesCenter for Disease Control and Prevention. (2015, May 31). Hepatitis B and a Healthy Baby. Retrieved from https://www.cdc.gov/hepatitis/partners/perinatal/perihepb-education.htm
Center for Disease Control and Prevention. (2019, October 25). Hepatitis B Questions and Answers for Health Professionals. Retrieved from https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm Center for Disease Control and Prevention. (2019, October 2). Perinatal Transmission. Retrieved from https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm Center for Disease Control and Prevention. (n.d.). Vaccinate Your Baby Against Hepatitis B: It Could Save Your Baby’s Life [PDF document]. Retrieved from https://www.cdc.gov/knowhepatitisb/PDFs/Infographic-Perinatal.pdf Schillie, S., Vellozzi
, C., Reingold, A., Harris, A., Haber, P., Ward, J. W., & Nelson, N. P. (2018, January 12). MMWR. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 67(1). Retrieved from https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm
Pictures
(Slide 1) https://www.cdc.gov/vaccines/parents/visit/holds-factsheet.html
(Slide 2) https://www.pexels.com/photo/clouds-way-direction-seat-belts-52531/
(Slide 3) https://www.cdc.gov/hepatitis/hbv/index.htm
(Slide 11) https://www.apha.org/topics-and-issues/maternal-and-child-health