Give birth to the end of Hep B
Give birth to the end of Hep B IAC’s ini%a%ve to eliminate hepa%%s B virus infec%on through the preven%on of perinatal transmission
Deborah L. Wexler, MD, Execu3ve Director, Immuniza3on Ac3on Coali3on White House Ini3a3ve on Asian Americans and Pacific Islanders & Hep B United Hepa33s B and Reducing Perinatal Transmission December 19, 2013
Hepa%%s B What Hospitals Need to Do to Protect Newborns
Give birth to the end of Hep B
Background • Many infants in the United States are not receiving the birth dose of hepa33s B vaccine. -‐ Only 70% of U.S. infants received hepa33s B vaccine within 3 days of birth.* -‐ States’ coverage rates varied between 29% and 88%.* • There is room for improvement in protec3ng newborn infants in every state.
*Reference: Data from the July 2011-‐June 2012 Na3onal Immuniza3on Survey, www.cdc.gov/vaccines/stats-‐surv/nis/data/tables_1112.htm
Hepa%%s B What Hospitals Need to Do to Protect Newborns
2
Give birth to the end of Hep B
Why should we give hepa33s B vaccine to all newborns? • Prevents mother-‐to-‐infant transmission: Prevents 70-‐95% of infec3on among infants born to HBsAg-‐posi3ve women • Prevents household transmission: Protects infants from infected family members and other caregivers • Protects when medical errors occur: Provides a safety net to prevent perinatal HBV infec3on when medical errors occur
Hepa%%s B What Hospitals Need to Do to Protect Newborns
3
Give birth to the end of Hep B
Why is a safety net needed?
Because medical errors happen!
Hepa%%s B What Hospitals Need to Do to Protect Newborns
4
Give birth to the end of Hep B
Types of medical errors reported • Ordering the wrong hepa33s B screening test • Misinterpre3ng or mistranscribing the hepa33s B test results • Failing to communicate the HBsAg test results to or within the hospital • Not giving hepa33s B vaccine to infants born to mothers of unknown HBsAg status within 12 hours of birth • Not giving prophylaxis to an infant even when the mother’s HBsAg-‐posi3ve status is documented Hepa%%s B
What Hospitals Need to Do to Protect Newborns
5
Give birth to the end of Hep B
Because of these types of errors, children are chronically infected with hepa33s B (HBV) A universal hepa%%s B vaccine birth dose policy helps to protect newborn infants from human error and resul%ng chronic HBV infec%on which can cause serious liver disease. Hepa%%s B What Hospitals Need to Do to Protect Newborns
6
Give birth to the end of Hep B
The Opportunity • Hospitals have an opportunity to protect the future health of infants born in their facili3es -‐ Each year in the U.S., more than 24,000 infants are born to mothers who are infected with HBV, and not all of their infants receive post-‐exposure prophylaxis. -‐ Some infants are first exposed shortly ager birth to HBV by household members or caretakers who have chronic HBV infec3on.
• Most infants can be protected if hospitals rou3nely provide a birth dose of hepa33s B vaccine to all newborn infants. Hepa%%s B
Smith EA. Pediatrics 1012;129:609-‐616; MMWR 2005 ;57(RR-‐8):1-‐20
What Hospitals Need to Do to Protect Newborns
7
Give birth to the end of Hep B
Two Tools for Promo3ng the Hepa33s B Birth Dose • “Hepa33s B: What Hospitals Need to Do to Protect Newborns” -‐ a comprehensive guide • Hepa33s B Birth Dose Honor Roll www.immunize.org/ protect-‐newborns
Hepa%%s B What Hospitals Need to Do to Protect Newborns
Give birth to the end of Hep B
Hepa33s B: What Hospitals Need to Do to Protect Newborns Reviewed and endorsed by • American Academy of Family Physicians • American Academy of Pediatrics • American College of Obstetricians and Gynecologists • Centers for Disease Control and Preven3on www.immunize.org/protect-‐newborns/guide/endorsements.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
9
Give birth to the end of Hep B
Birth Dose Guidebook Sec3ons 1. Preven3ng Hepa33s B in Newborns: What’s Needed 2. Reducing Medical Errors: Case Reports 3. Addressing the Problem: Prac3cal Tools 4. Obtaining Support: Helpful Contacts 5. Appendix: Authorita3ve Resources www.immunize.org/protect-‐newborns/guide
Hepa%%s B What Hospitals Need to Do to Protect Newborns
10
Give birth to the end of Hep B
Chapter 1. Preven3ng Hepa33s B in Newborns: What’s Needed 1. Execu3ve Summary -‐ What Hospitals Need to Do to Protect Newborns 2. Na3onal Quality Forum (NQF) has established newborn hepa33s B vaccina3on as a na3onal standard for measurement by healthcare semngs www.immunize.org/protect-‐newborns/guide/chapter1/whats-‐needed.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
11
Give birth to the end of Hep B
Chapter 2. Reducing Medical Errors: Case Reports 1. States Reports Hundreds of Medical Errors in Perinatal Hepa33s B Preven3on
2. Unprotected Infant Dies of Fulminant Hepa33s B 3. Medical Errors Put Infants at Risk for Chronic Hepa33s B Virus Infec3on – Six Case Reports 4. Two More Infants Chronically Infected with Hepa33s B Virus. . . the Medical Errors Con3nue 5. Give the Birth Dose. . .Hepa33s B Vaccine at Birth Saves Lives!
www.immunize.org/protect-‐newborns/guide/chapter2/case-‐reports.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
12
Give birth to the end of Hep B
Chapter 3. Addressing the Problem: Prac3cal Tools for Hospitals • Guidance for Developing Admission Orders in Labor & Delivery and Newborn Units to Prevent Hepa33s B Virus Transmission
• Sample Text for Developing Admission Orders in Newborn Units for the Hepa33s B Vaccine Birth Dose
www.immunize.org/protect-‐newborns/guide/chapter3/prac3cal-‐tools.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
13
Give birth to the end of Hep B
Sample Text for Developing Admission Orders in Newborn Units for the Hepa33s B Vaccine Birth Dose
www.immunize.org/protect-‐newborns/guide/chapter3/admission-‐orders.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
14
Give birth to the end of Hep B
Chapter 3. Addressing the Problem: Prac3cal Tools for Parents • About Hepa33s B Vaccine Informa3on Statements • English-‐language Hepa33s B VIS • Spanish-‐language Hepa33s B VIS • Hepa22s B Shots Are Recommended for All New Babies • Childhood Immuniza3on Records Cards
www.immunize.org/protect-‐newborns/guide/chapter3/prac3cal-‐tools.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
15
Give birth to the end of Hep B
Hepa22s B Shots Are Recommended for All New Babies
www.immunize.org/protect-‐newborns/guide/chapter3/parent-‐handout.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
16
Give birth to the end of Hep B
Chapter 4. Obtaining Support: Helpful Contacts
1. Your State or Local Perinatal Hepa33s B Coordinator Can Help Implement the Hepa33s B Birth Dose 2. How the Vaccines For Children (VFC) Program Can Help Your Hospital
www.immunize.org/protect-‐newborns/guide/chapter4/helpful-‐contacts.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
17
Give birth to the end of Hep B
Appendix. Authorita3ve Resources • CDC Recommenda3ons: A Comprehensive Immuniza3on Strategy to Eliminate Transmission of Hepa33s B Virus Infec3on in the United States, MMWR, December 23, 2005, Vol. 54(RR16)
• Gaps in Hospital Policies and Prac3ces to Prevent Perinatal Transmission – Pediatrics, April 2010, Vol. 125 (4) • Addi3onal Resources
www.immunize.org/protect-‐newborns/guide/ appendix/ authorita3ve-‐resources.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
18
Give birth to the end of Hep B
CDC Hepa33s B Recommenda3ons with Highligh3ng The guidebook includes a reprint of the official CDC recommenda3ons with highligh3ng of crucial points about the birth dose
www.immunize.org/protect-‐newborns/ guide/appendix/acip-‐recommenda3ons.pdf
Hepa%%s B What Hospitals Need to Do to Protect Newborns
19
Give birth to the end of Hep B
IAC’s Hepa33s B Birth Dose Honor Roll Recognizes hospitals and birthing centers that have arained 90% or greater coverage rates for administering hepa33s B vaccine at birth.
www.immunize.org/ honor-‐roll/birthdose Hepa%%s B What Hospitals Need to Do to Protect Newborns
20
Give birth to the end of Hep B
Criteria for Birth Dose Honor Roll • At least 90% of babies (regardless of weight) born during a 12-‐month period receive hepa33s B vaccine prior to discharge (including those infants whose parents refuse). • Wriren policies, procedures, and protocols for implemen3ng the universal hepa33s B vaccine birth dose are in place and include the following: - Parents are informed about the importance of the hepa33s B vaccine birth dose and that it is recommended for all newborns. - All infants rou3nely receive hepa33s B vaccine before hospital discharge. Hepa%%s B What Hospitals Need to Do to Protect Newborns
21
Give birth to the end of Hep B
Criteria for Birth Dose Honor Roll – cont. • Staff review the mother’s chart to make sure the correct test, HBsAg, was ordered during this pregnancy. The result is also reviewed. Note: It is recommended to review a copy of the original test report, if at all possible. • If HBsAg test result is not on mother’s chart, it is ordered ASAP. • Infants born to HBsAg-‐posi3ve mothers receive hepa33s B vaccine and hepa33s B immune globulin (HBIG) within 12 hours of birth. • Infants born to mothers whose HBsAg status is unknown receive hepa33s B vaccine within 12 hours of birth, and also receive HBIG within 12 hours of birth if they weigh less than 2,000 grams. • Newborn admission orders include a standing order to administer hepa33s B vaccine to all infants prior to discharge. • No3fica3on of the state or local health department’s perinatal hepa33s B preven3on program is done prior to discharge (or as soon as known, if ager discharge) for all mothers whose HBsAg test result is posi3ve.
Hepa%%s B What Hospitals Need to Do to Protect Newborns
22
Give birth to the end of Hep B
Enrollment into the Honor Roll • Applica3ons at www.immunize.org/honor-‐roll/birthdose • Review by IAC • No3fica3on of acceptance • Cer3ficate of enrollment • Placement on Birth Dose Honor Roll web page • Recogni3on in IAC Express www.immunize.org/express • To subscribe to IAC Express www.immunize.org/subscribe Hepa%%s B What Hospitals Need to Do to Protect Newborns
23
Give birth to the end of Hep B
Birth Dose Honor Roll Cer3ficate
Hepa%%s B What Hospitals Need to Do to Protect Newborns
24
More about the Birth Dose Honor Roll • Hepa33s B Birth Dose Honor Roll home page, including
Give birth to the end of Hep B
the criteria for inclusion: www.immunize.org/honor-‐roll/birthdose
• Lis3ng of hospitals on the Birth Dose Honor Roll: www.immunize.org/honor-‐roll/birthdose/honorees.asp • Applica3on for enrollment into the Honor Roll www.immunize.org/honor-‐roll/birthdose/apply.aspx • Do You Qualify for the Birth Dose Honor Roll? www.immunize.org/catg.d/p2205.pdf (color) www.immunize.org/catg.d/p2206.pdf (B&W) Hepa%%s B What Hospitals Need to Do to Protect Newborns
25
Give birth to the end of Hep B
What You Can Do • Download the guidebook Hepa22s B: What Hospitals Need to Do to Protect Newborns at www.immunize.org/protect-‐newborns • Share the guide with hospitals and birthing centers to help them improve birth dose coverage rates • Distribute the handout “Give birth to the end of Hep B,” to educate others about the importance of the hepa33s B birth dose • Distribute “Do you qualify for the Birth Dose Honor Roll?” and encourage hospitals to apply, including those with whom you are affiliated. Hepa%%s B What Hospitals Need to Do to Protect Newborns
26
Give birth to the end of Hep B
Promo3ng the Birth Dose
www.immunize.org/protect-‐newborns
Hepa%%s B What Hospitals Need to Do to Protect Newborns
27
Give birth to the end of Hep B
Promo3ng the Hep B Birth Dose Honor Roll
www.immunize.org/honor-‐roll/birthdose
Hepa%%s B What Hospitals Need to Do to Protect Newborns
28
Give birth to the end of Hep B
Hepa%%s B What Hospitals Need to Do to Protect Newborns
Safety Net 29
Give birth to the end of Hep B
Thank You! For more informa3on, please visit: www.immunize.org/protect-‐newborns For ques3ons about Give birth to the end of Hep B, e-‐mail
[email protected] Hepa%%s B What Hospitals Need to Do to Protect Newborns
30
