Gustavo H. Dayan1, Carmen Rodriguez Caquias
2, Yanire Garcia
2, Tasneem Malik
3, John Copeland
4, and Susan Reef
5. (1) NIP/ESD, CDC, Atlanta, GA, USA, (2) Department of Health Puerto Rico, San Juan, PR, USA, (3) CDC/NIP, 1600 Clifton Road, MS E-52, Atlanta, GA, USA, (4) Mathematical Statistician, Centers for Disease Control and Prevention, 12 Corporate Square Blvd., NE, Atlanta, Georgia, USA, (5) Centers for Disease Control and Prevention, National Immunization Program, Rubella/Mumps Activity Chief, 1600 Clifton Road, NE, MS E-61, Atlanta, Georgia, USA
BACKGROUND:
There are no data on implementation of infectious rubella or hepatitis B (HBV) prevention activities for women either during pregnancy or after delivery in Puerto Rico.
OBJECTIVE:
To characterize adherence with recommendations for prenatal infectious disease screening, and to assess missed opportunities for prevention of rubella infection during pregnancy and perinatal hepatitis B transmission.
METHOD:
A stratified, random sample of live births during 2002 to women who delivered in hospitals in the 8 health regions in Puerto Rico was selected. Demographic, prenatal, and peripartum information was abstracted from labor and delivery records. Adherence with prenatal screening recommendations was evaluated for HBV, syphilis, rubella, and human immunodeficiency (HIV). Information on rubella and HBV prevention was searched in the obstetrician's records when not found at the hospital. Characteristics associated with lack of screening were assessed.
RESULT:
Information was obtained on 2003 maternal records. Documented testing rates in the hospital records were 86% for rubella, 89% for HBV surface antigen (HBsAg), 85% for HIV and 89% for syphilis. Prenatal screening rates for rubella (97%) and HBsAg (99%) were higher when the obstetrician's records were checked. Women with inadequate prenatal care were 6 (95% CI 2.6, 13.3) and 4 (95% CI 1.2, 10.5) times less likely to have received testing for rubella and HBV respectively than women with adequate prenatal care. Postpartum rubella vaccination (PPV) was documented for only 1% of rubella-susceptible or no tested women. Only 1% of newborns born to mothers whose HBsAg serology were unknown in the hospital, received hepatitis B vaccine at birth.
CONCLUSION:
Although screening rates for perinatal infectious diseases prevention is high, availability of screening information at the hospitals could be improved. Recommended prevention interventions for rubella and hepatitis B should be implemented.
LEARNING OBJECTIVES:
Assess missed opportunities for rubella post-partum vaccination.
Assess missed opportunities for perinatal hepatitis B vaccination.
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