Steps to Improve Reporting of Perinatal Hepatitis B in North Dakota

Background:
North Dakota has historically had a low prevalence of hepatitis B, thus a low prevalence of hepatitis B surface antigen positive (HBsAg+) pregnant women. The CDC estimates that each year North Dakota should have an average of 21 births to HBsAg+ women. In previous years on average in North Dakota only 3-5 HBsAg+ pregnant women were reported.

Setting:
In 2007, North Dakota had 18 active birthing facilities.

Population:
North Dakota has a predominantly Caucasian population; American Indians comprise about 5 percent of the population. Historically, the majority of perinatal hepatitis B cases have been located in or near the largest city, Fargo. The geographically clustered cases are due mainly to a larger influx of refugees to this region.

Project Description:
The goal of this project was to increase reporting of HBsAg+ women, and therefore, increase the number of infants included in the perinatal hepatitis B program to ensure proper vaccination and testing. Early in 2008 the Perinatal Hepatitis B Coordinator updated and distributed a manual to all pertinent health care providers, which included all policies and procedures to follow regarding HBsAg+ pregnant women. Along with sending out updated manuals, perinatal in-services have been, or will soon be, scheduled at all major birthing centers targeting key birthing staff that are involved with the care of this population.

Results/Lessons Learned:
North Dakota has seen a dramatic increase in the number of perinatal HBsAg+ women reported. From 2002-2004, North Dakota averaged only 4 reported births to HBsAg+ women each year. During 2005-2007, the average only rose to 6 births per year. However, to date, 14 births to HBsAg+ mothers have been reported in 2008, showing the education program is helping.