Evaluation of Perinatal Hepatitis B Case Management: a Demonstration Project

Background:
The purpose of the Enhanced Perinatal Hepatitis B Case Management Project is to improve state and local perinatal hepatitis B virus (HBV) prevention programs by ensuring identification and treatment of all infants born to hepatitis B surface antigen (HBsAg) positive women (HPW), optimizing case management, and optimizing secondary prevention methods.

Objectives:
1. Describe identification and demographics of HPW
2. Describe infant case management
3. Describe extent of HBV prevention activities for HPW and their contacts

Methods:
Core clinical and program data elements were developed by the 5 project sites and CDC. Data collection at the city, county, and/or state level began in 2008; data were analyzed using SAS.

Results:
Initial data on 846 HPW and 524 infants were submitted in October 2008. In 4 of 5 project sites, HPW were primarily identified via laboratory reporting (44%). Median age of HPW was 29.5 years (range, 13-51 years). Among HPW, 51% were Asian or Pacific Islander, 13% black, 8% white, and 29% unknown. Interpreters were needed for 43% of HPWs in New York City and for 18% of HPWs elsewhere. Sixteen percent of HPW were known to be under the care of a physician for hepatitis B. Data on the infants born to HPW showed that 438 (84%) received hepatitis B vaccine and 427(81%) received hepatitis B immune globulin (HBIG) within 24 hours of birth; 421 (80%) received both vaccine and HBIG within 24 hours. It was not possible to analyze whether vaccine and HBIG were given within 12 hours of birth, as recommended, due to missing time data. Sexual contacts represented 48% of the 629 reported contacts; 18% of 227 tested contacts were HBsAg-positive.

Conclusions:
Collection of case management data through this project permits description of program activities and populations served. Such data are useful for program evaluation and targeting program improvements.