Assessing the Completeness of Perinatal Hepatitis B Case Reporting Using Capture-Recapture

Background: Prevention of perinatal transmission of Hepatitis B virus (HBV) is a key component of the HBV elimination program in the United States. However, the programs set up to address perinatal infection miss many infected women, which limits the effectiveness of the entire elimination effort.

Objectives: To assess the completeness of perinatal hepatitis B case reporting to the Philadelphia Department of Public Health Perinatal Hepatitis B Program (PDPH PHBP).

Methods: Capture-recapture was performed using reports from 3 datasets: 1) individuals with confirmed or probable chronic HBV infections reported to the PDPH’s Hepatitis B Surveillance Registry between 2001-2009, 2) pregnant females with chronic HBV reported PDPH’s PHBP tracking system between 2007 and 2009, and 3) preliminary 2008 birth certificate data for Philadelphia residents. Surveillance registry and PHBP tracking data were linked to birth certificates using individual’s (mother’s) name, date of birth, and residential address.  Individuals identified in surveillance data but not found in the PHBP tracking database were investigated for reasons contributing to the missed opportunity.

Results: Of the 23,480 Philadelphia births during 2008, 232 (1%) were represented in one of the other databases. Of the 232, many (41%) were included in both the surveillance and perinatal databases. Only 2 (1%) were found only in the PHBP database alone. However, 58% were in the surveillance registry but not the perinatal tracking system. Of these missed opportunities, 62 (48%) did not have appropriate tests reported during pregnancy, 62 (48%) were not appropriately assessed for pregnancy status, and 5 (4%) were still pregnant.

Conclusions: Methods and data existing within public health departments can be used to improve identification of potential perinatal HBV cases for investigation and follow up by PHBPs.