Improving Perinatal Hepatitis B Prevention In Oregon

Background:  All 34 Oregon local health departments have personnel designated for perinatal hepatitis B prevention but this work is a fraction of their duties. Follow up to encourage and document the hepatitis B vaccine series and post-series serologies was a challenge, especially for the Portland Metro tri-county coordinators. Rates of post series serologies were lower than desired, the detected number of infants born to chronic hepatitis B carriers was below the number expected, and birth dose rates were lower than targets.

Setting:  The case load for perinatal hepatitis B prevention is highest in the Portland Metro tri-county area where 71% of mother/infant pairs for prevention activities reside.

Population:  Oregon’s population is 3,844,195. The tri-county area of Clackamas, Multnomah and Washington Counties’ population is 1,644,535.

Project Description:  Oregon sought to improve case management and increase birth dose administration. Hours were increased for the state coordinator to better provide guidance and manage data. A tri-county health assistant was hired to handle the administrative/coordination role for cases. Reimbursement for case follow up was increased. To increase case detection, the Electronic Birth Registration System (EBRS) was used to find mothers reported as HBsAg positive. As part of the Birth Dose Initiative, the Immunization Program began offering hepatitis B vaccine at no cost to hospitals and birth dose administration rates were provided semi-annually to Oregon birth centers.

Results/Lessons Learned:  Since 2006 acquisition of post series serologies improved 4% statewide and by 5% for the tri-county area. Birth dose rates reported through the EBRS increased 21%. Using EBRS data, 14% and 17% more mother/infant pairs were detected in 2008 and 2009, respectively. Increasing resources, surveillance, and providing feedback are metrics for quality improvement that provide positive results.