Perinatal Hepatitis B in Texas - Texas Department of State ......PHR 1 PHR 2/3 PHR 4/5N PHR 6/5S PHR...

Perinatal Hepatitis B in Texas

Rachel Wiseman, MPH

Overview

• CDC Estimates

• PHBPP Demographics

• PHBPP Performance Measures

NOTE:

All 2017 data is provisional. Babies born in 2017 may not be old enough to have completed the series or be tested for infection/immunity.

Data for San Antonio and Houston is not included in any of the data presented. 2

CDC Estimates of Births to Hepatitis B-infected Women

Source of HBsAg prevalence estimates: • National Health and Nutrition Examination Survey 2009-2014• 2009-2014 Annual Reports• Walker TY, Smith EA, Fenlon N, et al. Characteristics of Pregnant Women with

Hepatitis B Virus Infection in Five U.S. Public Health Jurisdictions, 2008–2012. Public Health Reports. 2016 Aug 2016.

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CDC Estimates & Texas PHBPP

•Point:1194

•Low: 882CDC

•2015: 648 (54%)

•2016: 654 (55%)Texas

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Questions We Need to Answer

Who are these missing moms?

Where are these missing moms?

How do we find them or get them

reported to us?

1194 Moms

5

Drilling Down the Estimate

2015

CDC

TX

East Asia

237

Africa

186

Southeast Asia

167

East Asia: China, Hong Kong, Japan, North Korea, South Korea, Macau, Mongolia, Taiwan, Southern Ryukyu Islands Southeast Asia: Burma, Brunei, Cambodia, Indonesia, Laos, Malaysia, Paracel Islands, Spratly Islands, Papua New Guinea, Timor, Philippines, Singapore, Thailand, East Timor, Vietnam 6

Maternal Country of Birth, Texas PHBPP, 2016

Country Number of Moms (%)

VIETNAM 129 (18%)

UNKNOWN 101 (14%)

USA 79 (11%)

CHINA 74 (10%)

NIGERIA 68 (9%)

BURMA 24 (3%)

CONGO 24 (3%)

INDIA 18 (3%)

TAIWAN 14 (2%)

MEXICO 12 (2%)

TOTAL 716

An additional 57 countries are represented in the 2016 enrollment.7

Infants Born to Foreign-Born and US-Born Moms, 2015

0

100

200

300

400

500

600

700

800

US-Born Foreign-Born

Num

ber

of In

fants

CDC Estimate PHBPP Reported

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Maternal Age, Texas PHBPP, 2016-17*

1 12 3 30

50

100

150

200

250

<19 19-24 25-29 30-34 35-39 40-44 45-49 50+

No. of M

oth

ers

Age by Year

2016 2017*

*Data is provisional as of 5/1/18 9

Infants Born to HBV-infected Moms, Texas PHBPP, 2013-17*

562

632655 654

568603

765736 716

607

0

100

200

300

400

500

600

700

800

900

2013 2014 2015 2016 2017*

Num

ber

of In

fants

Infants Identified Mothers Identified

1

2%

2/3

47%

4/5N

1%

6/5S

34%

7

10%

8

1%

9/10

3%11

2%

2016 Births

*Data is provisional as of 5/1/18 10

Perinatal Infection in Infants, Texas, 2003-18*

5

7

1

5

6

2

3

1

3

4

3

1 1

2

1

00

1

2

3

4

5

6

7

8

9

10

Peri

Hep

B C

ases

*Data is provisional as of 5/1/1811

Infants with Birth Dose/HBIG within 1 Day of Birth, 2013-17*

96.0%

98.0%98.8%

98.0%

96.0%

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

2013 2014 2015 2016 2017*

% o

f In

fan

t C

ases

2015 National Average= 96%

*Data is provisional as of 5/1/1812

Infants with Birth Dose/HBIG within 1 Day of Birth by PHR, 2016

100.0%

98.3%

100.0%

98.5% 98.5%

100.0%

94.0%93.0%

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

PHR 1 PHR 2/3 PHR 4/5M PHR 6/5S PHR 7 PHR 8 PHR 9/10 PHR 11

2016 Texas Average= 98%

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Infants that Completed the Series, 2013-17*

92.1%90.4%

85.9% 87.5%

63.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2013 2014 2015 2016 2017*

% o

f In

fan

t C

ases

2015 National Average= 77%

*Data is provisional as of 5/1/1814

Infants that Completed the Series by PHR, 2016

87.5%89.8%

77.8%80.5%

94.0%100.0%

76.5%

85.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PHR 1 PHR 2/3 PHR 4/5N PHR 6/5S PHR 7 PHR 8 PHR 9/10 PHR 11

2016 Texas Average= 87.5%

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Infants with Post-Vaccine Serological Testing, 2013-17*

54.5%57.6% 55.8%

60.5%

30.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2013 2014 2015 2016 2017*

% o

f In

fan

t C

ases

2015 National Average= 72%

*Data is provisional as of 5/1/1816

Infants with Post-Vaccine Serological Testing by PHR, 2016

80.0%

69.7%

50.0%

63.5%

69.5%

100.0%

55.0% 53.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PHR 1 PHR 2/3 PHR 4/5N PHR 6/5S PHR 7 PHR 8 PHR 9/10 PHR 11

2016 Texas Average= 60.5%

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Summary

Areas for improvement

• Identifying all pregnant women with hepatitis B infection

• Ensuring PHBPP infants are tested for immunity and infection after vaccination

Areas of success

• Vaccination of all infants at birth

• Prophylaxing exposed infants with HBV/HBIG at birth

• Completing the 3-dose HBV seriesSuzy Wiseman getting Hep B shot at 1 hour old

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Thank you!Questions?

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