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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.
3
CDC Estimates & Texas PHBPP
•Point:1194
•Low: 882CDC
•2015: 648 (54%)
•2016: 654 (55%)Texas
4
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
8
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%
13
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%
15
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%
17
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
18
Thank you!Questions?
19