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Perinatal Hepatitis B in Texas Rachel Wiseman, MPH

Perinatal Hepatitis B in Texas - Texas Department of State ......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

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Page 1: Perinatal Hepatitis B in Texas - Texas Department of State ......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

Perinatal Hepatitis B in Texas

Rachel Wiseman, MPH

Page 2: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 3: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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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Page 4: Perinatal Hepatitis B in Texas - Texas Department of State ......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

CDC Estimates & Texas PHBPP

•Point:1194

•Low: 882CDC

•2015: 648 (54%)

•2016: 654 (55%)Texas

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Page 5: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

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Page 6: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 7: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 8: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 9: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 10: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 11: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 12: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 13: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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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Page 14: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 15: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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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Page 16: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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

Page 17: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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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Page 18: Perinatal Hepatitis B in Texas - Texas Department of State ......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

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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Page 19: Perinatal Hepatitis B in Texas - Texas Department of State ......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

Thank you!Questions?

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