Hennepin County
Perinatal Hepatitis B
Prevention Program
Partners
In
Prevention
Clinical Features of Hepatitis B
• Hepatitis B virus is a DNA virus
whose primary site of replication is
the liver
• Hepatitis B is a known carcinogen
– 2nd leading cause of cancer
worldwide
CDC, MMWR, Recommendations and Reports, December 23, 2005 / Vol. 54 / No. RR-16
CDC, MMWR, Recommendations and Reports, December 8, 2006 / Vol. 55 / No. RR-16
Burden of Disease
According to the World Health
Organization over 350 million
people are affected by chronic
hepatitis B worldwide
Death Rates
QuickStats: Death Rates from Viral Hepatitis Among Adults Aged ≥18 Years,*
by Age Group and Sex — National Vital Statistics System, United States, 1999–2011
Weekly
January 2, 2015 / 63(51);1230-1230
How is Hepatitis B Spread?
Hepatitis B virus is highly infectious (50-100
times more infectious than HIV) and is found
in certain body fluids of infected people such
as:
Blood
– Blood from highly infectious persons can
contain up to 1,000,000 virions/ml
– Hepatitis B virus can live in dried blood
outside the body for at least 7 days
CDC, MMWR, Recommendations and Reports, December 23, 2005 / Vol. 54 / No. RR-16
WHO, Fact Sheet No. 204, October 2000
Mode of Transmission
Worldwide:
• Perinatal (vertical transmission)
• Child to child transmission
(horizontal transmission)
CDC, MMWR, Recommendations and Reports, December 23, 2005 / Vol. 54 / No. RR-16
WHO, Fact Sheet No. 204, October 2000
Geographic Distribution of Chronic Hepatitis B Infection
HBsAg Prevalence
≥8% - High
2-7% - Intermediate
<2% - Low
Country of origin of
Hepatitis B positive women
East Asia: China, Hong Kong,
Japan, Korea, Taiwan
South Asia: India, Tibet,
Pakistan, Bangladesh
Southeast Asia: Burma,
Cambodia, Laos, Philippines,
Thailand, Vietnam, Malaysia
South Pacific: Marshall Islands
Middle East: Turkey, Palestine
Country of origin of Hepatitis B positive
women
East Africa: Ethiopia (Oromo),
Somalia, Kenya
West Africa: Liberia, Nigeria,
Togo, Sierra Leone, Ghana
Central Africa: Sudan
Eastern Europe + Northern Asia:
Slovak Republic, Russia, Ukraine
Mexico & Central America:
Mexico, Honduras
South America: Guyana
U.S.A.: Native American, AfricanAmerican
Etnicity
Ethnicity of Hepatitis B positive women
within Hennepin County:
Somali
Liberian
Hmong
Ethiopian
Former Soviet Union
Per Refugee Health -MDH
Demographics
•
•
•
•
Women with first pregnancy
Women with multiple pregnancies
Secondary and tertiary immigrants
Children of immigrants who are
now in child-bearing age
Screening of Pregnant
Women
• Tests Used:
HBsAg (surface antigen)
Anti-HBs (surface antibody)
• Document Hepatitis B status of mother in
prenatal record and hospital chart by a
copy of the original lab test result.
• Report positive women to MDH as soon
as possible
• Provide ongoing care for Hepatitis B
positive women
CDC recommendations
Refer woman to hepatologist during
pregnancy
Medical Assistance covers a woman
during pregnancy and up to 60
days postpartum
Impact of the disease
• Exposure during delivery
• 1 ml of blood can contain 1 million
parts of Hepatitis B virus
• Hep B vaccine and HBIG is
“Treatment” for infants who have
been exposed
• Without treatment 90% of the babies
will become infected with the virus
Hepatitis B Vaccination at
Birth with known
Hepatitis B positive mom
Hepatitis B
vaccine #1 &
HBIG given within
12 hours of birth.
Hepatitis B Vaccination with
Mothers of unknown Hepatitis B
status.
1) Hepatitis B vaccine #1
given within 12 hours of
birth.
2) Draw HBsAg test on
Mom, in hospital
Additional vaccinations
• Hepatitis B vaccine #2 between 1
to 2 months of age
• Hepatitis B vaccine #3 at 6 months
of age
(some variations, depending on the
type of vaccine used)
Post Vaccination Serology
Collect blood work
between 9 to 12
months of age.
Test for HBsAg
(surface antigen)
and anti-HBs
(surface antibody).
Case Management process
• Initial Clinic referral to MDH
• MDH referral to local public health
• PHN Contacts mom after provider
has discussed Hep B status
Role of PHN
Contact investigation
Case management
Follow up on shots for baby
Follow up on mother’s hep B status
Liaison
Education
Referral to resources
Advocate
Barriers to Access
•Transportation
•Language
•Cultural
Myths/Beliefs
Time
Gender
Education/Information
•Insurance
•Socioeconomic Needs
Community Resources
Office of Multicultural Services offers:
* Family advocates
* Multiple languages
* Assist with financial resources
WIC
C&TC
Community agencies: offering food programs,
diapers, etc.
Barriers to shots and
serology:
Belief that shots cause autism or
ADHD
Shots or serology are not done in
timely manner
Success of program
• CDC requires a 90% completion
rate for vaccines and serology. We
are currently meeting those
completion rates.
Where to find information on
Perinatal Hepatitis B
MDH:
www.health.state.mn.us/divs/idepc/diseases/hepb/disea
se.html
Asian Liver Center: liver.Stanford.edu
CDC: www.cdc.gov/hepatitis.
Hepatitis B Foundation: [email protected]
Hennepin County Perinatal
Hepatitis B Prevention Program
I would like to thank the following individuals
for their input:
–
–
–
–
Kathleen Barrett
Susan Turner
Adele Clobes
Carol Hooker
Hennepin County Public Health
Perinatal Hepatitis B Prevention Program Contact:
Joanna Przybilla PHN
612-348-9282
[email protected]