Chrissy Cheung, MPH

Perinatal Research Coordinator Asian Liver Center at Stanford University

Hepatitis B Education and Immunization: Liver Cancer Prevention Begins at Birth

Celia Bird, MS, NP-C

Perinatal Hepatitis B Prevention Program Coordinator, CA California Department of Public Health, Immunization Branch

Hepatitis B

• 240 million people living with chronic hepatitis B virus (HBV) in the world.

• 1.4 million people living with chronic HBV in the United States.

• 280,000-350,000 people living with chronic HBV in California. • One of the leading causes of preventable deaths in the world. • More prevalent than HIV and up to 100% more infectious. • Vaccine Preventable: series of 3 shots in 6 months.

ACIP Recommendations: Elimination of HBV Transmission

• Infants are at higher risk: infected at birth they have a 85-90% chance of developing chronic infection.

• To reduce perinatal transmission of HBV: – The Advisory Committee for Immunization Practices

(ACIP) recommends: • All pregnant women be tested for HBV infection, • All infants be given HBV vaccine within 12 hours of birth, • Infants born to infected mothers receive hepatitis B immune

globulin (HBIG) within 12 hours of birth, complete the vaccine series and be tested for both immunity and infection.

Source: CDC. Recommendations of the ACIP Part 1: Immunization of Infants, Children, and Adolescents. MMWR 2005;54(RR16);1-23.

Perinatal Hepatitis B Prevention Program in California

• The California Perinatal Hepatitis B Prevention Program (CA PHPP) identifies and enrolls pregnant women who are HBV-infected into a case management program to ensure appropriate post-exposure prophylaxis (PEP) of their infants.

• Screening of pregnant women is very successful in CA, almost reaching the goal of 90%, but follow-through with the other recommendations has not been as successful.

Perinatal Hepatitis B Prevention Program in California

• Goal of CA PHPP is to reduce HBV transmission to infants, collaborating with: – Local health jurisdictions (LHJs), prenatal providers, birth hospitals, infant

pediatricians and laboratories. – 23 LHJs enroll approximately 2,500 women in the program annually. – The county programs involve:

• Screening pregnant women for HBV, • Informing birth hospitals, • Educating patients, • Ensuring post-exposure prophylaxis for the infants, • Ensuring a birth dose of HBV vaccine for all neonates, • Ensuring post-vaccine serologic testing for the infants, • And follow-up for the remainder of the HBV vaccine series for the infants, and case-

management.

Hepatitis & Liver Cancer Report 1. There is a lack of knowledge and awareness about chronic viral

hepatitis on the part of health-care and social-service providers

2. There is a lack of knowledge and awareness about chronic viral hepatitis among at-risk populations, members of the public, and policy makers

3. There is insufficient understanding about the extent and seriousness of this public health problem, so inadequate public resources are being allocated to prevention, control, and surveillance programs

Source: Institute of Medicine. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C.

Washington DC: The National Academies Press, 2010

POOR ACIP GUIDELINE COMPLIANCE • CDC studies gaps in hospital policies and practices • Study of 4672 chart reviews across 242 hospitals

• Of infants born to HBsAg+ women, 38% did not receive birth dose within 12 hours

• Of infants born to women of unknown status, 48% not vaccinated within 12 hours and 20% still not vaccinated by discharge

• Of infants born to HBsAg- women, only 69% were vaccinated by discharge

• 87% missing laboratory copy of test results

• Clinicians misinterpret/mistranscribe test results

Source: Willis, et al. Gaps in Hospital Policies and Practices to Prevent Perinatal Transmission of Hepatitis B Virus. Pediatrics. 2010; 125(4):704-11

POOR PROVIDER KNOWLEDGE

Physicians n=142

92%

94%

23%

30%

26%

45%

Chronic HBV infection has no symptoms Sequelae of chronic HBV infection 1 in 10 API have chronic HBV If infected as newborn, infant has 90%

chance of developing chronic HBV 1 in 4 people with chronic HBV will die

of liver disease

Provides hepatitis B educational materials to patients

Nurses N= 493

89%

22%

26%

16%

26%

51%

Percent answering correctly

Sources: Chao et al. Low Levels of Knowledge and Preventive Practices. JOGNN. 2012; 41(4):494-505. Yang et al. Education and Counseling of

Pregnant Patients with Chronic Hepatitis B. APJCP. Accepted 2013

www.HepBMoms.org

This website was developed as a resource for moms, health-care providers, and public health officials to reduce perinatal hepatitis B transmission and

the associated health consequences.

Dedicated to the prevention of perinatal transmission of hepatitis B

Educational Materials • Diagnosis Packets for obstetricians • Hospital Discharge Packets for new moms • Educational brochures • Provider education materials • Distributed internationally FREE of charge!

Public Service Announcement

• PSA and patient testimonial videos • DVDs distributed to public health departments,

hospital systems, and non-profit organizations • FREE of charge and available online

THANK YOU Celia Bird, MS, NP-C

Celia.Bird@cdph.ca.gov (510) 620-3728

Chrissy Cheung, MPH ccheung1@stanford.edu

(650) 566-8818

congratulations on your baby

1-888-311-3331 http://liver.stanford.edu

Funded in part by Cooperative Agreement CD07-005 from the U.S. Centers for Disease Control and Prevention©2008 Asian Liver Center

The Jade Ribbon is folded like the Chinese character for people “ ” to symbolize the united effort worldwide to

eliminate hepatitis B and liver cancer.

Congratulations on your new baby! During your pregnancy, your blood test for hepatitisB surface antigen (HBsAg) was positive. This means you are chronically infected with thehepatitis B virus (HBV). HBV is an infection of the liver that can lead to liver cancer andliver disease, and can be transmitted by your blood or to your newborn at birth. Thispacket provides you with information to protect you, your baby, and your family from HBVand liver cancer.

Remember:Make sure your baby received 2 shots at birth (before leaving the hospital) to protect

from infection – the first dose of hepatitis B vaccine and another shot called the hepatitis Bimmunoglobulin (HBIG).

Be sure your baby completes the hepatitis B vaccine series – usually consisting of 3shots within 6 months of birth. See the enclosed yellow “Immunization Record”

At 9-15 months of age, make sure your baby gets a blood test to check whether yourbaby is protected or infected. See “Hepatitis B and Moms to Be” brochure.

Not every one with chronic hepatitis B needs treatment, but be sure you follow upwith your doctor regularly to screen for liver damage and liver cancer. Use the enclosedgreen “Hepatitis B Management and Liver Cancer Screening Record” to keep track of yourhealth.

Be sure your family and those living with you are tested for HBV, and vaccinated if theyare not already protected. See “Know HBV” brochure.

Protect yourself and your family. We wish you a lifetime of health and happiness!

The Jade Ribbon Campaign