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. 3 Public Health Reports. 2016 Aug 2016.
CDC Estimates & Texas PHBPP • Point:1194 CDC • Low: 882 • 2015: 648 (54%) Texas • 2016: 654 (55%) 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 Southeast 2015 East Asia Africa Asia CDC 237 186 167 TX 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, 6 Spratly Islands, Papua New Guinea, Timor, Philippines, Singapore, Thailand, East Timor, Vietnam
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 800 700 600 Number of Infants 500 400 300 200 100 0 US-Born Foreign-Born CDC Estimate PHBPP Reported 8
Maternal Age, Texas PHBPP, 2016-17* 250 2016 2017* 200 No. of Mothers 150 100 50 3 3 2 1 1 0 <19 19-24 25-29 30-34 35-39 40-44 45-49 50+ Age by Year *Data is provisional as of 5/1/18 9
Infants Born to HBV-infected Moms, Texas PHBPP, 2013-17* 2016 Births Infants Identified Mothers Identified 9/10 11 3% 2% 900 1 8 2% 1% 765 800 736 716 7 10% 700 655 654 632 Number of Infants 607 603 562 600 568 500 400 2/3 300 47% 200 6/5S 100 34% 0 2013 2014 2015 2016 2017* 4/5N 10 1% *Data is provisional as of 5/1/18
Perinatal Infection in Infants, Texas, 2003-18* 10 9 8 7 Peri Hep B Cases 7 6 6 5 5 5 4 4 3 3 3 3 2 2 2 1 1 1 1 1 1 0 0 *Data is provisional as of 5/1/18 11
Infants with Birth Dose/HBIG within 1 Day of Birth, 2013-17* 2015 National 100% 98.8% 98.0% 98.0% Average= 96% 98% 96.0% 96.0% 96% 94% % of Infant Cases 92% 90% 88% 86% 84% 82% 80% 2013 2014 2015 2016 2017* *Data is provisional as of 5/1/18 12
Infants with Birth Dose/HBIG within 1 Day of Birth by PHR, 2016 100.0% 100.0% 100.0% 100% 2016 Texas 98.5% 98.5% 98.3% Average= 98% 98% 96% 94.0% 94% 93.0% 92% 90% 88% 86% 84% 82% 80% PHR 1 PHR 2/3 PHR 4/5M PHR 6/5S PHR 7 PHR 8 PHR 9/10 PHR 11 13
Infants that Completed the Series, 2013-17* 2015 National 100% 92.1% 90.4% Average= 77% 87.5% 85.9% 90% 80% 70% % of Infant Cases 63.9% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017* *Data is provisional as of 5/1/18 14
Infants that Completed the Series by PHR, 2016 2016 Texas 100.0% 100% Average= 87.5% 94.0% 89.8% 85.7% 87.5% 90% 80.5% 77.8% 76.5% 80% 70% 60% 50% 40% 30% 20% 10% 0% PHR 1 PHR 2/3 PHR 4/5N PHR 6/5S PHR 7 PHR 8 PHR 9/10 PHR 11 15
Infants with Post-Vaccine Serological Testing, 2013-17* 100% 2015 National Average= 72% 90% 80% 70% % of Infant Cases 60.5% 57.6% 55.8% 60% 54.5% 50% 40% 30.2% 30% 20% 10% 0% 2013 2014 2015 2016 2017* *Data is provisional as of 5/1/18 16
Infants with Post-Vaccine Serological Testing by PHR, 2016 100.0% 100% 2016 Texas 90% Average= 60.5% 80.0% 80% 69.7% 69.5% 70% 63.5% 60% 55.0% 53.0% 50.0% 50% 40% 30% 20% 10% 0% PHR 1 PHR 2/3 PHR 4/5N PHR 6/5S PHR 7 PHR 8 PHR 9/10 PHR 11 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 Suzy Wiseman getting • Completing the 3-dose HBV series Hep B shot at 1 hour old 18
Thank you! Questions? 19
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