![[ Visit Client Website ]](images/banner.jpg)
BACKGROUND: Infants born to hepatitis B virus (HBV) infected women are at risk for perinatal HBV transmission and subsequent chronic liver disease. Appropriate and timely treatment with the hepatitis B immunoglobulin (HBIG) and HBV vaccine is up to 95% effective in preventing transmission. To identify at-risk infants, New Jersey Department of Health (NJDOH) perinatal HBV surveillance utilizes multiple reporting sources: (1) referrals from identified HBV-infected pregnant women, (2) manually reviewed reports of electronic birth certificates (EBC) from NJ Bureau of Vital Statistics and Registration (NJBVSR), and (3) physician, hospital and out-of-state notifications. Although NJDOH uses pooled sources and confirms all reports, the Centers for Disease Control and Prevention (CDC) estimates that NJ identifies only half the number of at-risk infants. We evaluated the sensitivity for the identification of infants born to HBV-infected mothers by assessing surveillance and clinical management (including vaccination and testing).
METHODS: The surveillance system was evaluated using CDC guidelines (2001) with a focus on sensitivity of at-risk infant identification. Clinical management completion was also analyzed. To evaluate EBC, a representative reporting source, and its review process, EBC 2010-2011 data were requested from NJBVSR and matched to surveillance data using Link Plus 2.0. To evaluate as a potential reporting source, independent hospital discharge 2010-2011 data were matched to surveillance data using Link Plus 2.0 using capture-recapture method.
RESULTS: Of 805 infants with confirmed perinatal HBV exposure, 787 (98%) received the birth dose of the HBV vaccine and 754 (94%) received HBIG within one calendar day of birth. Among 714 infants residing in NJ during clinical management, 504 (71%) completed HBV vaccine series by age 8 months. Of 625 eligible infants, 283 (45%) completed post-vaccine serology testing at any age. Evaluation of EBC data identified 513 at-risk infants; of these 421 were reported in the surveillance system and 92 were not. 384 out of 805 infants were identified in the surveillance system by other sources but not in EBC data. Evaluation of hospital discharge data identified 484 at-risk infants; of these 192 were not identified in the surveillance system.
CONCLUSIONS: Among identified infants, HBV birth dose vaccine and HBIG rates were high. Efforts should focus on improving completion of HBV vaccine series and post-vaccine serology testing. EBC can be useful as a reporting source; however, the process should be reviewed and standardized to ensure efficiency and accuracy. Hospital discharge data can be a useful additional reporting source to improve surveillance at-risk infant identification.