Evaluation of Hepatitis B Surveillance Among Pregnant Women in New York City, 2011-2012

BACKGROUND: The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) Perinatal Hepatitis B Prevention Program (PHBPP) annually conducts surveillance of an estimated 2000 pregnant women with hepatitis B virus (HBV) infection.  Reporting of infected pregnant women is mandatory in New York State at the time of diagnosis and at delivery.  Documentation of mother’s HBV status on the Newborn Metabolic Screening Form (NMSF) is also required and serves as a reporting safety net.  We evaluated timeliness, sensitivity of reporting methods, data quality, and acceptability of the surveillance system.

METHODS:   Cases were defined as pregnant women with a positive hepatitis B surface antigen (HBsAg) laboratory result, residence in NYC, and delivery from October 2011 through September 2012.  Timeliness was evaluated as the proportion of cases identified before delivery.  Sensitivity of reporting methods was determined by the proportion of cases reported before delivery, the proportion reported at delivery, and the proportion reported by NMSF.  Data quality was assessed as the percentage of data missing for critical case management variables.  User acceptability was assessed by administration of a 13-question paper-based survey to PHBPP staff.  Patient acceptability was estimated as the percentage of women completing a patient interview.  Analyses utilized SAS v9.2 statistical software.

RESULTS: Among the 1,722 cases that delivered between October 2011 and September 2012, 57.8% were reported prenatally, 67.4% were reported at time of delivery, and 82.8% were reported by NMSF.  NMSF was the only source of report for 10.5% of cases.  Missing data elements included diagnosis date of HBsAg-positivity (0.6%), initial source of report (2.1%), and birth country (8.5%).  Responses to the user acceptability survey indicated moderate to high satisfaction with the system.  Patient interview completion was 89.4%.

CONCLUSIONS: Data quality essential to case management was found to be excellent and the survey of PHBPP staff determined the system to be acceptable by users.  Recommendations for system improvements include the following:  1) Patient interview completion rate may be improved through examination of factors associated with a lack of patient interview; 2) Timeliness and sensitivity of reporting methods should be improved by focusing on enhancing prenatal reporting and reinforcing mandatory reporting at delivery and via NMSF; 3) An assessment of provider and delivery facility reporting barriers may identify strategies to increase timeliness and sensitivity of reporting methods; and 4) Completeness of case identification should be evaluated.