The Centers for Disease Control and Prevention (CDC) estimates that 800 infants are born to hepatitis B virus (HBV)-infected women in Georgia annually. In 2012, only 367 of these high-risk births were reported to the Department of Public Health (DPH). Unidentified infants remain at risk for perinatal HBV infection at birth by failure to receive postexposure prophylaxis (PEP) with hepatitis B immune globulin (HBIG) and hepatitis B (HepB) vaccine.
In 2013, the Georgia Perinatal Hepatitis B Prevention Program (PHBPP) implemented strategies to increase the number of identified HBV-exposed infants and decrease the number of infants who failed to receive PEP within seven days of birth. One of the strategies included incorporating a real-time feed from the Vital Records system into Georgia’s PHBPP tracking system. Another strategy included retrospectively searching for missed cases through postnatal capture/recapture analysis.
The objectives of the capture/recapture processes were to: (1) identify and recall HBV-exposed infants within seven days of birth to receive PEP; and, (2) enroll previously-unidentified HBV-exposed infants into PHBPP case management services.
METHODS:
We developed a capture/recapture process that compared the names of females reported with HBV in the State Electronic Notifiable Disease Surveillance System (SendSS) to the mother’s name and date of birth listed in Georgia’s Vital Records system. The capture/recapture linking process was run daily to identify infants that were within the 7-day window of opportunity for PEP. The delivery hospital was contacted to confirm that HBIG and HepB were administered before discharge. If PEP was not administered, the infant was recalled to the hospital for immediate administration of PEP. The postnatal capture/recapture report was run monthly to identify infants that were not previously being managed by the PHBPP.
RESULTS:
In Georgia birth cohorts from 2013-2015, seven infants were recalled for HBIG administration before the 7-day window of opportunity had expired; a total of 142 (15%) HBV-exposed infants were enrolled into case management services postnatally. These processes resulted in a 10% increase in the number of infants receiving PEP since 2012.
CONCLUSIONS:
Identification of HBV-exposed infants in real-time increases the likelihood of high-risk infants receiving PEP within seven days of birth and decreases their risk of perinatal HBV infection. The capture/recapture process identified deficiencies and opportunities to improve hospital policies for identifying and caring for HBV-exposed neonates. These processes are helping Georgia change the future of HBV-exposed infants by protecting them from perinatal HBV.