BACKGROUND: To prevent perinatal Hepatitis B (HBV) transmission, the Advisory Committee on Immunization Practices (ACIP) recommends that infants born to HBV positive women receive post-exposure prophylaxis with hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth, and complete the 3-dose hepatitis B series. To determine infant outcomes after post-exposure prophylaxis, ACIP recommends post-vaccination serologic testing (PVST) at age 9 to 12 months. The New York State (NYS) Communicable Disease Electronic Surveillance System (CDESS) infant tracking module tracks on average 300 infants of HBV positive or unknown mothers annually. To improve the tracking and monitoring of infants born to HBV positive women in NYS excluding New York City (NYC), the module was redesigned to be infant centric where each infant is a suspect case report of HBV Infant Perinatal. This case is linked to the mother; and can be tracked for vaccine, serology completeness, movement, and lost-to-follow-up (LTF).
METHODS: A positive or unknown status HBV mother from newborn screening (NBS) transferred to the Electronic Clinical Laboratory Reporting System (ECLRS) will begin the creation of a suspect HBV Infant Perinatal case in CDESS. The delivery, birth, and demographic information will populate from NBS when available. The module has the capability to add vaccination, serology, and contacts information. Serology data is auto-mapped from ECLRS to the infant case. The improved LTF section includes suggestions for locating infants, methods which have located previously LTF infants. A report is generated when a child moves to ensure continuation of proper treatment. CDESS report writer and queries are created for infant tracking purposes.
RESULTS: The ease of identifying and updating each infant has decreased the burden of infant tracking at the local health department. Reports identifying infants in need of vaccination or serology can be generated by the user. Expansion and amendments to measured data elements has improved public reporting capabilities, the ability to conduct program evaluations, and identify areas for quality improvement. The 2016 birth cohort began with 252 infants. Seven have moved out of jurisdiction and one has been LTF. Three infants have been located through enhanced LTF methods. Through November 21, 2016 ten infants have completed vaccination and PVST. There have been no cases of Infant Perinatal Hepatitis B in NYS excluding NYC since 2014.
CONCLUSIONS: The Infant centric module has greatly improved flexibility in terms of identifying, modifying, and querying records. Ensuring these infants stay on track is vital to prevent seroconversion and chronic hepatitis.