Perinatal Hepatitis B Program Evaluation Post-Vaccination Serology Testing February 19, 2009 Presenter: Shana J

1. Perinatal Hepatitis B Program Evaluation Post-Vaccination Serology Testing February 19, 2009 Presenter: Shana Johnny, RN, MN Immunization Program CHILD Profile

2. Overview of Washington State Perinatal Hepatitis B Prevention Program • 1990, Initiated with CDC funds • Contract with 35 Local Health Jurisdictions (LHJ’s) to provide services • Components: • State-supplied hepatitis B vaccine • Laboratory testing • Information, education, consultation and technical assistance

3. Rational for Selecting Evaluation Activity • Identify barriers to post-vaccinations serology testing • Increase understanding of barriers providers are facing in practice • Develop strategies to increase post-vaccination serology

4. Post-VaccinationSerology Testing Data

5. Evaluation Goal • To increase awareness, knowledge and practice with perinatal hepatitis B post-vaccination serology

6. Stakeholders and Partners Perinatal Hepatitis B Coordinator Local Health Jurisdictions Evaluation Plan Within Reach-API Hepatitis B Task Force DOH-Immunization Program CHILD Profile Staff Communicable Disease EPI DOH-MCH Epidemiologist Other Health Care Professionals

7. Objectives 1. By January 31, 2009, determine the number of providers identified by LHJ’s as caring for infants of HBsAg+ moms and number of providers with standing orders in place for post vaccination serology. 2. By March 31, 2009, survey providers identified as caring for infants of HBsAg+ moms to determine the percent of those providers who are: a. aware of the value of early detection and the criticality of post serology testing for infants born to HBsAg positive moms b. educated on the value of early detection and the criticality of post serology testing for infants born to HBsAg positive moms.

8. Objectives (Continued) 3. By December 31, 2009, increase the number of providers identified as caring for infants of HBsAg positive moms who are: a. aware of the value of early detection and the criticality of post serology testing for infants born to HBsAg positive moms by 5%. b. educated on the value of early detection and the criticality of post serology testing for infants born to HBsAg positive moms by 5%. • By December 31, 2009, the percent of providers who have written standing orders for post serology testing for infants born to HBSAg positive mothers will increase by 10%. • By December 31, 2010, the rate for a three-year period from December 31, 2006-December 31, 2009, for post serology testing for infants born to HBsAg positive mothers will increase from 58% to 70% (increase of 42 infants/yr).

10. Evaluation Activities • Identify LHJ’s and geographical areas where post-vaccination serology is low. • Identify providers where post vaccination serology is low

11. Evaluation Activities • Plan outreach to providers to assess awareness of why infants born to HBsAg positive mom’s are not getting post-vaccination serology testing ( pre-test survey) • Use findings to develop strategies to increase the testing rates for these infants (post-test survey)

12. Short-Term Outcomes • Providers are more aware of importance of post-vaccination serology testing • Providers are educated on the value of early detection • An increased number of providers who are conducting post-vaccination serology testing • An increase number of LHJ’s providing consultation with providers

13. Data collection and Analysis Evaluation question #1: • To what degree did the number of providers who are aware of the value of early detection and the criticality of post vaccination serology testing for infants born to HBsAg positive mothers increase from March 31, 2009 to December, 2009

14. Data collection and Analysis Evaluation question #2: • To what degree did the number of providers who have been educated on the value of early detection and the criticality of post-vaccination serology testing for infants born to HBsAg positive mothers increase between march 31, 2009 and December, 2009

15. Data collection and Analysis Evaluation Question # 3 • To what degree did the number of providers have written standing orders for post-vaccination serology testing for infants born to HBsAg positive mothers increase from January 31, 2009 to December, 2009

16. Data collection and Analysis Evaluation Question #4 • To what degree did the rate for post-vaccination serology testing for infants born to HBsAg positive mothers increase from December 2006 (baseline collected in 2007) to December 2009 (collected in December 2010)

17. Long term outcomes • An increase percentage of infants born to HBsAg positive moms who receive post-vaccination serology testing • An increase ability to track efficacy of Hepatitis B vaccination thru post-vaccination serology • A decrease in hepatitis B disease in infants born to HBsAg positive moms

18. Challenges in Developing a Plan • Agreement of consensus on plan with stakeholders and partners • Methodology • Resources. Fitting into overall workload

19. Lessons Learned • Partnerships Work – can’t do it alone! • Target efforts – can’t do it all.

20. Washington State Department of Health Lin Watson Janna Bardi Marsha Fraser Pat DeHart Gary Gant Katherine Harris-Wollburg Debbie Carlson Chrystal Averette Steve Bichler Within Reach Organization Kim Nguyen Acknowledgements • Local Health Jurisdictions • Shelly McKeirnan Public Health Seattle King County • Jackie Ramsey Snohomish Health District • Ginger Dobberthan Southwest Washington Health District • Denny Hursch Yakima Health District • Denise Stinson Tacoma-Pierce Count Health Department • Delores Dorffeld Thurston County Public Health and Social Services

21. This document • This document can be found on the CDC website at:http://www.cdc.gov/vaccines/programs/progeval/downloads/wash-eval-02-09-508.ppt