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Health Protection input to the antenatal hepatitis B screening programme

Health Protection input to the antenatal hepatitis B screening programme. N Irvine June 2011. Policy/standards/guidelines. HSS(MD)43/2010 Infectious diseases in pregnancy screening programme: standards and handbook for laboratories (National Screening Committee)

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Health Protection input to the antenatal hepatitis B screening programme

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  1. Health Protection input to the antenatal hepatitis B screening programme N Irvine June 2011

  2. Policy/standards/guidelines • HSS(MD)43/2010 Infectious diseases in pregnancy screening programme: standards and handbook for laboratories (National Screening Committee) • Appointment with hepatitis B specialist within 6 weeks of issue of positive result • Maternal consent for baby to be vaccinated • Care during pregnancy • Considerations for intrapartum care (maternal status, neonatal vaccination needs, avoid fetal blood sampling/ fetal scalp electrodes) • Postnatal dose within 24 hours of birth • Arrangements for completion of the vaccination schedule • Process to ensure subsequent doses

  3. Current Northern Ireland process (1) • NIBTS: testing and notification of results to Obstetrician, GP, PHA • Trusts: testing, counselling, referral to specialist, referral to GUM, vaccination at birth, serology testing at 12/12 • PHA: further communication of results according to area protocol, telephone and written follow up with GP re: • - Referral to GUM and hepatitis B specialist if not already actioned • - Screening/vaccination household contacts

  4. Current Northern Ireland process (2) • NIBTS: testing and notification of results, advice re neonatal vaccination schedule, provision of vaccine/HBIG to hospitals (and D2,3 to primary care) Follow up vaccination • Mixture of Trust and primary care provision • All processes are (or are moving to) being Trust managed • PHA: monitoring via Child Health System, follow up of orphan NIBTS reports, alerting Trusts to delayed doses/serology

  5. Vaccination schedule and rationale • Risk of perinatal transmission (without intervention) is high • 73-88% born to HBeAg positive • 7-14% born to HBeAg negative • 90% of infected babies will have chronic infection • Almost all infections are asymptomatic in infancy (so need to test with HBsAg) • Effectiveness of timely vaccination is 72-92% • 0, 1 and 2 months • Booster at 12/12 • HBIG further 50% reduction in highest risk infants

  6. HBIG • Offered in addition to vaccine to babies born to higher risk mothers: • HBeAg positive • Anti-HBe negative • Acute hepatitis B in pregnancy • High viral load if measured • Infants with very low birthweight

  7. Follow up of babies • Many published audits • Coverage variable, often low completion rates • Often very low proportion with documented follow up serology

  8. Babies born in Northern Ireland, calendar year 2008 • Movements out of N Ireland; English not first language

  9. Ongoing work re infant vaccination • Regional group comprising Trust leads and ANC coordinators, RVL, CHS and PHA • Standard serology request form • COVER-style statistics and detail feedback to Trusts • 5 year booster reminders • Regionally agreed CHS flag

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