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Assessment of Perinatal Hepatitis B and Rubella Prevention in New Hampshire Delivery Hospitals

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Assessment of Perinatal Hepatitis B and Rubella Prevention in New Hampshire Delivery Hospitals Assessment of Perinatal Hepatitis B and Rubella Prevention in New Hampshire Delivery Hospitals Susan Bascom, BSN; Stephanie Miller, MPH; and Jesse Greenblatt, MD, MPH ABSTRACT. Objective. To evaluate current perfor- renatal health care providers and delivery hos- mance on recommended perinatal hepatitis B and rubella pitals play a crucial role in preventing vertical prevention practices in New Hampshire. transmission of the hepatitis B virus (HBV) and Methods. Data were extracted from 2021 paired moth- P 1 congenital rubella infection. HBV infection is an er–infant records for the year 2000 birth cohort in New established cause of both acute and chronic hepatitis, Hampshire’s 25 delivery hospitals. Assessment was done as well as cirrhosis of the liver2; transmission from a on the following: prenatal screening for hepatitis B and chronically infected woman to her infant accounts rubella, administration of the hepatitis B vaccine birth for ϳ24% of chronic HBV infections in the United dose to all infants, administration of hepatitis B immune 3,4 globulin to infants who were born to hepatitis B surface States. To prevent perinatal HBV infection, the Ad- antigen–positive mothers, rubella immunity, and admin- visory Committee on Immunization Practices (ACIP) istration of in-hospital postpartum rubella vaccine to ru- and the American Academy of Pediatrics (AAP) rec- bella nonimmune women. ommend routine prenatal screening to identify Results. Prenatal screening rates for hepatitis B women who carry the hepatitis B surface antigen (98.8%) and rubella (99.4%) were high. Hepatitis B vac- (HBsAg); newborns who are born to such women cine birth dose was administered to 76.2% of all infants. should receive the first dose of hepatitis B vaccine All infants who were born to hepatitis B surface antigen– and hepatitis B immune globulin (HBIG) within 12 positive mothers also received hepatitis B immune glob- hours of birth.5,6 ulin. Multivariate logistic regression showed that the First-trimester congenital rubella infection can re- month of delivery and infant birth weight were indepen- sult in fetal death, premature delivery, and an array dent predictors of hepatitis B vaccination. The proportion of congenital abnormalities known as congenital ru- of infants who were vaccinated in January and February 7,8 2000 (48.5% and 67.5%, respectively) was less than any bella syndrome (CRS). The number of reported other months, whereas the proportion who were vacci- rubella and CRS cases in the United States has de- nated in December 2000 (88.2%) was the highest. Women clined dramatically since licensure of rubella vaccine who were born between 1971 and 1975 had the highest in 1969,9 and elimination of indigenous rubella and rate of rubella nonimmunity (9.5%). In-hospital postpar- CRS is a national public health goal.10 However, 7.5% tum rubella vaccine administration was documented for to 17.4% of women of childbearing age may be ru- 75.6% of nonimmune women. bella nonimmune, and their unborn children may Conclusion. This study documents good compliance be at risk for CRS.11 To prevent future cases of CRS, in New Hampshire’s birthing hospitals with national the ACIP and American College of Obstetrics and guidelines for perinatal hepatitis B and rubella preven- Gynecology recommend prenatal rubella immuno- tion and highlights potential areas for improvement. Pe- globulin G screening and postpartum vaccination of e e diatrics 2005;115: 594– 599. URL: www.pediatrics.org/ women who lack evidence of rubella immunity.7,9 To cgi/doi/10.1542/peds.2004-2057; hepatitis B vaccine, hepatitis B surface antigen, rubella, rubella vaccine, post- evaluate current performance on recommended peri- partum, congenital rubella syndrome. natal hepatitis and rubella prevention practices, we conducted a statewide hospital record review of ma- ternal and infant medical records from the year 2000 ABBREVIATIONS. HBV, hepatitis B virus; ACIP, Advisory Com- birth cohort in New Hampshire. mittee on Immunization Practices; AAP, American Academy of Pediatrics; HBsAg, hepatitis B surface antigen; HBIG, hepatitis B immune globulin; CRS, congenital rubella syndrome; NH DHHS, METHODS New Hampshire Department of Health and Human Services; CI, Paired mother–infant records for births in 2000 were sampled confidence interval. from New Hampshire’s 25 delivery hospitals. Assuming 10% ru- bella nonimmunity, a target sample of 1800 records was deter- mined to be sufficient to estimate with 95% confidence the pro- portion (Ϯ7 percentage points) of nonimmune women who From the New Hampshire Department of Health and Human Services, received postpartum rubella vaccination. Hospital records were Division of Public Health Services, Concord, New Hampshire. systematically sampled proportional to the size of their birth Accepted for publication Nov 30, 2004. cohorts; oversampling was done to make up for missing charts doi:10.1542/peds.2004-2057 and incomplete data. Hospital Medical Record Department man- No conflict of interest declared. agers were instructed to generate a line list of year 2000 births for Reprint requests to (S.B.) New Hampshire Department of Health and Hu- their facility and select infant records on the basis of the sample man Services, Division of Public Health Services, 29 Hazen Dr, Concord, interval (total births per hospital/sample size needed for that NH 03301-6504. E-mail: [email protected] hospital) provided to them by New Hampshire Department of PEDIATRICS (ISSN 0031 4005). Copyright © 2005 by the American Acad- Health and Human Services (NH DHHS) staff. They then selected emy of Pediatrics. the corresponding maternal record to complete the pair. Maternal e594 PEDIATRICS Vol.Downloaded 115 No. 5 from May www.aappublications.org/news 2005 www.pediatrics.org/cgi/doi/10.1542/peds.2004-2057 by guest on September 28, 2021 and newborn medical chart abstractions were conducted by TABLE 1. Demographics: New Hampshire Hospital Births, trained staff from NH DHHS using a standardized abstraction 2000 form to collect maternal and infant characteristics, as well as Total Births, Study Births, delivery payor, results of prenatal HBsAg and rubella immunity ϭ ϭ tests, and, when applicable, infant hepatitis B vaccine and HBIG (N 13 841) (N 2021) administration and maternal postpartum rubella vaccination. Pa- n (%) n (%) tient identifiers were not collected unless a woman found in the Maternal characteristics study sample had positive HBsAg test results; this is reportable by Race state statue and ensured that appropriate follow-up could be White 13 299 (96.1) 1842 (91.1) done. Prenatal laboratory reports were not part of the hospital Black 160 (1.2) 19 (0.9) record in most cases. Therefore, the screening test results for Asian/Pacific Islander 190 (1.4) 38 (1.9) HBsAg and rubella were based on handwritten documentation; Other 144 (1.0) 52 (2.6) laboratory testing methods were not apparent for this study and Unknown 48 (0.3) 70 (3.5) are not reported. Age group, y The proportions of the mothers who were screened and sero- 10–14 5 (0) 1 (0) positive for HBsAg were assessed. The receipt of the birth dose of 15–24 3643 (26.3) 539 (26.7) hepatitis B vaccine among all infants and receipt of HBIG among 25–34 7832 (56.6) 1153 (57.1) infants who were born to HBsAg-positive mothers were also 35–44 2347 (17.0) 325 (16.1) described. To examine risk factors for infant hepatitis B vaccina- 45–54 14 (0.1) 3 (0.1) ␹2 tion status, we performed univariate and multivariate analyses. Prenatal care tests and logistic regression analyses were conducted using SPSS Yes 13 587 (98.2) 2012 (99.6) software version 9.0 and Epi Info version 6.0. No 24 (0.2) 7 (0.3) For rubella, the proportion of mothers who had documentation Unknown 230 (1.7) 2 (0.1) of rubella screening and the proportion of nonimmune women Delivery payor (including those with equivocal results) were assessed. We also Private insurance 10 437 (75.4) 1511 (74.8) assessed univariate and multivariate predictors of rubella immu- Medicaid 2873 (20.8) 460 (22.8) nity, as well as the relative immunity among age groups. Among Self-pay 283 (2.0) 42 (2.1) rubella nonimmune women, the proportion that received postpar- Other 35 (0.3) 0 (0) tum rubella vaccination was evaluated. Unknown 213 (1.5) 8 (0.4) No. of pregnancies RESULTS 1 4487 (32.4) 623 (30.8) The final sample included 2021 mother–infant 2 4409 (31.9) 635 (31.4) Ն3 4928 (35.6) 761 (37.7) pairs of records. The maternal and infant demo- Unknown 17 (0.1) 2 (0.1) graphics in our study sample reflect demographics of Infant characteristics all New Hampshire hospital births for the same year Gender (Table 1). Male 7264 (52.5) 1092 (54.0) Female 6577 (47.5) 929 (46.0) Birth weight Perinatal Hepatitis B Prevention Normal (Ն2500 g) 13 037 (94.2) 1912 (94.6) Overall, 98.8% of maternal records had docu- Low (Ͻ2500 g) 800 (5.8) 109 (5.4) Ͻ mented HBsAg screening before delivery (Table 2). Unknown 4 ( 0.1) 0 (0) Gestational age Among these women, 0.2% (4) were HBsAg positive Ն37 wk 12 685 (91.6) 1866 (92.3) and 1.2% (25) had unknown status. Only 1 of the 4 Ͻ37 wk 1072 (7.7) 132 (6.5) HBsAg-positive pregnant women was reported to Unknown 84 (0.6) 23 (1.2) the NH DHHS. Of the women with unknown HBsAg status, 7 were screened after hospital admission. Of those 7, 4 were HBsAg negative, 1 result was still during any other months. In contrast, the proportion pending on hospital discharge, and 2 had the appro- of infants who were born in December 2000 and priate screening test (HBsAg) ordered by the physi- received the birth dose (88.2%) was the highest (Fig cian but the wrong test (HBsAb) processed.
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