<p> PUBLIC HEALTH FOLLOW-UP OF HEPATITIS B IN THE WINNIPEG HEALTH REGION</p><p>This document provides the operational process for the public health follow-up of Hepatitis B. It is intended as a companion document to the Manitoba Health Communicable Disease Protocol for Hepatitis B http://www.gov.mb.ca/health/publichealth/cdc/protocol/hepb.pdf</p><p>Type of CD Admin person CD Coordinator Public Health Admin Public Health Nurse Referral person Chronic  Receives new Hep B lab report  Obtains additional Hepatitis  Receives the referral via Within 1 day contact the testing physician to review the result: Hepatitis B  Enters the referral into iPHIS and serology results from e-chart. email and iPHIS. refers to CD Coordinator for further  Document the results in iPHIS  Assigns it to a CA PHN via  Advise physician PHN will be contacting client to provide assessment notes. iPHIS education and do PH follow-up.  Preliminary assessment  Confirm client demographic information  Sends the referral via email and indicates chronic infection  Collect further details about the client. iPHIS to the CA Public Health admin Refer to Appendix # 2 person  Advise physician: o that referral to liver specialist is recommended o Hepatitis A vaccine is recommended if Hep A susceptible o (as per Manitoba Health protocol Sec.8.12)</p><p>PHN to contact client within 5 working days of receiving results Meet with client in person Follow Manitoba Health Protocol for Hepatitis B http://www.gov.mb.ca/health/publichealth/cdc/protocol/hepb.pdf (Sec 8.12)  Provide education to the client ( Sec 8.14)  Interview case for contacts ( Sec 8.2)  Contact follow-up (Sec 8.2) Coordinate contact testing through primary healthcare provider. Appendix 5- Letter to HCP can be used. PHN is not routinely required to f/u completion of HBV series of contacts once series is initiated. Exception: high risk newborns.  Contact CD Coordinator for serology results on contacts once PHN has confirmed that contacts have been tested. E- chart could also be checked. Provide HBV series to contacts- if susceptible. Appendix 3 Letter to contacts re: HBV series.  PHN can provide Hep A immunization to case- if susceptible.</p><p>Final May 2013 Type of CD Admin CD Coordinator Public Health Admin Public Health Nurse referral</p><p>File to be closed ( Refer to Closure section below) Type of CD Admin CD Coordinator Public Health Admin Public Health Nurse referral</p><p>Acute Hepatitis B  Receives new Hep B referral  Obtains additional Hepatitis  Receives the referral and  Contact the testing physician IMMEDIATELY to review the  Enters the referral into iPHIS and results from e-chart. assigns it to a CA PHN via result: refers to CD Coordinator for further  Markers indicate ACUTE hep B iPHIS  Advise physician PHN will be contacting client to provide assessment infection education and do PH follow-up.  Sends the referral via email and  Contact the CA PHN to advise o Confirm client demographic information. Refer to iPHIS to the CA Public Health admin of ACUTE hep B referral for Appendix 2 person immediate f/u o Determine when physician will be contacting client to advise of results. o Advise that PHN will be contacting client IMMEDIATELY  PHN to contact client IMMEDIATELY  Meet with client in person</p><p> Follow Manitoba Health Protocol for Hepatitis B http://www.gov.mb.ca/health/publichealth/cdc/protocol/hep b.pdf (Sec 8.12)  Provide education to the client ( Sec 8.14)  Interview case for contacts ( Sec 8.2)  Contact follow-up (Sec 8.2) Coordinate contact testing IMMEDIATELY through primary healthcare provider. o Assess need for HBIG/HBV ASAP.</p><p>Prenatal New In addition to chronic hepatitis B follow-  Obtains EDC and confirm physician, contacts CD Clerk Chronic up: (204-940-2081)to advise of EDC  Will create a "pop-up" in iPHIS  Proceed with Hepatitis B investigation as above for chronic Hepatitis B- requesting EDC of client hepatitis B. or  Newborn prophylaxis letter to  Investigation can be closed and await birth of infant for household physician and PHN. further follow-up member is known HBV positive Type of CD Admin CD Coordinator Public Health Admin Public Health Nurse referral</p><p>Prenatal  New prenatal blood work received.  Refers via iPHIS to the PHN  Uses this opportunity to connect with the case Chronic  Previously tested positive for Hepatitis o Obtains EDC and confirm physician, Hepatitis B- B. Public Health investigation has o Contacts CD Clerk (204-940-2081)to advise of been done. EDC and physician Previously  Refer to Public Health admin person o Assess if any additional contacts that may need investigated in iPHIS. follow-up since last contact.  Newborn prophylaxis letter to physician and PHN.</p><p>Prenatal In addition to acute hepatitis B Acute Hep B follow-up:  Close consultation with CD Coordinator and MOH infection-  Obtain EDC and confirm name of physician. Advise CD  Work closely with PHN to Clerk 204-940-2081 monitor Hep B status prior to  Advise and f/u with pregnant female to determine HBV delivery. status 1 month prior to EDC. Advise CD Coordinator when  Obtains follow-up test results testing has been done from e-chart</p><p>Newborn Hepatitis B  Post partum/ infant referral form  CD Coordinator to assess if  Refers via iPHIS to the  For low risk newborns: Recommend completion of series. received indicating HBIG/HBV high or low risk as per assigned PHN. Confirm primary care provider and advise CD Coordinator. prophylaxis administered. If Post partum referral Manitoba Health protocol No f/u for completion of HBV required. Close referral not received f/u with PP desk http://www.gov.mb.ca/health/pu  Creates newborn in iPHIS blichealth/cdc/protocol/hepb_ne  For high risk newborns: Follow-up completion of HBV x 3  Refer to CD Coordinator wborn.pdf doses.  If low risk: send letter to health care provider/parent/PHN- no further f/u necessary. Close when baby's name and PHIN received  If high risk- diarize for f/u of HBV series in MIMS @ 3 and 8 months of age   If 2nd or 3rd dose not entered in MIMS after 3 and 8 months respectively refer to CA PHN for f/u with family Type of CD Admin CD Coordinator Public Health Admin Public Health Nurse referral</p><p>Insurance testing-  Receives new Hep B referral Receives the referral and  PHN to contact client within 5 working days of receiving Hepatitis B  Enters the referral into iPHIS and and assigns it to a CA PHN via referral. give to CD Coordinator for further iPHIS  Advise client of results from insurance testing. positive assessment  Advise retesting is recommended through primary care  provider as soon as possible. Recommend Hepatitis B  Sends the referral via email and surface antigen, antibody to Hepatitis B and Hepatitis B iPHIS to the CA Public Health admin core antibody. Facilitate this with primary care provider. person  Put “pop-up” to call CD Coordinator If positive - follow Hepatitis B protocol If negative - no further f/u required. Close file.</p><p>Canadian Blood  Receives new Hep B referral  Advise the PHN to wait the two  Receives the referral and  PHN to contact client after the time frame given in the CBS Services  Enters the referral into iPHIS and r week waiting period as assigns it to a CA PHN via letter CD Coordinator for further requested by CBS. Refer to iPHIS  Advise client of results from CBS (CBS) - assessment CBS letter  Advise retesting is recommended through primary care Hepatitis B  provider as soon as possible. Recommend Hepatitis B positive  Put “pop-up” to call CD Coordinator surface antigen, antibody to Hepatitis B and Hepatitis B core antibody. Facilitate this with primary care provider.</p><p>If positive - follow Hepatitis B protocol If negative - no further f/u required. Close file.</p><p>DOCUMENT- ATION</p><p>Cases:  All documentation will be done in iPHIS Notes tab  All new Hepatitis B cases will be  When investigation is complete PHN to fill out the created in iPHIS.  All documentation will be done  Refer iPHIS referral to CA Manitoba Health and Healthy Living Investigation Form for  Refer to CD Coordinator and Public in iPHIS Notes tab PHN Hepatitis B and C Positive cases Health Admin person http://home.wrha.mb.ca/prog/pph/cdc/files/MHHLhepbccas eform2.pdf</p><p> All contacts ( including newborns) will be entered into Contacts: Assist PHN to enter/create contacts iPHIS in the “Contacts” tab. Refer to iPHIS User Guide for in iPHIS instructions. http://home.wrha.mb.ca/prog/pph/surveillance/iphis_userguides Type of CD Admin CD Coordinator Public Health Admin Public Health Nurse referral</p><p>.php  Consult with CD Coordinator for assistance as necessary  Serology results and immunization history will be documented under ‘contact tab, details, comments section.</p><p> Complete documentation in iPHIS "Notes" tab  Send the ORIGINAL version  Refer to CD Coordinator in iPHIS indicating it is completed of the completed Manitoba  Completes the Manitoba Health and Healthy Living Health and Healthy Living Investigation Form for Hepatitis B and C Positive Cases  Review investigation in iPHIS. Investigation Form for when investigation is completed  Send Manitoba Health and Healthy  Once Manitoba Health and Hepatitis B and C Positive http://www.wrha.mb.ca/extranet/publichealth/files/HepB.do Living Investigation Form for Hepatitis Healthy Living Investigation Cases to the CD Unit. CLOSURE c B and C Positive Cases to Manitoba Form for Hepatitis B and C  Send via Medical Courier  Sign and date the bottom of the form when complete Health Positive Case form has been with a return fax for received- close file in iPHIS verification. ( Appendix 4  If client is a prenatal Hep B case, it can be closed when Administrative procedure # Hep B investigation is completed and will be re-opened at 58 and Appendix 4a Return the CD Unit when the baby is born. Fax Sheet)</p>