# Presentation: 632512

## Perinatal Hepatitis B Program Evaluation         Post-Vaccination Serology Testing 

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

## 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

## 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

## Post-Vaccination Serology Testing Data

**Post-Vaccination**** ****Serology Testing Data**

**Notes:**

2002-
2002-Out of 279 infants born to HBsAg positive pregnant women, 158 (57%) tested.  2003-Out of 344, 203 (59%) tested). 2004-321 infants reported and 194 (60%) tested. 2005-317 reported and 192 (61 percent) tested. In 2006, Out of 377, 217 (58%) tested. 

## Evaluation Goal

- To increase awareness, knowledge and practice with perinatal hepatitis B post-vaccination serology

**Notes:**
Broader goal to increase rate of post-serology testing from baseline of 58% to 70%.  This would be an increase of 42 infants.

## Stakeholders and Partners

**Stakeholders and Partners**

**Evaluation Plan**

- Perinatal
- Hepatitis B
-  Coordinator

- Local
-  Health
-  Jurisdictions

- Communicable
- Disease EPI

- DOH-Immunization
- Program
-  CHILD Profile
-  Staff

- Within Reach-API
- Hepatitis B
-  Task Force

- Other
- Health Care
- Professionals

- DOH-MCH
- Epidemiologist

## 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.

**Notes:**
Our work around developing strategies for improving the rate of post-vaccination is part of this work.

## 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).

## Slide 9

## Evaluation Activities

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

**Notes:**
Discuss types of activities, reporting system in place

## 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)

**Notes:**
Discuss Activities, survey of physicians. 

## 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

## 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

**Notes:**
Our target is a 5% increase from March to December.
Method of data collection-LHJ's survey their healthcare professionals. DOH collects data from LHJ
Method of analysis-compare number of providers who answer survey positively in January and March, 2009 compared with the number who answer positively in December, 2009 and calculate the percentage change.

## 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

**Notes:**
Our target is a 5% increase from March to December.
Method of data collection-LHJ's survey their healthcare professionals. DOH collects data from LHJ
Method of analysis-compare number of providers who answer survey positively in January and March, 2009 compared with the number who answer positively in December, 2009 and calculate the percentage change.
Method of data collection-LHJ's survey their healthcare professionals. DOH collects data from LHJ
Method of analysis-compare number of providers who answer survey positively in January and March, 2009 compared with the number who answer positively in December, 2009 and calculate the percentage change.

## 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

**Notes:**
Target is to increase by 10% the number of providers who have standing orders for post-vaccination serology testing
Methodology-ask providers who are identified by LHJ's if they have standing orders, LHJ’s to survey providers.  Compare number of providers who have standing orders in place and calculate percentage of change

## 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)

**Notes:**
Target is to increase from 58% to 70%(increase of 42 infants) for post vaccination serology testing for infants born to HBsAg positive mothers.
Methodology-LHJ's provide surveillance data by entering into web based hep B module.  Compare the rate for post vaccination serology testing for infants born to HBsAg positive mothers in December 2006 (collected in 2007) with the rate for post vaccination serology testing for infants born to HBsAg positive mothers in December 2009 (collected in 2010) and calculate the percentage of change

## 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

**Notes:**
Coverage among target population increases

## Challenges in Developing a Plan

- Agreement of consensus on plan with stakeholders and partners
- Methodology
- Resources.  Fitting into overall workload

**Notes:**
Methodology- may be more variables than we think.
Resources-LHJ’s stretched. A piece that has to be constantly on the radar screen

## Lessons Learned

- Partnerships Work – can’t do it alone!
- Target efforts – can’t do it all.

## Acknowledgements

**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

**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

## 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](http://www.cdc.gov/vaccines/programs/progeval/downloads/wash-eval-02-09-508.ppt)__ __ _