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Viral Hepatitis Program


... to Doc Holiday's Office (con't) ... High-risk Behaviors. Consider Disease Investigation ... Ask Doc Holiday to send a copy of the original lab to the hospital ... – PowerPoint PPT presentation

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Title: Viral Hepatitis Program

Perinatal Case Management
  • Amy E. Warner, M.P.H.
  • Colorado Department of Public Health and

(No Transcript)
Initial Call to Doc Holidays Office
  • Test results
  • Confirmed that Marianna was pregnant
  • Will fax all hepatitis test results to case
  • Date of test
  • January 29th
  • Expected date of delivery
  • June 15th
  • Expected delivery hospital
  • not sure

Initial Call to Doc Holidays Office (cont)
  • Has Marianna been evaluated for her hepatitis
  • Physician told her theres no problem
  • Previous births?
  • 1 child born in Texas
  • 1 child born in Colorado
  • Any immunization records for the children?
  • Doc thinks they were immunized, but does not know
    if they were tested. Call pediatrician, Dr. Quinn

Initial Call to Doc Holidays Office (cont)
  • Does Marianna speak English?
  • A little, but her relative interprets from
  • When is her next appointment
  • March 15th
  • Verify contact information
  • Marianna actually lives in Mexico but uses her
    sisters address in Colorado. She plans on moving
    in with her sister closer to the birth

(No Transcript)
Potential Issues with Positive HBsAg test
  • Ask for a copy of the lab results
  • Was it confirmed?
  • Were there additional tests done
  • Anti-HBs or anti-HBc
  • IgM
  • Liver enzymes
  • HBeAg
  • Anti-Hbe Ag
  • DNA Viral load

Issue Hepatitis B- No Problem
  • Hepatitis B infection can lead to liver disease
  • Babies need healthy moms
  • Evaluate HBV infection during pregnancy.
  • Mom is more likely to have some insurance
  • Mom may need treatment after the birth
  • Its a good time for the family to learn
  • How not to infect others
  • How to stay healthy

More Issues
  • Previous births
  • Check your own records on the previous case
  • Immunization registry
  • Perinatal database
  • Call Texas to gather information on previous
  • Language
  • Be prepared with an interpreter

File History
  • Marianna was HBsAg-negative with her first child
    in 2002. Texas does not have a case file
  • She was HBsAg-positive with the 2nd pregnancy in
  • Colorado files indicate that the 1st child
    received 2 doses of vaccine and the 2nd child
    received HBIG and 2 doses of vaccine
  • The father tested susceptible before the 2nd
    child was born, but there is no record of
  • They were lost to follow-up in 2006

Contacting Marianna-March 11th
  • Phone Interview
  • Use an interpretation service if needed
  • Explain the program
  • Conduct the interview
  • Answer questions and offer to send information
  • Try to identify alternate contact information.

Caring for Marianna
  • Emphasize the need for follow-up testing and
  • Ask if she has resources for follow-up care
  • Share information about local clinics that have a
    sliding fee or can provide free services

Marianna Baby
  • Explain the babys needs for prophylaxis
  • Identify birthing hospital
  • Identify pediatrician
  • Let her know that you will continue to work with
    her until the baby receives post-vaccination
    serologic testing

Marianna Contacts
  • Emphasize follow-up of children, and
    sexual/household contacts
  • Check your immunization registry for sibling
  • Speak with both Dr Quinn and Marianna about
    completing the childrens vaccine
  • Refer to local health department or Federally
    Qualified Health Center (FQHC)

  • Assess best venue for father and the children to
    get immunization and/or testing
  • Home
  • Local laboratory
  • Providers office
  • Local health department

Cant Reach Marianna?
(No Transcript)
Cant Reach Marianna?
  • Ask sister for a forwarding address and send a
    letter explaining that
  • you have important medical information, and
  • asking her to call you
  • Check registries for WIC or immunization
  • Meet Marianna at her next appointment
  • Consider a home visit
  • Consider an international phone call

High-risk Behaviors
  • Consider Disease Investigation Specialist (DIS)
  • Mother may not be able to notify contacts
  • Incarcerated
  • Feels threatened
  • Check registries
  • DIS may already be investigating/notifying
  • Call parole officers for contact information, but
    do not disclose health information

Prepare for the Infant
  • Educate Marianna about prevention
  • Ensure that Dr. Quinn orders HBIG and hepatitis B
    birth dose
  • Ask Doc Holiday to send a copy of the original
    lab to the hospital or you send it
  • Notify the hospital of the impending birth and
    provide guidelines for appropriate treatment of
    the infant

More Preparation for the Infant
  • Send an HBIG fax back form to the hospital
  • Keep in touch with hospital staff
  • Keep email lists updated
  • Offer in-service training
  • Forward new recommendations as they are released
  • Review hospital protocols regularly

  • Follow-up with hospital
  • Did hospital fax the health department a
    completed HBIG form?
  • Follow-up with Doc Holiday?
  • Did he perform the birth?
  • Who provided pediatric care? Dr. Quinn?
  • Call Marianna

Completing the Series
  • How do you keep Marianna engaged long enough to
    complete the infants vaccine series and
    post-vaccination testing?

  • Contact Dr. Quinn (pediatric provider)
  • What vaccine and what schedule will be used
  • Send a letter describing your program
  • Offer free vaccine and waive the administration
  • Reminder/Recall
  • Post-cards
  • Phone calls
  • emails

More Strategies
  • Incentives
  • Given with each service
  • Given once services are completed
  • Include Dad or Grandma
  • Focus on the need to know a childs infection

Even More Strategies
  • Offer a variety of free testing choices
  • In the home
  • At your office
  • Private laboratory
  • Their physician draws blood and sends it to your
  • Dont delay

Case Closed
  • Fully complete (Gold Standard)
  • The infant receives HBIG and all doses of vaccine
    and is tested for HBsAg and anti-HBsAg
  • All contacts are tested
  • Susceptible contacts are immunized with 3 doses
    of vaccine
  • Infected contacts are referred for care

Patient Information Packets
  • Language appropriate
  • Program description
  • Living with hepatitis B
  • Hepatitis B shots are recommended for new babies
  • Answers to specific questions raised by Mom

Physician Information Packet
  • Information given to patient
  • Published guidelines
  • Website links (IAC, CDC, ACOG, AAP,AAFP)
  • Names of local specialists

Case Status
  • Marianna was found through the WIC registry
  • Due to the programs persistence, Mariannas
    children are fully immunized and immune to
    hepatitis B
  • Marianna saw a specialist who is working with her
    doctor in Mexico

Case Status (cont)
  • Doc Holiday was actually a dentist. He decided
    that this was too much work and went back to
    gambling, drinking, and pulling teeth before his
    lifestyle and tuberculosis took his life
  • Dr. Quinn became an energetic advocate for
    hepatitis B vaccination and cared for many women
    with hepatitis B