Viral Hepatitis Program - PowerPoint PPT Presentation

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Title:

Viral Hepatitis Program

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... 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


1
Perinatal Case Management
  • Amy E. Warner, M.P.H.
  • Colorado Department of Public Health and
    Environment

2
(No Transcript)
3
Initial Call to Doc Holidays Office
  • Test results
  • Confirmed that Marianna was pregnant
  • Will fax all hepatitis test results to case
    manager
  • Date of test
  • January 29th
  • Expected date of delivery
  • June 15th
  • Expected delivery hospital
  • not sure

4
Initial Call to Doc Holidays Office (cont)
  • Has Marianna been evaluated for her hepatitis
    infection
  • 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

5
Initial Call to Doc Holidays Office (cont)
  • Does Marianna speak English?
  • A little, but her relative interprets from
    Spanish
  • 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

6
(No Transcript)
7
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

8
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
    prevention
  • How not to infect others
  • How to stay healthy

9
More Issues
  • Previous births
  • Check your own records on the previous case
  • Immunization registry
  • Perinatal database
  • Call Texas to gather information on previous
    cases
  • Language
  • Be prepared with an interpreter

10
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
    2005
  • 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
    vaccination
  • They were lost to follow-up in 2006

11
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.

12
Caring for Marianna
  • Emphasize the need for follow-up testing and
    evaluation
  • Ask if she has resources for follow-up care
  • Share information about local clinics that have a
    sliding fee or can provide free services

13
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

14
Marianna Contacts
  • Emphasize follow-up of children, and
    sexual/household contacts
  • Check your immunization registry for sibling
    records
  • Speak with both Dr Quinn and Marianna about
    completing the childrens vaccine
  • Refer to local health department or Federally
    Qualified Health Center (FQHC)

15
Contacts
  • Assess best venue for father and the children to
    get immunization and/or testing
  • Home
  • Local laboratory
  • Providers office
  • Local health department

16
Cant Reach Marianna?
17
(No Transcript)
18
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

19
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
    contacts
  • Call parole officers for contact information, but
    do not disclose health information

20
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

21
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

22
Birth
  • 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

23
Completing the Series
  • How do you keep Marianna engaged long enough to
    complete the infants vaccine series and
    post-vaccination testing?

24
Strategies
  • 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
    fee
  • Reminder/Recall
  • Post-cards
  • Phone calls
  • emails

25
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
    status

26
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
    lab
  • Dont delay

27
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

28
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

29
Physician Information Packet
  • Information given to patient
  • Published guidelines
  • Website links (IAC, CDC, ACOG, AAP,AAFP)
  • Names of local specialists

30
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

31
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
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