Perinatal hepatitis B prevention practices in Texas - 2008

Health department personnel in Texas have implemented targeted strategies to improve perinatal hepatitis B surface antigen (HBsAg) screening and newborn hepatitis B vaccination rates. To measure effectiveness, the Department of State Health Services contracted The Litaker Group to review 24,956 total medical records from 12,324 live birth events in 119 hospitals in Texas in calendar year 2008. Mothers were screened for HBsAg either prenatally or on hospital admission 99.7% of the time, 89.4% both prenatally and on admission. For the 25 mothers who had non-negative screening results for HBsAg, one baby born was not vaccinated with hepatitis B vaccine prior to discharge from the hospital. Fifteen (62.5%) of the remaining 24 received hepatitis B immunoglobulin (HBIG) in addition to vaccine. When documented, the average time after birth to vaccinate was 7.6 hours (range 1-36h); average time to administer HBIG was 10.7 hours (range 1-30h); five babies were documented to have received both in less than 12 hours after birth. About 10% of the mothers (1302, 10.6%) arrived at the hospital with unknown HBsAg status , but only 56 mothers remained unknown by time of discharge. Vaccination rate of babies born to these mothers was 94.6%, with 45.5% receiving within 12 hours of birth. Only 7.1% also received HBIG. Total newborn vaccination rates statewide were 90.5%, showing marked improvement over the National Immunization Survey rate published for 2008 (66.6+/-5.5%). Reasons for lack of vaccination included guardian refusal (2.6% of all newborns) and pediatrician choice to not vaccinate before hospital discharge (2.1%).