Document title: Hepatitis B Neonatal and Infant Protocols. Verified by: Matthew Dominey, Screening and Immunisation Manager

Transcription

1 South West PHE Screening and Immunisation Team Good Practice Guidance for the management of the NHS Hepatitis B Neonatal and Infant Immunisation Programme Document title: Hepatitis B Neonatal and Infant Protocols Version: 1.2 Author: Sara Dove, Screening and Immunisation Coordinator Verified by: Matthew Dominey, Screening and Immunisation Manager Date of Issue: June 2015 Date of Review: March 2016 Version Date Comments 1.0 April 2015 Protocol completed 1.1 May 2015 Final draft signed off following comments by screening and immunisation team 1.2 June 2015 Amendment re CHIS scheduling 1

2 South West PHE Screening and Immunisation Team Good Practice Guidance for the management of the NHS Hepatitis B Neonatal and Infant Immunisation Programme Introduction The following guidance is designed to ensure that all babies born to women identified as Hepatitis B positive are immunised promptly according to the recommended schedule and have their appropriate serology test at 12 months. The document clarifies the respective roles and responsibilities of the agencies involved in the Hepatitis B screening and immunisation pathway from the mother s Hepatitis B screening in pregnancy through to the vaccination and subsequent testing of infants. All provider Trusts and other local stakeholders involved should have written protocols and pathways that reflect this guidance and the standards specific to Hepatitis B in the NHS Infectious Diseases in Pregnancy Screening Programme. All staff involved should be mindful of the following key documents: 1. The Green Book: 2. Hepatitis B antenatal screening and Newborn immunisation programme: Best practice guidance: 3. Vaccination and Immunisation Programmes 2014/15: 4. NHS Infectious Diseases in Pregnancy Screening Programme standards: / Hepatitis B is an infectious disease caused by the Hepatitis B Virus (HBV). It is transmitted through blood and other body fluids and can result in an acute or chronic infection of the liver which can cause serious illness and premature death. The Hepatitis B vaccine forms part of the national immunisation programme and is delivered alongside the Hepatitis B antenatal screening programme. If a pregnant woman has chronic HBV infection, then a timely and complete course of vaccination can prevent development of persistent HBV infection in over 90% of these cases. This relies on consistent clear practice and record keeping as well as effective communication between partner agencies involved. 2

3 This guidance focuses on the management of the NHS Hepatitis B neonatal and infant vaccination programme but starts from the identification of a Hepatitis B infected (HBsAg positive) antenatal patient. Clinical management of the mother s Hepatitis B status will be addressed by prompt referral (within 6 weeks of identification) for assessment by an appropriate specialist eg. Hepatologist. The guidance aims to ensure that: all babies at risk are identified, mothers are encouraged to consent to the immunisation schedule and the first vaccine (and HBIG where appropriate) is administered within 24 hours of birth. there is effective handover from maternity services to services completing the immunisation schedule. call/recall systems are in place to enable timely uptake of the full immunisation schedule (according to the green book) systems are in place to support data reporting at appropriate points 12 month serology testing is undertaken to identify where immunisation has been unsuccessful at preventing transmission a failsafe audit of all babies born to HBsAg positive mothers is administered to ensure full completion of immunisation schedule Scheduled age Target standard Dose 1 Birth (within 24 hours of birth) *With HBIG where indicated Dose 2 1 month Dose 3 2 months Dose 4 12 months (at least one month from dose 3) Blood test (HBsAg surface antigen) 12 months to check child s infection status Dose 5 With pre-school booster. To be given to those at continued risk from HBV (babies with Hepatitis B positive close household member) *For babies born to women of high infectivity (as defined in Immunisation against infectious disease Green Book a dose of hepatitis B specific immunoglobulin (HBIG) should be given with the first dose of vaccine. 3

4 Overview of key responsibilities for the Hepatitis B neonatal and infant vaccination pathway Antenatal HBsAg positive pregnant woman identified Bloods taken ideally during 1 st trimester but can be anytime during pregnancy. Women who present later in pregnancy should be screened ASAP (even at delivery) Maternity Unit will: Take confirmatory specimen Send blood to PHE Laboratory - ensuring that any required vaccine or immunoglobulin is issued for the baby at the optimum time and place Inform patient of positive result offering discussion and written information Document results within 10 working days Refer woman for assessment and management by appropriate specialist (to be assessed within 6 weeks of screening result) Inform the GP and Child Health Information Service (CHIS) (after gaining parental consent) CHIS will: Record woman s Hepatitis B positive status Post natal Following birth of baby to HBsAg positive mother Maternity unit will: Explain implications and obtain parental consent for baby s immunisation Administer 1 st Hep B vaccine and, if appropriate, HBIG within 24 hrs of birth Ensure the parent(s) understand the baby s immunisation schedule and importance of completion Record 1 st vaccination in maternity notes, Personal Child Health Record and notify Child Health If baby is born outside maternity unit, arrange for immediate immunisation via GP or hospital Inform GP that baby has received first vaccination (letter from neonatologist) CHIS will: Run weekly report to check on any babies transferred home without 1 st dose vaccination Check with Antenatal Screening Coordinator (ANSC) if notification of Hepatitis B first dose vaccination has not been received. If baby has been transferred home without 1 st dose immunisation, CHIS to phone HV to ensure child is registered and will get first immunisation urgently via GP/hospital and follow up with letter. 4

5 Record 1 st dose in baby immunisation record Schedule 2 nd and 3 rd dose when due within GP immunisation clinic* ** Schedule 12 month (4 th ) Hep B booster with reminder for HBsAg surface antigen blood test to be carried out ** Record result of blood test Schedule 5 th booster dose around 5 years after primary immunisation (alongside pre-school booster for other childhood immunisations). Send monthly audit reports to PHE Screening and Immunisation Team (SIT) re any infants overdue immunisation dose/blood test** General Practice will (as per NHS England GMS additional service Vaccinations and Immunisations Programmes 2014/15): Reinforce with parent(s) the importance of completing immunisation schedule (including the continuity of care if child is moving out of the area) Administer 1 st (where not administered in hospital), 2 nd and 3 rd vaccinations and 4 th booster. (Where child is at continued lifestyle risk, a 5 th booster alongside pre-school booster for other childhood illnesses will be given) Carry out or arrange for HBsAg surface antigen blood test via dried blood spot - heel prick or venepuncture at 12 months (concurrently with booster dose) Communicate immunisations and result of test to CHIS and parent Refer baby for paediatric assessment and management if immunity not reached or test is positive for Hepatitis B. Health Visitors will: Ensure baby is registered with general practice and, where baby has not received first vaccination at delivery, arrange for immediate completion in general practice or hospital Ensure parents understand the baby s immunisation schedule and the importance of completion SIT will: Receive monthly audit reports of infants up to age 2 years with incomplete Hepatitis B immunisations/serology test from CHIS** Make three attempts to contact the relevant Practice regarding any infants with incomplete immunisation schedule/serology test. Follow up with letter. Inform CHIS if any babies are found to have moved out of the area or moved to another practice in the area Feedback any updated results to CHIS so their records can be updated *If mother or other close family member is identified as at risk Hepatitis B lifestyle, the same scheduling pathway for infant vaccination should be followed with CHIS recording appropriately. **Some infants move into the area with incomplete Hepatitis B immunisation and/or serology test. All infants up to the age of 2 years will be scheduled for vaccination/serology testing and monitored through the SIT failsafe. 5

6 Appendix One Public Health England (PHE) South West Screening and Immunisation Team (SIT) Hepatitis B Neonatal and Infant Immunisation Failsafe The following pathway will be used as a failsafe alongside the scheduling of infants up to age 2 years for Hepatitis B vaccination by CHIS. CHIS record infants receiving Hep B vaccinations (and serology test at 12 months) on spread sheet (including reason for receipt of vaccination programme) CHIS schedule infants eligible for Hepatitis B vaccination at 1, 2, 12 months and 5 years (plus test at 12 months) in practices updating the failsafe spread sheet when notified of vaccinations and/or DNAs. CHIS send updated failsafe spread sheet to Screening and Immunisation Coordinator (SIC) during the first week of every month SIC review report, confirming eligibility for Hepatitis B vaccination SIC identify infants that are born to HBsAg positive mother and recorded as having a second DNA for immunisation or serology test ( out of circulation ). Make three attempts to contact the relevant Practice regarding the infant. Identify what actions the practice has taken to chase patient. Ask practice to inform CHIS of any further vaccinations/tests. Follow up with letter. SIC inform CHIS if, as a result of contact with practice, infants are found to have moved out of the area or moved to another practice in the area SIC feedback any results of contact with practice to CHIS to enable spread sheet failsafe to be updated. 6