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ANTENATAL HEPATITIS B

JACKIE McGEAGH Regional Antenatal S creening Coordinator PHA. ANTENATAL HEPATITIS B. Background. Screening pregnant women since 1970s Formalised in 1998 by DHSSPS Aim to detect and prevent infection of infant HBeAG + ve 70-90% transmission HBeAG – ve 10% transmission

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ANTENATAL HEPATITIS B

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  1. JACKIE McGEAGH Regional Antenatal Screening Coordinator PHA ANTENATAL HEPATITIS B

  2. Background • Screening pregnant women since 1970s • Formalised in 1998 by DHSSPS • Aim to detect and prevent infection of infant • HBeAG +ve 70-90% transmission • HBeAG –ve 10% transmission • Hepatitis B vaccine +/- HBIG at birth • Further vaccine dose 1, 2, 12 months, serology at 12 months for surface antigen • Vaccination confers 90% infection prevention

  3. Standards/Guidance • 2010 Antenatal Screening Standards • 2011 DH Best Practice Guidance • Maternal referral and appt 6 wks within receiving positive result • DNA testing for all women • May require treatment in 3rd trimester • Referral standard implemented Aug 11 • Also is a KPI standard

  4. Audit of Referrals Retrospective audit conducted in March 2012 • Number of women confirmed positive in NIBTS during 2011 • Number of pregnant women referred to Liver Unit from Maternity Units • Timeline from referral to appt • Number seen within 6 wks of screening result • Compare pre August 11 and post August 11

  5. Findings • 35 women identified for 2011 • 30 HBeAG –ve • 5 HBeAG +ve • 28 referrals received in 2011 • 25 referred by Maternity Units, 3 by GP • 10 not referred by MU • 7 GP 3 in 2011, 4 referred in previous years • 1 Gastro referral 2008, not seen since then • 1 2009 A/N referral had appt to attend in 2011 • 1 not referred – left country

  6. Referrals • 35 total positives for 2011 • 21 positives Jan – July 2011 • 14 positives August – December 2011

  7. Maternity referrals Jan - July • 12/21 were referred 57% • 9 not referred to Liver Unit 43% • Reasons for non referral during • 3 referred from GP in 2011 • 1 left country prior to referral • 5 previously referred before 2011 (4 GP, 1 Gastro)

  8. Maternity referrals Aug - Dec • 13/14 were referred93% • 1 not referred but as existing pt was seen during pregnancy

  9. Appointments • 12/21 received appointments within 6 wks • 13/14 received appointments within 6 wks • 50% DNA/Canc first appointment

  10. Non Maternity Referrals • Of the 10 not referred from Maternity • 9 were yearly review patients • 1 was never referred (had care in England) • Of the 9 yearly review patients • 1 moved to England and transferred care • 8 were seen during pregnancy

  11. Conclusions • Overall 32/35 women were seen • Improvements from August 2011 • Referral from Maternity units improved from 57% to 93% • All women referred met the 6 wk standard • Attendance is still poor with 50% DNA/CNA 1st appointment • High number of repeat DNA/CNA • Screening Coordinators following up in local area

  12. Recommendations • Health professionals need to refer all pregnant women during each pregnancy • Women need to be advised to attend during each pregnancy even if previously seen • Further work and research to improve the attendance rates of these women

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