sábado, 23 de abril de 2011

Assessing Completeness of Perinatal Hepatitis B Virus Infection Reporting Through Comparison of Immunization Program and Surveillance Data --- United States

Assessing Completeness of Perinatal Hepatitis B Virus Infection Reporting Through Comparison of Immunization Program and Surveillance Data --- United States
Weekly
April 21/8, 2011 / 60(13);410-413






In the United States, an estimated 24,000 women with hepatitis B virus (HBV) infection give birth each year (1). To prevent mother-to-child HBV transmission, the Advisory Committee on Immunization Practices (ACIP) recommends administering postexposure prophylaxis of hepatitis B vaccine (HepB) and hepatitis B immune globulin (HBIG) to infants born to HBV-infected women within 12 hours of delivery, followed by completion of the HepB series (2). In 1990, CDC established a national Perinatal Hepatitis B Prevention Program (PHBPP) to support federal immunization program grantees in performing this ACIP-recommended case management of infants born to HBV-infected women. Perinatal HBV infections currently are reported by state and local health departments to CDC through two parallel processes: by immunization programs as part of federal program grant reporting requirements and by communicable disease surveillance units as part of the National Notifiable Diseases Surveillance System (NNDSS). A review of perinatal HBV infection reporting for infants born in 2005 identified 68 cases reported by immunization programs and 47 cases reported by communicable disease surveillance units, resulting in a total of 73 unique cases, 42 (58%) of which were reported by both systems. Following investigation, data reconciliation, and additional NNDSS reporting, 78 unique cases were identified, 63 (84%) of which were reported by both systems. Improved information-sharing between immunization programs and communicable disease surveillance units of health departments is essential to ensure more complete identification, case management, and quantification of perinatal HBV infections. Accuracy and completeness of perinatal HBV infection reporting can help ensure and measure progress toward elimination of HBV transmission in the United States.

A case of perinatal HBV infection is defined as hepatitis B surface antigen (HBsAg) positivity in any infant aged 1--24 months born in the United States or its territories to an HBsAg-positive mother (3). Since 1995, PHBPP activities have been reported to CDC through the Annual Immunization Program Report. Since 2001, communicable disease surveillance units have reported individual perinatal HBV infection cases to CDC through NNDSS. During 2001--2004, an average of 38 perinatal HBV infection cases per year (range: 18--54) were reported through NNDSS; during the same period, an average of 90 cases per year (range: 77--102) were reported via the Annual Immunization Program Report.

To investigate this discordance, CDC reviewed all reports of perinatal HBV infections in the two systems for infants born in 2005. To identify the 2005 birth cohort, NNDSS data entries from the reporting period January 1, 2005--March 30, 2007, were compared with those reported in the Annual Immunization Program Report submitted in April 2007. Because reporting of perinatal HBV infections through the annual report is in aggregate numbers and not line-listed as it is through NNDSS, for this analysis CDC requested PHBPP coordinators to share NNDSS case numbers and demographic information on HBV-infected infants enumerated in the annual report. Cases reported through the annual report or through NNDSS were then compared using infant date of birth, NNDSS case number, sex, and race. PHBPP coordinators were informed of discrepancies and asked to work with communicable disease surveillance unit staff members responsible for NNDSS data entry to reexamine program reports and NNDSS reports of perinatal HBV infections to resolve discrepancies.

Initially, 61 perinatal HBV infection cases were identified through NNDSS, and 86 were identified through the annual report (Figure 1). Fourteen cases reported through NNDSS were excluded: 11 because of erroneous reporting (nine reports actually were maternal HBV infections and not infant HBV infections, one infant was not born in the United States, and one was a duplicate entry) and three because of insufficient data to verify the case. Eighteen cases reported through the annual report were excluded: 11 because of erroneous reporting (seven infants not born in 2005 and four not HBsAg-positive) and seven (8%) because of insufficient data to verify the case. Case matching was complicated by incorrect or missing key data elements, such as race (eight annual report cases and 16 NNDSS cases), sex (one annual report case), and date of birth (two NNDSS cases). Before case reconciliation, of the 73 unique cases reported by the two reporting systems, 42 (58%) were reported by both (Figure 2). Case reconciliation included obtaining more information on previously unverified cases, NNDSS reporting of cases originally reported only in the annual report, and 7 months of additional reporting to NNDSS. Following case reconciliation, 78 unique cases were identified across the two reporting systems, with 63 (84%) reported by both (Figure 3).

When asked to identify factors that influenced whether a case was reported by both systems, health department staff members identified good communication between PHBPP coordinators and communicable disease surveillance staff as an important determinant of case reporting. Of 37 immunization program grantees who responded, 28 (76%) indicated regular communication between persons responsible for NNDSS data entry and the PHBPP coordinator before finalizing NNDSS data; 31 (84%) indicated that the PHBPP coordinator communicated with persons responsible for NNDSS data entry before submission of the annual report. PHBPP staff members reported that some incorrect or missed reporting resulted from misunderstanding of the questions and because annual reports often were completed by a person other than the PHBPP coordinator. Incorrect NNDSS reporting included misclassifications of perinatal HBV infections as acute HBV or chronic HBV infections and misclassifications of maternal HBV infections as perinatal HBV infections.

Reported by
DM Roque, MD, Magee-Womens Hospital of Univ of Pittsburgh Medical Center, Pennsylvania. SA Wang, MD,* A Wasley, ScD, Global Immunization Div; L Jacques-Carroll, MA, S Roush, MPH, CM Weinbaum, MD, Immunization Svcs Div, National Center for Immunization and Respiratory Diseases, CDC. *Corresponding contributor: Susan Wang, Global Immunization Div, National Center for Immunization and Respiratory Diseases, CDC, +41 22 791 1606
, sjw8@cdc.gov.

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Assessing Completeness of Perinatal Hepatitis B Virus Infection Reporting Through Comparison of Immunization Program and Surveillance Data --- United States

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