Percent of live newborn infants that receive hepatitis B vaccination before discharge at each single hospital/birthing facility during given time period (one year)

This work was prepared by employees of the US Federal Government and therefore is not protected by the Copyright Act, and copyright ownership cannot be transferred.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.  
CPT(R) contained in the Measure specifications is copyright 2004-2012 American Medical Association. LOINC(R) copyright 2004-2012 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2012 International Health Terminology Standards Development Organisation. ICD-10 copyright 2012 World Health Organization. All Rights Reserved.

The findings and conclusions in this measure do not necessarily represent the official position of the Centers for Disease Control and Prevention. 

These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

None

None

None

For the past 20 years, public health immunization programs have provided the leadership to establish, guide, provide services, and monitor activities to prevent perinatal transmission of hepatitis B infection in the United States (a). Some of these public health activities will be transitioned to the private sector. A quality measure will be increasingly important in monitoring prevention of perinatal hepatitis B in the US. A Healthy People 2020 goal addresses the reduction of perinatal hepatitis B transmission (b).

Because hepatitis B infection is largely asymptomatic until complications develop (accompanied by decreased life expectancy and productivity, and with ballooning healthcare costs), the universal hepatitis B birth dose will become an even more critical safety net (c). The purpose of this measure is to encourage administration of the birth dose of hepatitis B vaccine and to provide a safety-net for infants who would not receive post-exposure prophylaxis because their mother's chronic hepatitis B infection is not determined or detected, is misinterpreted or incorrectly recorded, or who return to a household with risk of transmission from family members with chronic hepatitis B infection (often unknown). Infants have a 90% chance of chronic hepatitis B if infected. The first dose of hepatitis B vaccine provides the initial step for prevention of almost certain life-long chronic hepatitis B infection with ~25% risk of cirrhosis, liver failure, and liver cancer (d). This is the critical "window" for prevention since chronic hepatitis B infection is not "curable". A universal birth dose measure will be critical in measuring the quality of this important disease prevention activity.

The National Immunization Survey currently produces hepatitis B birth dose rate estimates at the state and national level (e). Obstetric and pediatric providers, hospital staff, public health National Hepatitis B Perinatal Program coordinators are acutely familiar with these results. However, data have not been available at the hospital level, with the exception of special studies, as was carried out by the Public Health Evaluation Project and Feasibility Studies in Texas (f,g). These studies are unlikely to be repeated given their cost and resource requirements.

a. WHO-SAGE(2009)
- Since perinatal or early postnatal transmission is an important cause of chronic infections globally, all infants should receive their first dose of hepatitis B vaccine as soon as possible (<24 hours) after birth even in low-endemicity countries.
- The primary hepatitis B immunization series conventionally consists of 3 doses of vaccine (1 mono-valent birth dose followed by 2 monovalent or combined vaccine doses at the time of DTP1 and DTP3 vaccine doses). However, 4 doses may be given for programmatic reasons (e.g. 1 monovalent birth-dose followed by 3 monovalent or combined vaccine doses with DTP vaccine doses), according to the schedules of national routine immunization programmes.
- Premature low birth weight (<2000g) may not respond well to vaccination at birth. However, by 1 month of chronological age, premature infants, regardless of their initial weight or gestational age at birth, are likely to respond adequately. Therefore, doses given to infants <2000g should not be counted towards the primary series.

b. Advisory Committee on Immunization Practices (ACIP) (2005):
- Infants born to mothers who are HBsAg-positive should receive hepatitis B vaccine and hepatitis B immune globulin (HBIG) <12 hours of birth.
- Infants born to mothers whose HBsAg status is unknown should receive hepatitis B vaccine <12 hours of birth. The mother should have blood drawn as soon as possible to determine her HBsAg status; if she is HBsAg positive, the infant should receive HBIG as soon as possible (no later than age 1 week).
- Full-term infants who are medically stable and weigh >2,000 g born to HBsAg-negative mothers should receive single-antigen hepatitis B vaccine before hospital discharge.
- Preterm infants weighing < 2000 g born to HBsAg-positive mothers should receive HBIG plus a single-antigen hepatitis B vaccine within 12 hours of birth. …. And 3 additional hepatitis B vaccine doses to complete the vaccine series.
- Preterm infants weighing < 2000 g born to mothers whose HBsAg status is unknown should receive HBIG plus a single-antigen hepatitis B vaccine within 12 hours of birth… and 3 additional hepatitis B vaccine doses to complete the vaccine series.
- Preterm infants weighing <2,000 g born to HBsAg-negative mothers should receive the first dose of vaccine 1 month after birth or at hospital discharge.

c. AAP-ACOG Guidelines for Perinatal Care (2007):
- Universal HBV immunization is recommended for all infants. Delivery hospitals should develop policies and procedures that ensure administration of a birth dose of the vaccine as part of routine care of all medically stable infants weighing at least 2,000 g at birth, unless there is a physician’s order to defer immunization and the serologic status of the mother is in the infant’s medical record.

A higher score indicates better quality

WHO: meeting of the Immunization Strategic Advisory Group of Experts, November 2008—Conclusions and Recommendations. Weekly Epidemiological Record (2009, 84: 405-420 . http://www.who.int/immunization/policy/immunization_tables/en/index.html

CDC: A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP); Part 1: Immunization of infants, children, and adolescents. MMWR 2005;54 (No. RR-16)

(a)
i. Smith E, Jacques-Carroll L, Walker TY, Sirotkin B, Murphy TV. The National Perinatal Hepatitis B Prevention Program, 1994-2008. Pediatrics 2012;129:609-16.
ii. Zhao Z, Murphy TV, Jacques-Carroll L. Progress in newborn hepatitis B vaccination by birth year cohorts – 1998-2007, USA. Vaccine 2011;30:14-20.
iii. Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Part 1: Immunization of infants, children and adolescents. MMWR 2005;54 (RR-16):1-31.

(b) United States Department of Health and Human Services, Healthy People 2020. (2011, 6/29). IDD-25: Reduce chronic hepatitis B virus infections in infants and young children (perinatal infections). Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=23

(c) Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Part 1: Immunization of infants, children and adolescents. MMWR 2005;54 (RR-16):1-31.

(d) 
i.Beasley RP, Hwang L-Y. Epidemiology of hepatocellular carcinoma. In: Vyas GN, Dienstag JL, Hoofnagle JH, eds. Viral Hepatitis and liver disease. New York: Grune & Stratton, 1984:209-24.
ii. Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Part 1: Immunization of infants, children and adolescents. MMWR 2005;54 (RR-16):1-31.

(e) Centers for Disease Control and Prevention. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61:689-96.

(f) Texas Department of State Health Services, Public Health Evaluation Project (PHEP). (Draft report). Unpublished data from the Texas Department of Health.

(g) The Litaker Group. Perinatal Hepatitis B Hospital Policy and Practices Survey, June 30, 2010 (Draft report). Document Number: DSHS-2009-01-5. Unpublished data from the Texas Department of Health.

Guidelines for Perinatal Care, 6th edition. American Academy of Pediatrics Committee and the American College of Obstetrics and Gynecology. Perinatal Infections, pp 306-309. October 2007

None

If the length of stay for the inpatient encounter is greater than 28 days, the vaccine should be administered within the first 28 days of life.

The logic phrase AND: “Occurrence A of Encounter, Performed: Inpatient Encounter (reason: 'Birth')” intends to capture admission type of newborn for the encounter. Where this information is available in existing EHR structured fields (e.g. data that is fed to UB 04, field location 14), it can be used to map the criterion specified in the logic.

The logic phrase AND: “Diagnosis, Active: Liveborn Born In Hospital” starts during “Occurrence A of Encounter, Performed: Inpatient Encounter” intends to capture the point of origin for the inpatient admission. Where this information is available in existing EHR structured fields (e.g. data that is fed to UB-04, field location 15), it can be used to map the criterion specified in the logic.

TBD

The number of live newborn infants born at the hospital/birthing facility, during the reporting window (one calendar year).

Equals Initial Patient Population

None

The number of live newborn infants administered hepatitis B vaccine prior to discharge from the hospital/birthing facility ("birth dose" of hepatitis B vaccine).

Not Applicable

The number of live newborn infants born at the hospital/birthing facility whose parent/guardian refused hepatitis B birth dose.

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex