1. Hepatitis B Vaccine Birth Dose Promotion & Policy Evaluation
National Immunization Conference
5/31/2018
Hepatitis B Vaccine Birth Dose Promotion & Policy Evaluation
Ohri LK, Eslinger C, Stapp K, Chatterjee A, Christensen C, Hrdy M
Immunization Task Force – Metro Omaha
Immunization Task Force – Metro Omaha
Immunization Task Force - Metro Omaha

2. Immunization Task Force Metro Omaha
National Immunization Conference
5/31/2018
Immunization Task Force Metro Omaha
Began in 1991 by Children’s Hospital and Douglas County Health Department (along with other partners) - in response to identified low immunization rates and measles outbreaks
Paid part time staff in early years (CDC funds)
Volunteer only since ~2003
Currently represents approximately 27 different organizations and agencies, with approximately 68 individual members.
Organizational Structure:
- Steering Committee
- Professional Liaison Committee
- Community Liaison Committee
- Legislative / Advocacy Committee
Parent organization to the Nebraska Immunization Registry Coalition (NE-IRC)
Examples of Activities:
Health Fairs - Screening; Assessment; Education; Promotion
Vacci-Fax newsletter, eventually distributed electronically across state
Speaker’s Bureau (episodically over years) – Professional (with CE provided) and some Lay programs as well
Successful Legislative Advocacy (Immunization Registry; Vaccine school mandates; opposition to Thimerosal legislation)
Annual Flu campaign to Metro Daycares (School promotion added in 2008) + general promotion (Bus signs + Marquee advertising, etc)
Annual Governor’s Proclamation of August Immunization month
Immunize Nebraska Conference – Since 2004 (This program is the major source of funds raised for Task Force activities)
Participation on 317 Coalition
5-6 national presentations and posters at the National Immunization Conference and National Immunization Coalition meetings
2 publications in Nebraska Pediatrician journal
Assistance to two additional regional immunization coalitions in start up and development of by-laws
Immunization Task Force - Metro Omaha

3. National Immunization Conference - 2009
5/31/2018
Background
Hepatitis B Birth Dose (HBBD) Project:
2002 Survey
25% of Nebraska birthing hospitals had a policy to offer hepatitis B vaccine to all newborns prior to discharge
NIS – Nebraska infants (born 1/2003 – 6/2005)
13% received hepatitis B vaccine within 24 hrs
Chatterjee A, Yasmin T, Vanderbur LE, Ohri LK. Hepatitis B: Maternal screening and infant immunization policies in Nebraska hospitals. Nebraska Pediatrician Winter 2004/2005; 1, 6, 9-11.
CDC. Newborn Hepatitis B Vaccination Coverage Among Children Born January June United States. MMWR Weekly 2008; 57(30):
Immunization Task Force - Metro Omaha

4. Promotion Efforts – Metro Omaha
National Immunization Conference
5/31/2018
Promotion Efforts – Metro Omaha
Grand Rounds presentation at Children’s Hospital
Recognized Expert – Thomas Saari, MD, PID, FAAP
Provision of educational materials to medical and birthing unit staff
Utilization of physician colleague advocate to promote hepatitis B birth dose (HBBD) to birthing unit medical staff
Direct educational presentations by ITF’s pediatric infectious disease consultant
Birthing unit staff and physicians
Thomas N. Saari, FAAP, U. WI – Author of:
Neonatal Vaccination in the United States: Implementation of the Hepatitis B Birthdose -
Immunization of Preterm and Low Birth Weight Infants. Pediatrics, July 2003, Vol. 112(1):193-8 – URL:
Immunization Task Force - Metro Omaha

5. National Immunization Conference - 2009
5/31/2018
Tipping Point
Efforts between 2004 and 2006 eventually achieved establishment of HBBD policies at all 7 metro birthing facilities
Pharmacy chart review study at hospital with high use birthing unit: 11/2005 – 11/50 (22%) received HBBD (4/11 within 12 hrs) 9/ /50 (100%) received HBBD (49/50 within 12 hrs)
Immunization Task Force - Metro Omaha

6. National Immunization Conference - 2009
5/31/2018
State-wide Effort
Request for assistance from NE H & HS Immunization Program personnel
Promotion and Assessment Project initiated
Birthing facility mailing list provided from state
Promotional PowerPoint created
Resource materials identified
Survey post card developed
Immunization Task Force - Metro Omaha

7. Promotion Effort (June 2007)
National Immunization Conference
5/31/2018
Promotion Effort (June 2007)
Packets mailed to:
Manager of Birthing Unit
Hospital CEO
Promotional materials:
PowerPoint handout – Offer to mail CD per request
Saari report on HBBD in Preterm/LBW infants
Policy implementation resources
Reports on infant Hep B cases / Legal risks
Immunization Task Force - Metro Omaha

8. National Immunization Conference - 2009
5/31/2018
Survey Questions
Does your hospital currently have a policy to administer the hepatitis B vaccine birth dose to all newborns prior to discharge?
If so, is hepatitis B vaccination a part of your newborn standing orders?
Immunization Task Force - Metro Omaha

9. Telephone Follow-up (November 2007)
National Immunization Conference
5/31/2018
Telephone Follow-up (November 2007)
Facilities not responding to postcard survey
Facilities indicating no policy on postcard
Birthing unit nursing staff member
Standardized question set / Problem solving assistance offered:
Perceived reasons for lack of policy
Offer to provide additional resource materials
Actual policies / standing orders not obtained
Immunization Task Force - Metro Omaha

10. National Immunization Conference - 2009
5/31/2018
Survey Results
94% (58/62) response rate, by mail and/or follow- up telephone call
40 (65%) had a policy to administer hepatitis B birth dose vaccine in place, along with standing orders for administration
18 (29%) - No policy / standing orders
4 (6%) - No response / Status unknown
Six (~10%) hospitals reported change to a HBBD policy in the follow-up telephone survey after indicating no policy on the initial postcard survey.
No way of telling why these facilities changed their policy (some may have been at some point in process of change when first interviewed)
Immunization Task Force - Metro Omaha

11. Estimated Impact (Newborn access)
National Immunization Conference
5/31/2018
Estimated Impact (Newborn access)
Based on Nebraska vital statistics report on births occurring annually 2004 – 2006 in counties where hospitals located:
4 hospitals with unknown status - < 1% annual NE births
18 hospitals with no policy – 8-9% annual NE births
Therefore, estimated that ~ 90% of NE infants now born in hospitals with HBBD policy
Immunization Task Force - Metro Omaha

12. Barriers to Implementation
National Immunization Conference
5/31/2018
Barriers to Implementation
Economic – 5 respondents - Free dose typically obtained at public health at 1-2 mo
Considered low risk / unnecessary – 4
Concern over loss of records – 3
Physician preference – 3
Perceived unnecessary; high clinic compliance – 2
Only a few deliveries; so considered unnecessary - 2
Better reimbursement in clinic – 2
“Extra” dose (4 vs 3) considered unnecessary - 1
Immunization Task Force - Metro Omaha

13. National Immunization Conference - 2009
5/31/2018
“Mop Up” Activities
Report published in Nebraska Pediatrician
This NIC presentation
Plans for “telehealth” presentations
Follow-up promotion / survey of facilities
Id / confirm current status
Promote conversion if policy not in place (share study reports) – Unit manager AND CEO
Plans to extend campaign to education and promotion re Tdap for family members before or at time of delivery
Immunization Task Force - Metro Omaha

14. The Little Engine that Could!
National Immunization Conference
5/31/2018
The Little Engine that Could!
Immunization Task Force - Metro Omaha