Raising awareness and implementing Universal Hepatitis B screening and vaccination between ages 19-59

From the 2023 HVPA National Conference

Knkush Hakobyan, Medical Resident (Capital Health Medical Center), Amy Theresa Pulikeyil, Medical Resident, Khadija Merchant, Medical Doctor

Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality worldwide. Chronic infection is associated with an increased risk of cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC). Hepatitis B infection in the general population remains highly underdiagnosed, as it can be asymptomatic leading to diagnosis at a later stage. The population at our Family Health Center (FHC) clinic comes from a largely underserved and diverse immigrant community with numerous chronic ailments, having limited resources and minimal health literacy, thus posing a high risk for infections. By initiating universal hepatitis B screening with the ultimate plan of vaccination for all, we aim to decrease chronic hepatitis B cases and eventually decrease the burden of complications associated with the disease. Implementing universal screening gives an opportunity for early treatment and management in the undiagnosed population and vaccinate those who are non-immune and highly susceptible in encountering the disease.

The aim of this project was to achieve screening of 30% of the patient panel for Hepatitis B from July to December 2022 at FHC and start vaccination series by December 2022.

Residents prepared charts for patients, between the ages of 19-59 years, to determine history of Hepatitis B infection, screening and vaccination. Those who did not have a history of Hepatitis B vaccination or screening were educated about the disease, outcomes, complications and available preventive strategies during the primary visit. An order set was created in our EMR to aid providers regarding ordering tests. Educational sessions were conducted by residents regarding updated guidelines for universal Hepatitis B screening and vaccination, serological course and interpretation of screening results. Initial testing for Hepatitis B surface antigen (HbsAg), total Hepatitis B core antibody (total HbcAb) and Hepatitis B surface antibody (HbsAb), were ordered. In subsequent visits, these test results were  discussed, and non-immune patients were offered the 3-series vaccination. The first dose of vaccine was administered by the nurse during this visit and subsequent doses were scheduled for the next month and sixth month. Those who refused vaccination or screening were subjected to motivational interviewing. Those who were positive for the surface antigen or core antibodies were offered further workup and testing, given additional information and counselling and referred to gastroenterology for subsequent management.

At baseline, 9.8% of our patients were screened for Hepatitis B. At the 6month mark, we were able to achieve our goal and screened 42% of the population. Additionally, 3% of our population were vaccinated for Hepatitis B at baseline which increased to 13% at the end of December 2022. Our next goal is to vaccinate 30 % of this patient population by July 2023.

Universal Hepatitis B screening and vaccination for the public aids in early identification of Hepatitis B cases that would otherwise be asymptomatic and prevention of complications like cirrhosis and hepatocellular carcinoma. It is also more cost effective for the health care system, easy to implement and prevents stigmatization of groups already marginalized.

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