Master's Project Title:

Validity and Reliability of Perinatal Hepatitis B Information in the 2013 Birth Records Data

MCH Student:

Selamawit Gebremariam

Date of Defense:

July 28, 2015


Intro: Hepatitis B virus (HBV) infection, the most common  form of chronic hepatitis worldwide, is a  major public health problem affecting an estimated 240 million people globally. Vertical transmission of  Hepatitis B virus is the predominant route of transmission for hepatitis endemic areas because of its  transmission efficiency (Hou et al. 2005). According to the CDC, in the United States about 40% of  babies born to hepatitis B positive mother become infected with the virus in absence of post – exposure  prophylaxis and are at risk of developing HBV – related complications, such as cirrhosis and hepatic  carcinoma. Perinatal transmission of hepatitis B can be reduced by early identification, routine monitoring  of hepatitis B virus (HBV) carrier mothers, and treatment of infants born to HBV – infected women.  Currently, major public health organizations such as, CDC and the Advisory Committee on Immunization  Practices (ACIP), and the American Academy of Pediatrics (AAP) recommend that all pregnant women  receive prenatal testing for hepatitis B during each pregnancy by screening serum for the presence of  HBsAg, regardless of risk factors or immunization history.

Research Objective: Through surveillance data at the Minnesota Department of Health, the Perinatal  Hepatitis B Prevention Program is able to follow all reported pregnancies to HBV infected women and  recommend timely screening and treatment, if needed, during pregnancy, and timely screening and  treatment for the babies in our program. In the past the Perinatal Hepatitis Program at MDH has met, and  exceeded, all goals set nationwide by the CDC, and is one of the high performing programs around the  country. It has reached a 98% post exposure prophylaxis rate among the reported pregnancies. The Office  of Vital Records also collects hepatitis B related, among many other, in formation in the Birth Records.  This information includes for the mother’s side – hepatitis B status of the mother and HBsAg lab test  results – and for the infant’s side – timing and administration of birth dose, and HBIG. The birth record  database can be  used for different purposes. It can be used for a) policy making, that is, to form the basis  for policy guidance, planning and projections; (b) for administration, that is, to monitor current  demographic trends and action programmes; and (c) for research,  that is, to support the scientific study of  the interrelationship between fertility and mortality trends and socio – economic development. Therefore it  is crucial to look at the validity and reliability of the information collected in the Birth Records, including  hepatitis B related information. That is the focus of the project. We will use the Perinatal Hepatitis  Prevention Database as our highest standard.

Method: A previously merged and de-identified dataset from Birth Record dataset and Perinatal HBV  data set was used in this analysis. The merging occurred by obtaining a dataset containing all births in  2013 from Birth Records and matching that dataset to all women who were followed by the Perinatal  Hepatitis B program due to positive HBV status/lab reports . The final dataset used in this project included  women with confirmed or probable HBV status that gave birth in 2013. All the women were between the  ages of 14 – 46. Overall percent agreement analysis was performed comparing information within the Birth  Records dataset and comparing the HBV status information in the Birth Records dataset to the Perinatal  HBV dataset. Final analysis also incorporated infants’ birth dose administration, or lack thereof, to better  understand knowledge of provider regarding HBV  status of the women. For all the analysis SAS software  of utilized, and p – values were calculated using the McNemar’s Test.

Results: Overall, the Birth Record dataset correctly identified 361 of 430 individuals with their accurate  HBV infection status. How ever, there are a significant number of people who were reported with  inaccurate or missing information in the Birth Records. Findings included the presence of  inconsistence/unreliable information within the Birth Records dataset (such as HBsAg – negative an d  Infection the HBV – Yes) and presence of inaccurate information on HBV infection in the Birth Record  compared to the Perinatal Hepatitis B data set, which is the gold standard. Roughly about 16% (out of  430) of the women had an “unknown” HBV infection stat us. For the 361 women that were correctly  identified to be infected with HBV, 47 of them had negative and 3 of them had missing HBsAG lab test  result. All the tables above that that compared the two datasets demonstrate that there is misreporting and  conflicting information in the Birth Records dataset.

Conclusion: Even though there was a significant level of misreporting on the Birth Records, the Perinatal  Hepatitis B Program has looked into all babies born to the women in this data set and all babies received  both the birth dose and HBIG. Therefore, the HBV statuses of all the women were known prior to  pregnancy, during pregnancy or during childbirth. However, there was a failure in retesting,  communicating, and/or reporting the lab tests used to diagnose  the women. The error/misreporting that  was noted in birth certificate warrants attention from the birth facilities, Office of Vital Records, the  CDC, and other public health professionals who use these data for studies, monitoring and/or  surveillance.