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. 2022 Jun 23;7(4):e570.
doi: 10.1097/pq9.0000000000000570. eCollection 2022 Jul-Aug.

Improving Hepatitis B Vaccination Rates among At-risk Children and Adolescents with Inflammatory Bowel Disease

Megan Megan McNicol  1 , Amy Donegan  2 , Kate Hawa  3 , Angelique E Boutzoukas  3 , Barb Drobnic  2 , Melanie Oates  2 , Maudie Orraca-Tetteh  2 , Hilary K Michel  2 , Ross M Maltz  2 , Jennifer L Dotson  2 , Don Buckingham  4 , Brendan Boyle  2 , Monica I Ardura  5
Affiliations

Improving Hepatitis B Vaccination Rates among At-risk Children and Adolescents with Inflammatory Bowel Disease

Megan Megan McNicol et al. Pediatr Qual Saf. .

Erratum in

Abstract

Patients with inflammatory bowel disease (IBD) receiving tumor necrosis factor alpha inhibitors (TNFai) may be at higher risk for hepatitis B virus (HBV) infection. We conducted a quality improvement (QI) initiative to improve HBV vaccination rates in seronegative children with IBD.

Methods: This QI initiative implemented an HBV vaccination strategy from September 2018 to March 2020 in patients with newly diagnosed IBD with hepatitis B surface antibody (HBsAb) <10 mIU/mL. The project aimed to (1) increase HBV vaccination rates in seronegative patients and (2) document immunogenicity after completing a three-dose vaccine series. Outcome measures included the percentage of seronegative patients who received HBV vaccines (dose 1 and three-dose series). Interventions included applying a standardized vaccination protocol, and creating a vaccine workflow in two clinical areas, previsit planning and stakeholder engagement.

Results: One hundred seventy-four children and adolescents with IBD were evaluated during the study period, and 132 (76%) were HBsAb negative. After plan-do-study-act (PDSA) 1, the proportion of eligible patients who received HBV vaccine dose 1 increased from a baseline of 7% to 100% and was sustained for over 12 months. During PDSA 2, the proportion of patients completing the three-dose vaccine series improved from a baseline of 0% to 82% (n = 100); among 93 children in this subgroup who had repeat serology performed, 86 (92%) demonstrated serologic evidence of HBV protection.

Conclusions: A multidisciplinary approach applying QI methodology allowed for improved and sustained HBV vaccination rates in at-risk seronegative children and adolescents with IBD. A three-dose HBV vaccine series proved immunogenic in 92% of eligible patients.

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Figures

Fig. 1.
Fig. 1.
Key driver diagram of factors impacting hepatitis B vaccination among nonimmune children with newly diagnosed IBD.
Fig. 2.
Fig. 2.
Algorithm for hepatitis B vaccination among nonimmune children with newly diagnosed IBD. *Minimum interval between doses 1 and 2 = 4 weeks, minimum interval between doses 2 and 3 = 8 weeks from dose 2 and 16 weeks from dose 1. **Risk for Hep A: clotting liver disease, clotting factor disorder, men who have sex with men, users of elicit drugs, close contact with international adoptee, travel to countries with intermediate/high endemnicity.
Fig. 3.
Fig. 3.
Process flow diagram of HBV nonimmune children with newly diagnosed IBD who underwent HBV vaccination.
Fig. 4.
Fig. 4.
Shewhart P-chart of proportion of HBV nonimmune children and adolescents with newly diagnosed IBD receiving the first dose of HBV vaccine.
Fig. 5.
Fig. 5.
Shewhart P-chart of proportion of HBV nonimmune children and adolescents with newly diagnosed IBD completing the three-dose HBV series. A, Start of COVID-19 pandemic.
See this image and copyright information in PMC

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