(871) Hepatitis B Triple-Panel Screening in Pregnancy: A Quality Improvement Project

Objective:
Recent ACOG/SMFM guidelines recommend universal Hepatitis B virus triple-panel screening once per adult lifetime, with vaccination as indicated. We describe the results of triple panel screening and vaccination after implementation of a quality improvement (QI) initiative in our obstetric population.

Study Design:
Retrospective cohort study evaluating the implementation of hepatitis B triple panel screening (hepatitis B surface antigen, hepatitis B surface antibody, total hepatitis B core antibody) among all patients establishing prenatal care at a large academic medical center between January and September 2024. The primary outcome was completion of triple panel screening. Process measures included the proportion of hepatitis B susceptible patients with documentation of hepatitis B vaccination recommendations. Triple-panel results were interpreted per CDC guidance. For patients without testing, charts were reviewed for prior results.

Results:
1,996 patients were included, with a mean age of 33.2 (± 4.8 years), the majority being English-speaking (88.1%), White (61.7%), and non-Hispanic (87.1%). The monthly rate of incomplete testing decreased during the study period, ranging from 45% in January 2024 to 4% in August 2024 (Figure 1). 1,085 (55.2%) were immune to hepatitis B due to prior vaccination, 620 (31.5%) were susceptible to hepatitis B infection, 19 (1%) were immune to hepatitis B due to previous infection, 6 (0.3%) had acute or chronic hepatitis B infection, and 3 (0.2%) had uncertain testing (Table 1). Of the 620 patients susceptible to hepatitis B, 121 (19.5%) had documentation of prior complete hepatitis B vaccination.

Conclusion:
Rates of susceptibility to the hepatitis B virus in our population were higher than expected. Pregnancy is a time of increased access to care, and given recent FDA approval of a 2-dose vaccine (Heplisav-B), vaccination during pregnancy and postpartum is feasible. Our findings demonstrate that triple-panel screening is feasible across an obstetric population and can enable vaccination of susceptible persons during pregnancy and postpartum.