P3.F109: Optimizing Hepatitis B Screening Strategies in the Pediatric Population: Addressing Non-Responders and Waning Antibody Levels

Background: CDC guidelines advise screening for Hepatitis B (HepB) antibodies in the pediatric population only following potential exposure. However, 5%-15% of patients may be unable to generate an immune response even after completing two full series of HepB vaccinations, termed non-responders. Additionally, antibody levels may decline to ineffective levels by age 7. Both scenarios significantly increase the risk of HepB development among certain pediatric patients. The CDC states the Appalachian region has rates of acute HepB higher than the US average. Our goal is to evaluate HepB vaccination response in high-risk pediatric patient populations such as child abuse victims to develop screening guidelines. Younger children have the highest chance of developing a chronic infection with HepB that can lead to liver damage, failure, and cancer. Effective HepB antibody response to vaccination can prevent infection.

Methods: This retrospective chart review aims to investigate factors that contribute to increased risk of acquiring HepB in pediatric patients. Patients selected were between 0-18 years old. Currently, 131 charts were reviewed out of 509 and 32 met the criteria of being screened by pediatricians. Additional charts are currently being reviewed. A HIPAA-compliant REDCap program was used.

Results: Preliminary results showed that all patients screened for HepB antigens were negative and not infected when the titer was drawn. Of the patients who were also screened for HepB antibodies,12.5% had levels high enough to prevent infection. 50% had negative titer levels, leaving them susceptible, and 37.5% of the individuals lacked a documented HepB titer. This highlights significant potential for improvement in the screening these patients. The most prevalent risk factors were child abuse in 50% of screened patients, sexual abuse in 54.8%, and a CPS investigation in 56.3%.

Conclusion: The risk factors child abuse, sexual abuse, and CPS investigation being at or over 50% shows that if patients have these factors coded in their chart, they might be at higher risk for contracting Hepatitis B as these are the kids that are being tested for infection. In the future, patients who have these factors could be tested for HepB antibodies. If titers are negative, a revaccination protocol could be implemented. This information could be used to educate providers about coding factors such as child abuse in the patient’s chart, as it can inform future care. While completing our chart reviews, we found that many pediatric patients were being screened for HepB infection for the first time by an OBGYN after a confirmation of pregnancy, usually without the co-testing of antibody titer levels. This is another avenue that we could explore as an opportunity to check antibody titer levels and prevent future infection through revaccination. We are currently collecting more data points and will update our research as that data is analyzed.