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Serologic testing for infants born to mothers with Hepatitis B, Opiod management & Expedited partner therapy (EPT) for sexually transmitted infections

Today’s topics:

  • Post-vaccination serologic testing of infants born to mothers infected with hepatitis B
  • Opioid management
  • Expedited partner treatment for sexually transmitted infections

 

Post-vaccination serologic testing of infants born to mothers infected with hepatitis B

Action requested:  Test infants who are vaccinated following birth to mothers infected with hepatitis B virus (HBV) at age 9-12 months or 1-2 months after the final dose of the hepatitis B vaccine series.

Background & Recommendations: The Centers for Disease Control & Prevention (CDC) estimates that 25,000 infants are born to HBV-positive mothers each year in the United States. However, post-exposure prophylaxis (PEP) is highly effective in preventing perinatal HBV transmission; only 1 percent of infants receiving PEP develop infection. Infants born to HBV-infected mothers should receive hepatitis B vaccine (consisting of a 3- or 4-dose series) and hepatitis B immune globulin within 12 hours of birth to prevent perinatal HBV transmission.  To determine whether the infant requires revaccination, post-vaccination serologic testing (PVST) was previously recommended at age 9–18 months. Because new evidence suggests that hepatitis B antibody levels decline following vaccination, CDC now recommends that PVST take place earlier—at age 9–12 months, or 1–2 months after the final dose of the hepatitis B vaccine series—in order to ensure antibodies are detected. Benefits to this shortened interval include a reduction in the time that non-responders are at risk for transmission from close contacts with HBV infection, opportunity for prompt revaccination when needed, and conservation of public health resources.  For more information, see Update: Shortened Interval for Postvaccination Serologic Testing of Infants Born to Hepatitis B-Infected Mothers.

 

Opioid management

Action requested: Obtain training in appropriate use of opioids. Consider offering office-based treatment of opioid use disorders.

Background & Recommendations:  Opioids, both prescription and illicit, are the major cause of poisoning deaths in Snohomish County and have become an increasingly costly treatment challenge.  Physicians are central to assuring that opioids are properly prescribed and used.  Physicians also have a critical role in assuring that anyone needing treatment for opioid addiction can access treatment.  Two trainings on these topics will be offered this Friday, October 23, at Swedish Medical Center’s Glaser Auditorium (apologies for the late notice!).  CME is available.

The first training, The ASAM Buprenorphine Course for Office-Based Treatment of Opioid Use Disorders, will run 8 AM -12:30 PM and combines independent online study and live education to provide the required 8 hours needed to obtain the waiver to prescribe buprenorphine in office-based treatment of opioid use disorders. The first half of the 8-hour course is administered online through 4 hours of independent self-paced learning followed by a competency exam which must be successfully completed as part of the process to obtain a waiver for prescribing buprenorphine. The second half of the course is delivered by experts in the 4 hour interactive setting. Cost is $75.  For more information and to register for this course, see https://elearning.asam.org/products/the-asam-buprenorphine-course or contact ASAM Education at education@asam.org or 301-656-3920.

The second training, ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care, will run 1-5 PM and covers the safe use of opioids, including updates to the new Interagency Guideline on Prescribing Opioids for Pain, which was recently revised by the state Agency Medical Directors' Group.  This training is free.  For more information and to register for this course, see http://www.wsma.org/OpioidREMS or contact Jodi Escareno at jodi@wsma.org or 206-956-3638.

 

Expedited partner therapy for sexually transmitted infections

Action requested: Treat heterosexual partners of patients diagnosed with chlamydia.  Do not refer to public health.

Background & Recommendations:  Providers are responsible for offering Expedited Patient Treatment (EPT) to all heterosexual patients who have tested positive for chlamydia. The Health District does not investigate or provide partner services for heterosexuals diagnosed with chlamydia. The Health District will contact all men who have sex with men (MSM) who are diagnosed with chlamydia, as well as all persons (heterosexuals and MSM) diagnosed with gonorrhea and/or syphilis, and in these cases will assist with partner notification and treatment.

Providers can obtain free EPT packs for your clinic by calling the Snohomish Health District at 425-339-5261.  Free medication for your patient’s partner(s) is also available from select pharmacies.  A prescription FAX form and list of participating Snohomish County pharmacies can be found on page 3 of our STD case report form at http://www.snohd.org/Providers/STD-Screening-Guidelines.  Recommended treatment regimens for sexually transmitted infections can be found on page 2 of the form.

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