PUBLIC HEALTH FOLLOW-UP OF HEPATITIS B IN THE WINNIPEG HEALTH REGION
This document provides the operational process for the public health follow-up of Hepatitis B. It is intended as a companion document to the Manitoba
Health Communicable Disease Protocol for Hepatitis B
http://www.gov.mb.ca/health/publichealth/cdc/protocol/hepb.pdf
Type of
Referral
Chronic
Hepatitis B
CD Admin person


Receives new Hep B lab report
Enters the referral into iPHIS and
refers to CD Coordinator for further
assessment
CD Coordinator




Sends the referral via email and
iPHIS to the CA Public Health admin
person
Obtains additional Hepatitis
serology results from e-chart.
Document the results in iPHIS
notes.
Preliminary assessment
indicates chronic infection
Public Health Admin
person


Receives the referral via
email and iPHIS.
Assigns it to a CA PHN via
iPHIS
Public Health Nurse
Within 1 day contact the testing physician to review the result:
 Advise physician PHN will be contacting client to provide
education and do PH follow-up.
 Confirm client demographic information
 Collect further details about the client.
Refer to Appendix # 2
 Advise physician:
o that referral to liver specialist is recommended
o Hepatitis A vaccine is recommended if Hep A
susceptible
o (as per Manitoba Health protocol Sec.8.12)
PHN to contact client within 5 working days of receiving results
Meet with client in person
Follow Manitoba Health Protocol for Hepatitis B
http://www.gov.mb.ca/health/publichealth/cdc/protocol/hepb.pdf
(Sec 8.12)
 Provide education to the client ( Sec 8.14)
 Interview case for contacts ( Sec 8.2)
 Contact follow-up (Sec 8.2) Coordinate contact testing
through primary healthcare provider.
Appendix 5- Letter to HCP can be used. PHN is not
routinely required to f/u completion of HBV series of
contacts once series is initiated. Exception: high risk
newborns.
 Contact CD Coordinator for serology results on contacts
once PHN has confirmed that contacts have been tested. Echart could also be checked. Provide HBV series to
contacts- if susceptible. Appendix 3 Letter to contacts re:
HBV series.
 PHN can provide Hep A immunization to case- if
susceptible.
File to be closed ( Refer to Closure section below)
Final May 2013
Type of
referral
Acute
Hepatitis B
CD Admin



Receives new Hep B referral
Enters the referral into iPHIS and
refers to CD Coordinator for further
assessment
Sends the referral via email and
iPHIS to the CA Public Health admin
person
CD Coordinator



Obtains additional Hepatitis
results from e-chart.
Markers indicate ACUTE hep B
infection
Contact the CA PHN to advise
of ACUTE hep B referral for
immediate f/u
Public Health Admin
 Receives the referral and
assigns it to a CA PHN via
iPHIS
Public Health Nurse








Prenatal
New
Chronic
Hepatitis Bor
household
member is
known HBV
positive
In addition to chronic hepatitis B followup:
 Will create a "pop-up" in iPHIS
requesting EDC of client
 Newborn prophylaxis letter to
physician and PHN.



Contact the testing physician IMMEDIATELY to review the
result:
Advise physician PHN will be contacting client to provide
education and do PH follow-up.
o
Confirm client demographic information. Refer to
Appendix 2
o
Determine when physician will be contacting client to
advise of results.
o
Advise that PHN will be contacting client
IMMEDIATELY
PHN to contact client IMMEDIATELY
Meet with client in person
Follow Manitoba Health Protocol for Hepatitis B
http://www.gov.mb.ca/health/publichealth/cdc/protocol/hep
b.pdf (Sec 8.12)
Provide education to the client ( Sec 8.14)
Interview case for contacts ( Sec 8.2)
Contact follow-up (Sec 8.2) Coordinate contact testing
IMMEDIATELY through primary healthcare provider.
o Assess need for HBIG/HBV ASAP.
Obtains EDC and confirm physician, contacts CD Clerk
(204-940-2081)to advise of EDC
Proceed with Hepatitis B investigation as above for chronic
hepatitis B.
Investigation can be closed and await birth of infant for
further follow-up
Type of
referral
Prenatal
Chronic
Hepatitis BPreviously
investigated
CD Admin




CD Coordinator

New prenatal blood work received.
Previously tested positive for Hepatitis
B. Public Health investigation has
been done.
Refer to Public Health admin person
in iPHIS.
Newborn prophylaxis letter to
physician and PHN.
Refers via iPHIS to the PHN
In addition to acute hepatitis B
follow-up:
Prenatal
Acute Hep B
infection-


Newborn
Hepatitis B
prophylaxis
Public Health Admin







Post partum/ infant referral form
received indicating HBIG/HBV
administered. If Post partum referral
not received f/u with PP desk
Creates newborn in iPHIS
Refer to CD Coordinator
If low risk: send letter to health care
provider/parent/PHN- no further f/u
necessary. Close when baby's name
and PHIN received
If high risk- diarize for f/u of HBV
series in MIMS @ 3 and 8 months of
age
If 2nd or 3rd dose not entered in
MIMS after 3 and 8 months
respectively refer to CA PHN for f/u
with family

Work closely with PHN to
monitor Hep B status prior to
delivery.
Obtains follow-up test results
from e-chart
CD Coordinator to assess if
high or low risk as per
Manitoba Health protocol
http://www.gov.mb.ca/health/pu
blichealth/cdc/protocol/hepb_ne
wborn.pdf
Public Health Nurse

Uses this opportunity to connect with the case
o Obtains EDC and confirm physician,
o Contacts CD Clerk (204-940-2081)to advise of
EDC and physician
o Assess if any additional contacts that may need
follow-up since last contact.


Close consultation with CD Coordinator and MOH
Obtain EDC and confirm name of physician. Advise CD
Clerk 204-940-2081
Advise and f/u with pregnant female to determine HBV
status 1 month prior to EDC. Advise CD Coordinator when
testing has been done


Refers via iPHIS to the
assigned PHN.

For low risk newborns: Recommend completion of series.
Confirm primary care provider and advise CD Coordinator.
No f/u for completion of HBV required. Close referral

For high risk newborns: Follow-up completion of HBV x 3
doses.
Type of
referral
Insurance
testingHepatitis B
positive
CD Admin





Canadian
Blood
Services
(CBS) Hepatitis B
positive




CD Coordinator
Public Health Admin
Receives new Hep B referral
Enters the referral into iPHIS and and
give to CD Coordinator for further
assessment
Receives the referral and
assigns it to a CA PHN via
iPHIS
Sends the referral via email and
iPHIS to the CA Public Health admin
person
Put “pop-up” to call CD Coordinator
Receives new Hep B referral
Enters the referral into iPHIS and r
CD Coordinator for further
assessment
Public Health Nurse



PHN to contact client within 5 working days of receiving
referral.
Advise client of results from insurance testing.
Advise retesting is recommended through primary care
provider as soon as possible. Recommend Hepatitis B
surface antigen, antibody to Hepatitis B and Hepatitis B
core antibody. Facilitate this with primary care provider.
If positive - follow Hepatitis B protocol
If negative - no further f/u required. Close file.

Advise the PHN to wait the two
week waiting period as
requested by CBS. Refer to
CBS letter

Receives the referral and
assigns it to a CA PHN via
iPHIS



Put “pop-up” to call CD Coordinator
PHN to contact client after the time frame given in the CBS
letter
Advise client of results from CBS
Advise retesting is recommended through primary care
provider as soon as possible. Recommend Hepatitis B
surface antigen, antibody to Hepatitis B and Hepatitis B
core antibody. Facilitate this with primary care provider.
If positive - follow Hepatitis B protocol
If negative - no further f/u required. Close file.
DOCUMENTATION


Cases:


Contacts:
All new Hepatitis B cases will be
created in iPHIS.
Refer to CD Coordinator and Public
Health Admin person

All documentation will be done
in iPHIS Notes tab
Assist PHN to enter/create contacts
in iPHIS

Refer iPHIS referral to CA
PHN

All documentation will be done in iPHIS Notes tab
When investigation is complete PHN to fill out the
Manitoba Health and Healthy Living Investigation Form for
Hepatitis B and C Positive cases
http://home.wrha.mb.ca/prog/pph/cdc/files/MHHLhepbccas
eform2.pdf
All contacts ( including newborns) will be entered into
iPHIS in the “Contacts” tab. Refer to iPHIS User Guide for
instructions.
http://home.wrha.mb.ca/prog/pph/surveillance/iphis_userguides
Type of
referral
CD Admin
CD Coordinator
Public Health Admin
Public Health Nurse
.php
 Consult with CD Coordinator for assistance as necessary
 Serology results and immunization history will be
documented under ‘contact tab, details, comments section.


CLOSURE
Send Manitoba Health and Healthy
Living Investigation Form for Hepatitis
B and C Positive Cases to Manitoba
Health


Review investigation in iPHIS.
Once Manitoba Health and
Healthy Living Investigation
Form for Hepatitis B and C
Positive Case form has been
received- close file in iPHIS

Send the ORIGINAL version
of the completed Manitoba
Health and Healthy Living
Investigation Form for
Hepatitis B and C Positive
Cases to the CD Unit.
Send via Medical Courier
with a return fax for
verification. ( Appendix 4
Administrative procedure #
58 and Appendix 4a Return
Fax Sheet)





Complete documentation in iPHIS "Notes" tab
Refer to CD Coordinator in iPHIS indicating it is completed
Completes the Manitoba Health and Healthy Living
Investigation Form for Hepatitis B and C Positive Cases
when investigation is completed
http://www.wrha.mb.ca/extranet/publichealth/files/HepB.do
c
Sign and date the bottom of the form when complete
If client is a prenatal Hep B case, it can be closed when
Hep B investigation is completed and will be re-opened at
the CD Unit when the baby is born.