Kim H Nina, Moore Kelly L, Sanders David L, Jackson Michaela, Cohen Chari, Andrews Richard, Graham Camilla S
Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98104, USA.
Immunize.org, St. Paul, MN 55116, USA.
Vaccines (Basel). 2024 May 14;12(5):536. doi: 10.3390/vaccines12050536.
Hepatitis B is a serious problem in the United States (US), with up to 2.4 million Americans living with a chronic infection. Only 26-32% of people living with hepatitis B in the US are diagnosed. Additionally, just 30% of all adults are vaccinated against the virus. In 2022, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) updated adult hepatitis B vaccination recommendations to include all adults aged 19-59 years and those 60 years and older with risk factors for hepatitis B. Subsequently, in 2023, the CDC recommended that all adults be screened at least one time in their lives.
Electronic health record (EHR) tools (prompts, order sets, etc.) have proven to be an effective method of increasing hepatitis B screening and vaccination, but longstanding challenges and questions around hepatitis B vaccines and tests could prevent effectual EHR implementation. As the new recommendations directly impact providers who may have limited familiarity with hepatitis B, guidance on how to identify eligible patients and triggers, order sets to facilitate vaccine/test selection, and proper documentation and patient follow-up is necessary.
This communication offers a practical framework for health systems to build an effective EHR strategy for the updated adult hepatitis B recommendations. We also provide comprehensive responses to clinicians' questions that are frequently asked prior to screening or vaccinating for hepatitis B.
乙型肝炎在美国是一个严重问题，多达240万美国人患有慢性感染。在美国，只有26% - 32%的乙型肝炎患者得到诊断。此外，所有成年人中只有30%接种了该病毒疫苗。2022年，疾病控制与预防中心（CDC）的免疫实践咨询委员会更新了成人乙型肝炎疫苗接种建议，将所有19 - 59岁的成年人以及60岁及以上有乙型肝炎危险因素的成年人纳入其中。随后，在2023年，CDC建议所有成年人一生中至少接受一次筛查。
电子健康记录（EHR）工具（提示、医嘱集等）已被证明是增加乙型肝炎筛查和疫苗接种的有效方法，但围绕乙型肝炎疫苗和检测长期存在的挑战和问题可能会阻碍EHR的有效实施。由于新建议直接影响可能对乙型肝炎了解有限的医疗服务提供者，因此需要有关如何识别 eligible患者和触发因素、便于疫苗/检测选择的医嘱集以及正确记录和患者随访的指导。
本交流为卫生系统构建针对更新后的成人乙型肝炎建议的有效EHR策略提供了一个实用框架。我们还对临床医生在进行乙型肝炎筛查或疫苗接种之前经常提出的问题提供了全面解答。
