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Infant Hepatitis B Virus Investigation
Virus Reference Department Phone +44 (0)20 8327 6017/6266 HPA Colindale 61 Colindale Avenue [email protected] CfI VRD Colindale www.hpa.org.uk/SRMTests DX 6530006 London. NW9 5HT Project code: SUHBV Colindale NW
COORDINATOR INFORMATION
Local coordinator for Hep B Babies (name and address)
Coordinator code
SPECIMEN DETAILS Date specimen taken
INFANT’S DETAILS Surname Forename
Date of Birth NHS Number
Sex M F Birth Weight Gestational age (if known)
Hospital of Birth
GP name and address
HPA code for GP
ACTION TAKEN FOR INFANT HBIG given Yes No N/K
Date HBIG given Location
Vaccine dose 1 (due at birth) given Yes No N/K Date dose 1
Vaccine dose 2 (usually at 4 weeks) given Yes No N/K Date dose 2
Vaccine dose 3 (usually at 8 weeks) given Yes No N/K Date dose 3
Vaccine dose 4 (usually at 12 months) given Yes No N/K Date dose 4
MOTHER’S DETAILS Surname Forename
Date of Birth Country of Birth
Current postcode NHS number
MOTHER’S HEP B STATUS (in personal child health record on Hep B page)
Hepatitis B surface antigen: Pos Neg N/K Hepatitis B e antibody: Pos Neg N/K
Hepatitis B e antigen: Pos Neg N/K High Viral Load (>106IU/ml): Yes No N/K
Acute hepatitis B in pregnancy: Yes No N/K
COMMENTS
Report will be sent to local Hepatitis B babies coordinator and the infant’s GP. PTO for notes. Please complete this form and send to HPA Colindale, Virus Reference Department, 61 Colindale Avenue, London. NW9 5HT with the dried blood spot sample on the card.
HPA
Mic
robi
olog
y re
ques
t for
m Protien Saver Card
903 TM
NHS No:
Name:
Sex:M / F
DOB:
Sample date:
For Research Use Only
Not for use in diagnostic procedure
Infant Hepatitis B Virus Investigation
Virus Reference Department Phone +44 (0)20 8327 6017/6266 HPA Colindale
61 Colindale Avenue [email protected] CfI VRD
Colindale [email protected] DX 6530006
London. NW9 5HT Project code: SUHBV Colindale NW
COORDINATOR INFORMATION
Local coordinator for Hep B Babies (name and address)
Coordinator code
SPECIMEN DETAILS
Date specimen taken
INFANT’S DETAILS
Surname Forename
Date of Birth NHS Number
Sex M F Birth Weight Gestational age (if known)
Hospital of Birth
GP name and address
HPA code for GP
ACTION TAKEN FOR INFANT
HBIG given Yes No N/K
Date HBIG given Location
Vaccine dose 1 (due at birth) given Yes No N/K Date dose 1
Vaccine dose 2 (usually at 4 weeks) given Yes No N/K Date dose 2
Vaccine dose 3 (usually at 8 weeks) given Yes No N/K Date dose 3
Vaccine dose 4 (usually at 12 months) given Yes No N/K Date dose 4
MOTHER’S DETAILS
Surname Forename
Date of Birth Country of Birth
Current postcode NHS number
MOTHER’S HEP B STATUS (in personal child health record on Hep B page)
Hepatitis B surface antigen: Pos Neg N/K Hepatitis B e antibody: Pos Neg N/K
Hepatitis B e antigen: Pos Neg N/K High Viral Load (>106IU/ml): Yes No N/K
Acute hepatitis B in pregnancy: Yes No N/K
COMMENTS
Report will be sent to local Hepatitis B babies coordinator and the infant’s GP. PTO for notes.
Please complete this form and send to HPA Colindale, Virus Reference Department, 61 Colindale Avenue, London.
NW9 5HT with the dried blood spot sample on the card.
HPA
Mic
robi
olog
y re
ques
t for
m
Skin cleansing swabSkin
cleansing
swab
Allow the blood to �ow naturally and �ll at least 3 circles with blood. Fill the circles evenly with one drop of blood per circle. Ensure blood has been absorbed into the �lter paper at the rear of the card
If the blood stops �owing, wipe away any congealed blood and gently massage the foot (do not squeeze). Excessive pressure reduces the density of the blood on the sample. If the infant is not bleeding, a second puncture is needed. This should be on the other foot or a di�erent part of the same foot
Be careful not to contaminate the sample. Allow the blood spots to air dry for 10 minutes away from direct sunlight or heat. Once completely dry, fold the top of the card over the blood spots and place the card in the sealed section of the clear plastic bag with the request form in the front pocket
2 Infant Hepatitis B Virus Investigation
Virus Reference Department Phone +44 (0)20 8327 6017/6266 HPA Colindale 61 Colindale Avenue [email protected] CfI VRD Colindale www.hpa.org.uk/SRMTests DX 6530006 London. NW9 5HT Project code: SUHBV Colindale NW
COORDINATOR INFORMATION
Local coordinator for Hep B Babies (name and address)
Coordinator code
SPECIMEN DETAILS Date specimen taken
INFANT’S DETAILS Surname Forename
Date of Birth NHS Number
Sex M F Birth Weight Gestational age (if known)
Hospital of Birth
GP name and address
HPA code for GP
ACTION TAKEN FOR INFANT HBIG given Yes No N/K
Date HBIG given Location
Vaccine dose 1 (due at birth) given Yes No N/K Date dose 1
Vaccine dose 2 (usually at 4 weeks) given Yes No N/K Date dose 2
Vaccine dose 3 ( usually at 8 weeks) given Yes No N/K Date dose 3
Vaccine dose 4 (usually at 12 months) given Yes No N/K Date dose 4
MOTHER’S DETAILS Surname Forename
Date of Birth Country of Birth
Current postcode NHS number
MOTHER’S HEP B STATUS (in personal child health record on Hep B page)
Hepatitis B surface antigen: Pos Neg N/K Hepatitis B e antibody: Pos Neg N/K
Hepatitis B e antigen: Pos Neg N/K High Viral Load (>106IU/ml): Yes No N/K
Acute hepatitis B in pregnancy: Yes No N/K
COMMENTS
Report will be sent to local Hepatitis B babies coordinator and the infant’s GP. PTO for notes. Please complete thi s form and send to HPA Colindale , Virus Reference Department, 61 Colindale Avenue, London. NW9 5HT with the dried blood spot sample on the card.
HPA
Mic
robi
olog
y re
ques
t for
m
Protien Saver Card
903 TM
NHS No:
Name:
Sex:M / F
DOB:
Sample date:
For Research Use Only
Not for use in diagnostic procedure
Infant Hepatitis B Virus Investigation
Virus Reference Department Phone +44 (0)20 8327 6017/6266 HPA Colindale
61 Colindale Avenue [email protected] CfI VRD
Colindale [email protected] DX 6530006
London. NW9 5HT Project code: SUHBV Colindale NW
COORDINATOR INFORMATION
Local coordinator for Hep B Babies (name and address)
Coordinator code
SPECIMEN DETAILS
Date specimen taken
INFANT’S DETAILS
Surname Forename
Date of Birth NHS Number
Sex M F Birth Weight Gestational age (if known)
Hospital of Birth
GP name and address
HPA code for GP
ACTION TAKEN FOR INFANT
HBIG given Yes No N/K
Date HBIG given Location
Vaccine dose 1 (due at birth) given Yes No N/K Date dose 1
Vaccine dose 2 (usually at 4 weeks) given Yes No N/K Date dose 2
Vaccine dose 3 ( usually at 8 weeks) given Yes No N/K Date dose 3
Vaccine dose 4 (usually at 12 months) given Yes No N/K Date dose 4
MOTHER’S DETAILS
Surname Forename
Date of Birth Country of Birth
Current postcode NHS number
MOTHER’S HEP B STATUS (in personal child health record on Hep B page)
Hepatitis B surface antigen: Pos Neg N/K Hepatitis B e antibody: Pos Neg N/K
Hepatitis B e antigen: Pos Neg N/K High Viral Load (>106IU/ml): Yes No N/K
Acute hepatitis B in pregnancy: Yes No N/K
COMMENTS
Report will be sent to local Hepatitis B babies coordinator and the infant’s GP. PTO for notes.
Please complete thi s form and send to HPA Colindale , Virus Reference Department, 61 Colindale Avenue, London.
NW9 5HT with the dried blood spot sample on the card.
HPA
Mic
robi
olog
y re
ques
t for
m
Public Health England
Bacterial Reference Unit
(VRD)
61 Colindale Avenue
London
NW9 5EZ
Skin cleansing swabSkin
cleansing
swab
- Fill at least 3 circles with blood on the card. Ensure the circles are full and the blood has soaked into the �lter paper at the rear of the card
If the blood stops �owing, wipe away any congealed blood and gently massage the foot (do not squeeze).If the baby is not bleeding, a second puncture is needed. This should be on the other foot, or a di�erent part of the same foot.
Do not contaminate the sample and do not apply excessive pressure to the area. Excessive pressure reduces the density of blood on the sample.
Allow the blood spots to air dry away from direct sunlight or heat. Once completely dry, place the blood spot card in the sealed section of the clear plastic bag with the request form in the front pocket
Protien Saver Card
903 TM
NHS No:
Name:
Sex:M / F
DOB:
Sample date:
For Research Use Only
Not for use in diagnostic procedure
Hepatitis B Dried Blood Spot – Testing kitContents:1 x Instruction sheet 1 x Request form1 x Dried Blood Spot card 1 x Lancet1 x Alcohol wipe1 x reply-paid specimen bag (for return of specimen)Please ensure that you complete the request form and return with the sample. If you have any queries, please contact the DBS Coordinator on 0208 327 6439 for assistance.Thank you
KIT EXPIRES END: …………………….…..
Taking dried blood spot samples for infants of Hep B positive mothers
Avoid the posterior curvature (back) of the heel.
Public Health England Bacterial Reference Unit(VRD)61 Colindale AvenueLondonNW9 5EZ
Hepatitis B Dried Blood Spot – Testing kitContents:1 x Instruction sheet 1 x Request form1 x Dried Blood Spot card 1 x Lancet1 x Alcohol wipe1 x reply-paid specimen bag (for return of specimen)Please ensure that you complete the request form and return with the sample. If you have any queries, please contact the DBS Coordinator on 0208 327 6439 for assistance.Thank you
KIT EXPIRES END: …………………….…..
NHS No:Name:Sex:
M / FDOB:Sample date:
NHS No:
Name:
Sex: M / F
DOB:
Sample date:
1x Instruction sheet
1x reply-paid specimen bag (for return of specimen)
1x Alcohol wipe
1x Lancet
1x Request form
1x clear bag
Hepatitis B Dried Blood Spot –Testing kit contents:
Clean the area to be used for the blood test with an alcohol wipe.
Place the infant in a comfortable position with their foot bare. Healthcare worker should wash and dry their hands thoroughly and wear appropriate PPE (gloves/apron) during the procedure
Complete the details on the blood spot card and request form, including the infants NHS No
remove the blue safety clip and place the automated incision device in light contact with the heel. This will ensure the incision is not too deep or too shallow. Press the trigger. The blade will create an incision and then retract. Dispose of the device in a sharps box
Place the clear bag into the reply-paid grey bag and post to the lab promptly using Royal Mail. Inform the parent/guardian that their GP will receive the result. Any questions - please contact: [email protected] or telephone 0208 327 6439
1x Dried Blood Spot card
Protien Saver Card
903 TM
NHS No:
Name:
Sex: M / F
DOB:
Sample date:
For Research Use Only
Not for use in diagnostic procedure
1
5
6 7 8 9
3 4
How to take a dried blood spot sample
3 JULY V1
Hepatitis B Dried Blood Spot – Testing kitContents:1 x Instruction sheet 1 x Request form1 x Dried Blood Spot card 1 x Lancet1 x Alcohol wipe1 x reply-paid specimen bag (for return of specimen)Please ensure that you complete the request form and return with the sample. If you have any queries, please contact the DBS Coordinator on 0208 327 6439 for assistance.Thank you
KIT EXPIRES END: …………………….…..
NHS No:Name:
Sex:M / F
DOB:
Sample date:
NHS No:
Name:
Sex: M / F
DOB:
Sample date:
1x Instruction sheet
1x Reply-paid specimen bag (for return of specimen)
1x Alcohol wipe
1x Lancet
1x Request form
1x Clear bag
Hepatitis B Dried Blood Spot –Testing kit contents:
Clean the area to be used for the blood test with an alcohol wipe
Place the infant in a comfortable position with their foot bare. Healthcare worker should wash and dry their hands thoroughly and wear appropriate PPE (gloves/apron) during the procedure
The best area for the heel prick is the sides of the heel (shaded green). The sample should not be taken from the back of the heel. Please avoid this area.
Reversed
Health Protection AgencyRespiratory & Vaccine Preventable Bacterial Reference Unit(RVPBRU)
61 Colindale AvenueLondonNW9 5EZ
Self adhesive clearplastic bag (C)
Cardboard Box (D)
Pre-paid grey plastic envelope (F)
Contents Swab Test package
Complete the details on the infant request form and blood spot card. Provide as much detail as possible, including the infants NHS No. and GP details to ensure timely reporting of results
Remove the blue safety clip and place the lancet in light contact with the heel. This will ensure the incision is not too deep or too shallow. Press the trigger. The blade will create an incision and then retract. Dispose of the device in a sharps box
Place the clear bag into the reply-paid grey bag and post to the lab promptly using Royal Mail. Inform the parent/guardian that their GP will receive the result. Any questions - please contact: [email protected] or telephone 0208 327 6439
1x Dried Blood Spot card
Protien Saver Card
903 TM
NHS No:
Name:
Sex: M / F
DOB:
Sample date:
For Research Use Only
Not for use in diagnostic procedure
1
2
5
6 7 8
3 4
Public Health England, Virus Reference Department, (VRD), 61 Colindale Avenue, London NW9 5EZ
Public Health England, Virus Reference Department, (VRD), 61 Colindale Avenue, London NW9 5EZ
Public Health England,
Virus Reference Department,
(VRD),
61 Colindale Avenue,
London
NW9 5EZ
Protien Saver Card
903 TM
NHS No:
Name:
Sex:M / F
DOB:
Sample date:
For Research Use Only
Not for use in diagnostic procedure
Hepatitis B Dried Blood Spot – Testing kitContents:1 x Instruction sheet 1 x Request form1 x Dried Blood Spot card 1 x Lancet1 x Alcohol wipe1 x reply-paid specimen bag (for return of specimen)Please ensure that you complete the request form and return with the sample. If you have any queries, please contact the DBS Coordinator on 0208 327 6439 for assistance.Thank you
KIT EXPIRES END: …………………….…..
Public Health England, Virus Reference Department, (VRD), 61 Colindale Avenue, London NW9 5EZ
9
