Impact of Recommendations to Suspend the Birth Dose of Hepatitis B Virus Vaccine

• Published in: JAMA : the journal of the American Medical Association 2001-04, Vol.285 (14), p.1874-1879
• Main Authors: Oram, Ronda J, Daum, Robert S, Seal, John B, Lauderdale, Diane S
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Epidemiology. Vaccinations; General aspects; Guideline Adherence; Hepatitis; Hepatitis B Vaccines - administration & dosage; Hospitals; Humans; Illinois; Infant, Newborn; Infectious diseases; Medical research; Medical sciences; Nurseries, Hospital - standards; Planification. Prevention (methods). Intervention. Evaluation; Practice Guidelines as Topic; Preservatives, Pharmaceutical; Public health. Hygiene; Public health. Hygiene-occupational medicine; Thimerosal; Vaccination - standards; Vaccines
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.285.14.1874

CONTEXT In July 1999, due to concerns about thimerosal content, the American Academy of Pediatrics (AAP) and the Public Health Service (PHS) recommended suspending hepatitis B virus (HBV) vaccination at birth except for mothers who had positive or unknown hepatitis B surface antigen (HBsAg) status. In September 1999, the Centers for Disease Control and Prevention recommended that hospitals resume HBV vaccination at birth with a new thimerosal-free vaccine. Whether the 2 changes in recommendations within 3 months led to less-than-optimal compliance in hospital nurseries is unknown. OBJECTIVE To determine hospital HBV vaccination policy before the recommendation for delay of HBV vaccination and 1 year later. DESIGN, SETTING, AND PARTICIPANTS Survey of all 46 hospitals with obstetric services and neonatal nurseries in Cook County, Illinois. MAIN OUTCOME MEASURES Hepatitis B virus immunization practices before July 1999 and in August 2000; hospital factors associated with routine HBV immunization and compliance with AAP and PHS recommendations. RESULTS Before July 1999, 74% of surveyed hospital nurseries offered HBV vaccine to all neonates; only 39% did so in August 2000. Being located in the Chicago city limits (88% vs 57%; P = .02) and having an academic affiliation (93% vs 66%; P = .05) were positively associated with routine neonatal immunization before July 1999. Both academic affiliation and city location were associated with routine immunization in August 2000 (71% vs 25% [P = .003] and 60% vs 14% [P = .002], respectively) and with compliance with recommendations for suspension (57% vs 25% [P = .03] and 56% vs 10% [P = .001]). CONCLUSIONS We documented a 35% decrease in hospital nurseries that routinely offered HBV immunization 1 year after the AAP and PHS recommendations were made. Special efforts may be required to make at-birth administration of HBV vaccination universal.