Hospitals' responses to universal infant hepatitis B vaccination recommendations

Hospitals appear to opt for newborn vaccination for hepatitis B even in areas with low prevalence of hepatitis B infection. The Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend immunizing all infants against hepatitis B, one option being giving the first dose before hospital discharge. However, it was thought that physicians in low-risk areas may question the need for universal immunization. Researchers surveyed 110 Wisconsin newborn nurseries. Wisconsin has a low rate of hepatitis B infection. Seventy-one (65%) hospitals offered the vaccine to all infants, which amounted to 80% of all births. Six hospitals planned to begin offering routine vaccination in the near future. Of 29 hospitals not offering routine vaccination, half said that doctors saw no need for universal vaccination in a low risk community, one-quarter thought the baby's doctor should give all three doses, and one-quarter were concerned about costs.
Objective. To assess the extent to which hospitals in a midwestern state with low acute hepatitis B virus (HBV) morbidity offered hepatitis B (Hep B) vaccine to all infants, whether offering infants Hep B vaccine was associated with hospital geographic location or size, as measured by the number of births, and how hospital staff resolved key programmatic issues. Methods. The managers of hospital newborn nurseries (N = 110) were surveyed by mail. The written response rate was 72%; all of the nonresponders were interviewed by telephone. The outcome measured was the number of hospitals offering Hep B vaccine to all infants by geographic region and hospital size. Results. Sixty-five percent of the hospitals routinely offered Hep B vaccine to all infants; these hospitals accounted for 80% of reported Wisconsin births. In univariate analysis, the decision to offer infants Hep B vaccine was associated with both hospital size and hospital location. After controlling for size, hospitals in the northeastern region were eight times more likely (relative risk, 8.21; 95% confidence interval, 1.30, 51.79) to offer infants Hep B vaccine than hospitals in the southeastern (referent) region. Regional differences in reported rates of acute HBV infection do not explain this finding, because morbidity in the northeastern region (1 per 100 000) is among the lowest in Wisconsin. Although more than 80% of hospitals with Hep B vaccination programs required written informed consent for vaccination, had standing orders for administering Hep B vaccine to infants whose mothers' hepatitis B surface antigen (HbsAg) test results were known, and had mechanisms to notify the infants' physicians that the infants had been vaccinated, only 38% had standing orders for testing mothers whose HbsAg test results were unknown. Conclusions. Hospitals are not necessarily deterred from implementing infant Hep B vaccination programs by low community HBV morbidity. Hospitals should develop policies to assure that parturient women with unknown HBsAg status are screened and their infants are appropriately treated. Pediatrics 1995;96:875-879; hepatitis B, vaccine, universal, infant, hospital, Wisconsin.
ABBREVIATIONS. ACIP, Advisory Committee on Immunization Practices; AAP, American Academy of Pediatrics; AAFP, American Academy of Family Physicians; Hep B, hepatitis B; HBsAg, hepatitis B surface antigen; HBV, hepatitis B [...]