Regional differences in infant immunization against hepatitis B: did intervention work?
OBJECTIVE
The impact of a community intervention to establish hospital nursery policies for universal newborn immunization against hepatitis B was determined by comparing primary care physician immunization practices in two counties, one intervention and one control.


METHODS
Surveys were mailed to 855 physicians in 1994; 322 of 533 respondents were eligible, with 155 from San Francisco (SF), the intervention county, and 167 from Sacramento (SAC), the control county. Adoption of universal hepatitis B immunization was defined as immunizing more than 90% of infants seen in 1993.


RESULTS
Although similar proportions of physicians agreed, 79% in SF and 72% in SAC, 64% of SF physicians and 40% of SAC physicians adopted universal infant immunization (P < 0.0001). Universal immunization was greater for pediatricians than for family physicians (OR = 2.00, 95% CI 1.66-2.41) but less for physicians who perceived their patients population to be at low risk for hepatitis B compared to those who did not (OR = 0.60, 95% CI 0.45-0.79). While 94% of physicians in both counties indicated their willingness to provide the second and third doses of the hepatitis B vaccine if the first dose had been administered in the newborn nursery, 64% of SF in contrast to 30% of SAC physicians reported routine nursery administration of the vaccine (P < 0.0001).


CONCLUSIONS
Primary care physician adoption of universal hepatitis B infant immunization and routine nursery administration of the first dose of the vaccine were both greater in San Francisco than in Sacramento, suggesting impact of a community intervention to increase hepatitis B immunization rates.
Department of Pediatrics, University of California, San Francisco 94143, USA. jtaka@itsa.ucsf.edu
J I
JI
Takayama
J P
JP
Iser
A
A
Gandelman
D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002140:California; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000193:education / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006509:Hepatitis B / Q000517:prevention & control* / Q000523:psychology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007115:Immunization Schedule; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009725:Nurseries, Hospital; D015397:Program Evaluation; D018570:Risk Assessment; D012495:San Francisco; D013223:Statistics as Topic; D014611:Vaccination / Q000523:psychology / Q000706:statistics & numerical data*
D017325:Hepatitis B Vaccines