title: Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis B immunisation service.
abstract: OBJECTIVE
  To determine the effectiveness of a selective hospital based hepatitis B immunisation programme and the barriers to be overcome in obtaining a successful outcome.
  
  
  METHODS
  Retrospective case note review of 265 infants born over a five year period to hepatitis B carrier mothers at a university affiliated hospital in Hackney, London.
  
  
  RESULTS
  A total of 242 infants (91%) were fully vaccinated; 217 (82%) had serology; 31 required booster doses. Percentages failing to reach second, third vaccinations, and serology on schedule rose exponentially (7%, 18%, 33% respectively). Mobility was high (25%) and significantly affected outcome. A total of 95% Hackney resident babies were fully vaccinated compared with 78% non-residents. Uptake of routine immunisations was higher in Hackney residents than non-residents and greater in those who were eligible for hepatitis B vaccine. Name changes occurred in 35%. Translation requirements were high (85% for Turkish, Vietnamese, and Asian families). Requirements for specific postnatal counselling of mothers and hepatology referral fell significantly during the course of the study. Only seven of 22 babies born in 1995 in Tower Hamlets compared with 53 of 58 Hackney babies received a full vaccination course in non-hospital based primary care.
  
  
  CONCLUSIONS
  In inner city areas with high prevalence of hepatitis B carriage, mobility, and diverse ethnicity, a dedicated centralised immunisation service can be highly effective, provided that adequate support services (translation, counselling, and parental referral) are available.
authors.affiliation: Department of Queen Elizabeth Children's Services, 3rd Floor, Fielden House, The Royal London Hospital, Whitechapel, London E1 1BB, UK.
authors.forename: V F
authors.initials: VF
authors.lastname: Larcher
authors.forename: J
authors.initials: J
authors.lastname: Bourne
authors.forename: C
authors.initials: C
authors.lastname: Aitken
authors.forename: D
authors.initials: D
authors.lastname: Jeffries
authors.forename: D
authors.initials: D
authors.lastname: Hodes
mesh_terms: D000349:Africa / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D017691:Caribbean Region / Q000208:ethnology; D002681:China / Q000208:ethnology; D003144:Communication Barriers; D005260:Female; D006509:Hepatitis B / Q000208:ethnology / Q000517:prevention & control* / Q000635:transmission; D006784:Hospitals, Teaching; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D007194:India / Q000208:ethnology; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008131:London; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011247:Pregnancy; D012189:Retrospective Studies; D014421:Turkey / Q000208:ethnology