Impact of recommendations to suspend the birth dose of hepatitis B virus vaccine.
BACKGROUND
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.


METHODS
Survey of all 46 hospitals with obstetric services and neonatal nurseries in Cook County, Illinois.


METHODS
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.
Oram
R J
RJ
University of Chicago, 5841 S Maryland Ave, MC 6054, Chicago, IL 60637, USA. roram@peds.bsd.uchicago.edu
Daum
R S
RS
Seal
J B
JB
Lauderdale
D S
DS
D019983:Guideline Adherence; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007087:Illinois; D007231:Infant, Newborn; D009725:Nurseries, Hospital / Q000592:standards*; D017410:Practice Guidelines as Topic; D011310:Preservatives, Pharmaceutical; D013849:Thimerosal; D014611:Vaccination / Q000592:standards*
D017325:Hepatitis B Vaccines; D011310:Preservatives, Pharmaceutical; D013849:Thimerosal