title: Hepatitis B vaccination among adolescents in 3 large health maintenance organizations.
abstract: OBJECTIVE
  In 1995, the Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis B (HB) vaccination of all unvaccinated 11- to 12-year-old adolescents. Little is known about the implementation of these recommendations in a managed care setting. The objective of this study was to determine the impact of ACIP recommendations on HB vaccination among adolescents in 3 managed care settings.
  
  
  METHODS
  We assessed HB vaccination coverage among adolescents who were enrolled in 3 large health maintenance organizations (HMOs) and who turned 13 years old after the 1995 ACIP recommendations. Children who were 8 to 10 years of age during May 1993 and were continuously enrolled through December 1998 were eligible. We used the HMOs' computerized immunization tracking system to collect HB vaccination dates. The percentage of adolescents who received 3 doses of HB vaccine was determined.
  
  
  RESULTS
  In HMOs A, B, and C, coverage levels for 3 doses of HB vaccine were 43.4%, 65.5%, and 25.7%, respectively, among 13-year-olds in 1998 compared with 26.1%, 50.4%, and 5.5% among 13-year-olds in 1996. Between the ages of 11 and 13 years, coverage rates among adolescents aged 13 in 1998 rose more than the coverage among adolescents aged 13 in 1996. The proportion of 13-year-olds in 1998 who received the first dose of HB vaccine by December 1998 was much higher at 89.6%, 65.2%, and 56.6% in HMOs A, B, and C, respectively, compared with the proportion who completed the 3-dose series (43.4%, 65.5%, and 25.7%, respectively).
  
  
  CONCLUSIONS
  After the 1995 ACIP recommendations, HB vaccination coverage levels among 13-year-olds increased in each of the HMOs, suggesting adherence with national recommendations. Differences among the 3 HMOs may reflect differences in internal policies. More effective strategies may be needed to achieve the Healthy People 2010 goal of 90% vaccination coverage rates among adolescents.
authors.affiliation: Epidemiology Program Office, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Idalia M
authors.initials: IM
authors.lastname: González
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Averhoff
authors.forename: Mehran S
authors.initials: MS
authors.lastname: Massoudi
authors.forename: Hussain
authors.initials: H
authors.lastname: Yusuf
authors.forename: Frank
authors.initials: F
authors.lastname: DeStefano
authors.forename: Piotr
authors.initials: P
authors.lastname: Kramarz
authors.forename: Julie E
authors.initials: JE
authors.lastname: Maher
authors.forename: John P
authors.initials: JP
authors.lastname: Mullooly
authors.forename: Colleen
authors.initials: C
authors.lastname: Chun
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davis
authors.forename: Steven B
authors.initials: SB
authors.lastname: Black
authors.forename: Henry R
authors.initials: HR
authors.lastname: Shinefield
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data / Q000639:trends; D007115:Immunization Schedule; D008297:Male; D012737:Sex Factors; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data* / Q000639:trends
chemical_list: D017325:Hepatitis B Vaccines