title: Hepatitis B vaccination timing: results from demographic health surveys in 47 countries.
abstract: OBJECTIVE
  To examine the impact of hepatitis B vaccination schedules and types of vaccines on hepatitis B vaccination timing.
  
  
  METHODS
  We used data for 211 643 children from demographic and health surveys in 47 low- and middle-income countries (median study year 2012). Data were from vaccination cards and maternal interviews. We grouped countries according to the vaccination schedule and type of vaccine used (monovalent or combination). For each country, we calculated hepatitis B vaccination coverage and timely receipt of vaccine doses. We used multivariable logistic regression models to study the effect of vaccination schedules and types on vaccination delay.
  
  
  RESULTS
  Substantial delays in vaccination were observed even in countries with fairly high coverage of all doses. Median delay was 1.0 week (interquartile range, IQR: 0.3 to 3.6) for the first dose (n= 108 626 children) and 3.7 weeks (IQR: 1.4 to 9.3) for the third dose (n= 101  542). We observed a tendency of lower odds of delays in vaccination schedules starting at 6 and at 9 weeks of age. For the first vaccine dose, we recorded lower odds of delays for combination vaccines than for monovalent vaccines (adjusted odds ratio, aOR: 0.76, 95% confidence interval, CI: 0.71 to 0.81).
  
  
  CONCLUSIONS
  Wide variations in hepatitis B vaccination coverage and adherence to vaccination schedules across countries underscore the continued need to strengthen national immunization systems. Timely initiation of the vaccination process might lead to timely receipt of successive doses and improved overall coverage. We suggest incorporating vaccination timing as a performance indicator of vaccination programmes to complement coverage metrics.
authors.affiliation: Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, Brunswick 38124, Germany .
authors.forename: Aparna
authors.initials: A
authors.lastname: Schweitzer
authors.affiliation: Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, Brunswick 38124, Germany .
authors.forename: Manas K
authors.initials: MK
authors.lastname: Akmatov
authors.affiliation: Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, Brunswick 38124, Germany .
authors.forename: Gérard
authors.initials: G
authors.lastname: Krause
mesh_terms: D000367:Age Factors; D003906:Developing Countries / Q000706:statistics & numerical data*; D014943:Global Health; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007115:Immunization Schedule; D012959:Socioeconomic Factors
chemical_list: D017325:Hepatitis B Vaccines