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Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis B immunisation service
V F Larcher1, J Bourne, C Aitken
1Department of Queen Elizabeth Children's Services, 3rd Floor, Fielden House, The Royal London Hospital, Whitechapel, London E1 1BB, UK.
Archives of Disease in Childhood
|February 13, 2001
Summary
A hospital-based hepatitis B vaccination program proved effective in diverse inner-city populations. Success depended on robust support services like translation and counseling to overcome barriers such as high mobility and diverse ethnicities.
Area of Science:
- Public Health
- Immunology
- Pediatrics
Background:
- Hepatitis B carriage is prevalent in diverse inner-city areas.
- Effective vaccination strategies are crucial for preventing perinatal transmission.
- Hospital-based programs face challenges including patient mobility and diverse ethnic backgrounds.
Purpose of the Study:
- To evaluate the effectiveness of a hospital-based hepatitis B immunization program.
- To identify barriers to successful vaccination outcomes in a high-risk population.
- To assess the impact of support services on vaccination uptake.
Main Methods:
- Retrospective case note review of 265 infants born to hepatitis B carrier mothers over five years.
- Analysis of vaccination status, serology results, and adherence to schedule.
- Assessment of factors including patient mobility, ethnicity, name changes, and translation needs.
Main Results:
- 91% of infants completed the vaccination course, with 82% having serology.
- Vaccination schedule adherence decreased significantly over time (up to 33% delay).
- High mobility (25%) and name changes (35%) impacted outcomes; resident infants had higher vaccination rates (95% vs. 78%).
- Translation services were required for 85% of families; postnatal counseling and hepatology referrals decreased.
Conclusions:
- A centralized, hospital-based immunization service can be highly effective in inner-city areas with high hepatitis B prevalence.
- Success is contingent upon comprehensive support services, including translation, counseling, and parental referral.
- Dedicated services are more effective than primary care for ensuring vaccination completion in this population.