Compliance with hepatitis B virus vaccination in a high-risk population

To quantify cultural barriers to hepatitis B virus (HBV) vaccination and parental compliance with a specific vaccination protocol among a primarily among population of infants born at a community hospital.

This study was concurrent with an immunogenicity study of two vaccination schedules and occurred prior to the inception of universal infant vaccination with hepatitis B vaccine (HepB). In this study, parental pairs were interviewed, consent obtained, subjects were randomly assigned to each group, and first immunization was administered in the hospital. Follow-up contacts required for completion were documented.

Of 260 eligible parental pairs interviewed, 175 (67%) declined participation, mainly because of fears of vaccine side effects (55%) or ignorance of the hepatitis B virus (HBV) (30%). Of 85 infants enrolled in the study, 28 (33%) were later withdrawn from the study; 13 (46%) of these 28 infants were withdrawn at the request of parents. Each infant who completed the study received 5 postcards, 10 phone calls, and 3 home visits.

Families were unaware of the risk of HBV infection and feared vaccination. Aversion to subjecting an infant to pain was a principal reason for failure to complete the study, and frequent contacts were required to ensure adherence. Existence of a safe and effective hepatitis B vaccine and universal vaccination is unlikely to change deeply felt attitudes against vaccination. Current vaccination strategies must take these prejudices into account.