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Attitudes, practices, and preferences of pediatricians regarding initiation of hepatitis B immunization at birth
A Cooper1, H Yusuf, L Rodewald
1National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Insights
Pediatricians
Area of Science:
- Pediatrics
- Immunology
- Public Health
Background:
- Hepatitis B vaccine is crucial for preventing perinatal transmission.
- Current guidelines recommend the first dose at birth for all infants.
- Pediatrician practices and attitudes towards the birth dose vary.
Purpose of the Study:
- To explore pediatrician practices and attitudes regarding the hepatitis B vaccine birth dose.
- To identify factors influencing the timing of the first hepatitis B vaccine dose (birth vs. 1-2 months).
Main Methods:
- A mail survey was sent to a random sample of 600 pediatricians from the American Academy of Pediatrics membership database.
- 380 pediatricians (68% response rate) responded, with 279 providing routine immunizations.
Main Results:
- 50% of surveyed pediatricians offered the hepatitis B vaccine birth dose to all infants.
- Factors associated with offering the birth dose included inner-city practice, affiliation with a medical school/government hospital, and state universal immunization policies.
- Barriers included vaccine tracking difficulty (39%), increased cost (27%), and lack of insurance reimbursement (26%).
- 38% of pediatricians who currently give the birth dose would prefer to delay it if a combination vaccine becomes available.
Conclusions:
- High implementation of the hepatitis B birth dose may decrease with the advent of combination vaccines.
- Universal prenatal screening for hepatitis B surface antigen and immunoprophylaxis for high-risk newborns are essential.
- Future programmatic efforts need to address potential shifts in vaccination timing.
Objectives:
To explore practices and attitudes of pediatricians toward administration of the first dose of hepatitis B vaccine to infants, and to identify factors influencing the decision of pediatricians to initiate immunization at birth versus at 1 to 2 months of age.
Methods:
A random sample of 600 pediatricians obtained from the American Academy of Pediatrics membership database was surveyed by mail.
Results:
Three hundred eighty (68%) of the 563 pediatricians who were located responded to the survey. Of these 380 pediatricians, 279 provided routine immunizations to children. Of the 270 pediatricians who vaccinated children with hepatitis B vaccine and indicated their practice regarding the birth dose, 50% offered the first dose of hepatitis B vaccine at birth to all infants; the rest either offered the vaccine at birth only to infants of hepatitis B surface antigen-positive mothers and mothers whose serostatus is unknown, or did not offer the birth dose to any infants at all. Practicing in the inner city, working for a medical school or government hospital, and living in a state with universal immunization supply policies were associated with the respondent giving the birth dose. The strongest perceived barriers to giving the birth dose in the hospital were the difficulty tracking these vaccines (39%), the increased cost (27%), and the lack of reimbursement from insurance companies (26%). If a combination vaccine that includes hepatitis B; diphtheria, tetanus, pertussis (diphtheria and tetanus toxoids and acellular pertussis vaccine); and polio (inactivated poliovirus vaccine) antigens become available in the near future, then 38% of physicians who currently give the birth dose to all infants would prefer to wait until 2 months of age to initiate hepatitis B immunization.
Conclusions:
Efforts to achieve high implementation of hepatitis B birth dose administration may falter once a hepatitis B-containing pentavalent combination vaccine becomes available. Programmatic efforts should ensure prevention of perinatal hepatitis B virus transmission through universal prenatal hepatitis B surface antigen screening and immunoprophylaxis of high-risk newborn infants.
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