Adherence to hepatitis B birth dose vaccine recommendations in two hospital systems in Houston

Timely hepatitis B virus (HBV) birth dose vaccination is critical to prevent vertical transmission, particularly when maternal hepatitis B surface antigen (HBsAg) status is positive or unknown. Although universal HBV vaccination has reduced pediatric infections, gaps in maternal screening and variation in adherence to national guidelines for vaccine timing based on maternal HBsAg status persist. We evaluated adherence to national guidelines across maternal risk groups at two hospital systems (HS) and the impact of institutional workflows on timely vaccination.

We conducted a retrospective cohort study of infants ≥2000 g born from 2019 to 2021 at a quaternary hospital system (HS1) and a county hospital system (HS2) to evaluate adherence to national guidelines. Infants were stratified by maternal HBsAg status (positive, unknown, negative). System protocols and workflows were compared.

In a cohort of 32,952 infants, HS2 had higher adherence to guidelines across maternal risk groups compared to HS1: HBsAg-positive 95.4% vs. 87.1% (p = 0.19), unknown 90.8% vs. 17.3% (p < 0.001), and negative 96.9% vs. 71.2% (p < 0.001). Despite lower HBsAg rescreening at delivery, HS2 maintained high birth dose vaccination of infants in the unknown group. Infants requiring neonatal intensive care were overrepresented among those with delayed or missed prophylaxis. Workflow differences included breadth of standing delegated orders (SDOs), nurse-led protocols, and hospital location of vaccine storage and administration. Comprehensive SDOs and delivery room administration were associated with timely prophylaxis, particularly among at-risk infants.

Adherence to national HBV birth dose recommendations varied between two large HS; this variation may be associated institutional workflow differences.