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California pediatricians' knowledge of and response to recommendations for universal infant hepatitis B immunization
D L Wood1, P Rosenthal, D Scarlata
1Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, Calif., USA.
Insights
Most California pediatricians (81.6%) provide universal infant hepatitis B immunization. However, 18.4% do not, citing concerns about vaccine efficacy and visit costs.
Area of Science:
- Pediatric Medicine
- Immunization Practices
- Public Health
Background:
- The hepatitis B vaccine is recommended for all infants.
- Understanding pediatrician adoption of universal infant immunization is crucial for public health.
Purpose of the Study:
- To assess California pediatricians' agreement with and implementation of universal infant hepatitis B immunization.
Main Methods:
- A 1993 mailed questionnaire surveyed 1030 California pediatricians.
- The survey assessed universal immunization practices and agreement with recommendations.
Main Results:
- 81.6% of pediatricians reported universal infant hepatitis B immunization.
- Agreement with recommendations, practice setting (HMO), and patient demographics influenced immunization rates.
- Concerns included unproven long-term efficacy, visit costs, and multiple shots per visit.
Conclusions:
- A majority of California pediatricians support universal infant hepatitis B immunization.
- A significant minority express concerns that need addressing through policy and research.
- Combination vaccines and further research may overcome barriers to universal immunization.
Objective:
To assess California pediatricians' level of agreement with and implementation of universal infant hepatitis B immunization.
Research Design:
Mailed questionnaire in the summer and fall of 1993 to a random sample of 1030 California pediatricians to determine whether they universally immunize infants with hepatitis B vaccine. The response rate was 71%.
Results:
More than 81% said they universally immunize infants against hepatitis B infection; however, 18.3% stated that they do not. Pediatricians were more likely to immunize infants universally against hepatitis B if they (1) agreed with the recommendations (90% vs 54%, P < .01), (2) practiced in a health maintenance organization setting vs private group practice (92% vs 79%, P < .05), or (3) practiced in settings with predominantly low-income patients (89% vs 78%, P = .01). Pediatricians who universally immunize infants against hepatitis B virus were in practice an average of 1.7 years longer than those who do not (13.3 years vs 11.6 years, P = .01). In multivariate analyses, the most powerful predictor of universal immunization was agreement with the recommendations. Among those who disagreed with the recommendations, the most common reasons for disagreement included the following: (1) the long-term efficacy of hepatitis B vaccine is not proved--54%; (2) an additional immunization would make the visits too costly--53%; and (3) three shots would be too much at one visit--53%.
Conclusions:
A majority (81.6%) of our sample of California pediatricians universally immunize infants against hepatitis B; however, a significant minority (18.4%) do not agree with the recommendations and do not plan to implement them. Many of their objections are being addressed through combination vaccine development and ongoing research; however, alternative policies and additional research should also be considered.