Regional differences in infant immunization against hepatitis B: Did intervention work?

Objective. The impact of a community intervention to establish hospital nur sery policies for universal newborn immunization against hepatitis B was de termined by comparing primary care physician immunization practices in two counties, one intervention and one control. Methods. Surveys were mailed to 855 physicians in 1994; 322 of 533 responde nts were eligible, with 155 from San Francisco (SF), the intervention count y, and 167 from Sacramento (SAC), the control county. Adoption of universal hepatitis B immunization was defined as immunizing more than 90% of infant s seen in 1993. Results. Although similar proportions of physicians agreed, 79% in SF and 7 2% in SAG, 64% of SF physicians and 40% of SAC physicians adopted universal infant immunization (P < 0.0001). Universal immunization was greater for p ediatricians than for family physicians (OR = 2.00, 95% CI 1.66-2.41) but l ess for physicians who perceived their patient population to be at low risk for hepatitis B compared to those who did not (OR = 0.60, 95% CI 0.45-0.79 ). While 94% of physicians in both counties indicated their willingness to provide the second and third doses of the hepatitis B vaccine if the first dose had been administered in the newborn nursery, 64% of SF in contrast to 30% of SAC physicians reported routine nursery administration of the vacci ne (P < 0.0001). Conclusions. Primary care physician adoption of universal hepatitis B infan t immunization and routine nursery administration of the first dose of the vaccine were both greater in San Francisco than in Sacramento, suggesting i mpact of a community intervention to increase hepatitis B immunization rate s. (C) 1999 American Health Foundation and Academic Press.