Hepatitis B vaccination among children in inner-city public housing, 1991-1997

Context In 1991, the Advisory Committee on Immunization Practices recommend ed universal vaccination of infants against hepatitis B virus (HBV), with s eries initiation within days of birth. Objective To determine HBV vaccine coverage in a low-income urban populatio n and to examine whether HBV immunization within the first month of life af fects subsequent vaccine receipt. Design Cohort study based on immunization records collected in the Pediatri c Immunization Program. Setting Large public housing development in Chicago, ill. Participants All 1143 children who were born between 1991 and 1997 and enro lled between 1993 and mid-1998, with follow-up to age 35 months. Main Outcome Measures On-time vaccine receipt of HBV vaccine doses, diphthe ria-tetanus-pertussis vaccine (DTP) dose 1, and the 4:3:1 series (4 doses o f DTP vaccine, 3 doses of poliomyelitis vaccine, and 1 dose of measles-cont aining vaccine), analyzed by year. Results On-time HBV vaccination increased quickly following new guidelines and reached a plateau of about 50% coverage for those born in or after 1995 , Since 1994, more children (64%) received the first HBV vaccine dose on ti me than any other vaccine. Children who received a dose of HBV vaccine duri ng their first month of life were more likely to receive the first DTP vacc ine dose on time (60.1%) than those who did not get an HBV vaccine dose dur ing the first month (36.4%; chi(2) = 53.7; P<.001). Children who received t he first HBV vaccine dose during their first month were more likely than th ose receiving it at age 1 to 2 months to complete 3 HBV doses by 19 months (70.6% vs 51.1%; chi(2) = 11.6; P =.001) and to complete the 4:3:1 series b y age 19 months (49.8% vs 37.9%; chi(2) = 4.0; P = .05). Conclusions In this inner-city population, HBV vaccine has been received at rates similar to those of other vaccines within 3 years of issuance of new recommendations. Of note, immunization with HBV vaccine at birth was assoc iated with timely receipt of other vaccines and, therefore, may have the po tential to increase vaccination among groups less likely to be up-to-date o n early childhood vaccines.