Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis Bimmunisation service

Aims-To determine the effectiveness of a selective hospital based hepatitis B immunisation programme and the barriers to be overcome in obtaining a su ccessful outcome. Methods-Retrospective case note review of 265 infants born over a five year period to hepatitis B carrier mothers at a university affiliated hospital in Hackney, London. Results-A total of 242 infants (91%) were fully vaccinated; 217 (82%) had s erology; 31 required booster doses. Percentages failing to reach second, th ird vaccinations, and serology on schedule rose exponentially (7%, 18%, 33% respectively). Mobility was high (25%) and significantly affected outcome. A total of 95% Hackney resident babies were fully vaccinated compared with 78% non-residents. Uptake of routine immunisations was higher in Hackney r esidents than non-residents and greater in those who were eligible for hepa titis B vaccine. Name changes occurred in 35%. Translation requirements wer e high (85% for Turkish, Vietnamese, and Asian families). Requirements for specific postnatal counselling of mothers and hepatology referral fell sign ificantly during the course of the study. Only seven of 22 babies born in 1 995 in Tower Hamlets compared with 53 of 58 Hackney babies received a full vaccination course in non-hospital based primary care. Conclusion-In inner city areas with high prevalence of hepatitis B carriage , mobility, and diverse ethnicity, a dedicated centralised immunisation ser vice can be highly effective, provided that adequate support services (tran slation, counselling, and parental referral) are available.