Impact of recommendations to suspend the birth dose of hepatitis B virus vaccine

Context In July 1999, due to concerns about thimerosal content, the America n Academy of Pediatrics (AAP) and the Public Health Service (PHS) recommend ed suspending hepatitis B virus (HBV) Vaccination at birth except for mothe rs who had positive or unknown hepatitis B surface antigen (HBsAg) status. In September 1999, the Centers for : Disease Control and Prevention recomme nded that hospitals resume HBV vaccination at birth with a new thimerosal-f ree vaccine. Whether the 2 changes in recommendations within 3 months led t o less-than-optimal compliance in hospital nurseries is unknown. Objective To determine hospital HBV vaccination policy before the recommend ation for delay of HBV Vaccination and 1 year later, Design, Setting, and Participants Survey of aff 46 hospitals with obstetric services and neonatal nurseries in Cook County. Illinois. Main Outcome Measures Hepatitis B virus immunization practices before July 1999 and in August 2000; hospital factors associated with routine HBV immun ization and compliance with AAP and PHS recommendations. Results Before July 1999, 74% of surveyed hospital nurseries offered HBV va ccine to all neonates; only 39% did so in August 2000. Being located in the Chicago city-limits (88 % vs 57%, P = .02) and having an academic affiliat ion (93% vs 66%; P = .05) were positively associated with routine neonatal immunization before July 1999. Both academic affiliation and city location were associated with routine immunization in August: 2000 (71% vs 25% [P = .003] and 60% vs 14% [P = .002], respectively) and with:compliance with rec ommendations for suspension (57% vs 25% [P = .03] and 56% vs 10% [P = .001] ). Conclusions We documented a 35% decrease in hospital nurseries that routine ly offered HBV immunization 1 year after the AAP and PHS recommendations we re made. Special efforts may be required to make at-birth administration of HBV vaccination universal.