Attitudes, practices, and preferences of pediatricians regarding initiation of hepatitis B immunization at birth

Objectives. To explore practices and attitudes of pediatricians toward admi nistration of the first dose of hepatitis B vaccine to infants, and to iden tify factors influencing the decision of pediatricians to initiate immuniza tion at birth versus at 1 to 2 months of age. Methods. A random sample of 600 pediatricians obtained from the American Ac ademy of Pediatrics membership database was surveyed by mail. Results. Three hundred eighty (68%) of the 563 pediatricians who were locat ed responded to the survey. Of these 380 pediatricians, 279 provided routin e immunizations to children. Of the 270 pediatricians who vaccinated childr en with hepatitis B vaccine and indicated their practice regarding the birt h dose, 50% offered the first dose of hepatitis B vaccine at birth to all i nfants; the rest either offered the vaccine at birth only to infants of hep atitis B surface antigen-positive mothers and mothers whose serostatus is u nknown, or did not offer the birth dose to any infants at all. Practicing i n the inner city, working for a medical school or government hospital, and living in a state with universal immunization supply policies were associat ed with the respondent giving the birth dose. The strongest perceived barri ers to giving the birth dose in the hospital were the difficulty tracking t hese vaccines (39%), the increased cost (27%), and the lack of reimbursemen t from insurance companies (26%). If a combination vaccine that includes he patitis B; diphtheria, tetanus, pertussis (diphtheria and tetanus toxoids a nd acellular pertussis vaccine); and polio (inactivated poliovirus vaccine) antigens become available in the near future, then 38% of physicians who c urrently give the birth dose to all infants would prefer to wait until 2 mo nths of age to initiate hepatitis B immunization. Conclusions. Efforts to achieve high implementation of hepatitis B birth do se administration may falter once a hepatitis B-containing pentavalent comb ination vaccine becomes available. Programmatic efforts should ensure preve ntion of perinatal hepatitis B virus transmission through universal prenata l hepatitis B surface antigen screening and immunoprophylaxis of high-risk newborn infants.