California pediatricians' knowledge of and response to recommendations for universal infant hepatitis B immunization
D. L. Wood, P. Rosenthal and D. Scarlata
Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, Calif., USA.
OBJECTIVE: To assess California pediatricians' level of agreement with and
implementation of universal infant hepatitis B immunization. RESEARCH
DESIGN: Mailed questionnaire in the summer and fall of 1993 to a random
sample of 1030 California pediatricians to determine whether they
universally immunize infants with hepatitis B vaccine. The response rate
was 71%. RESULTS: More than 81% said they universally immunize infants
against hepatitis B infection; however, 18.3% stated that they do not.
Pediatricians were more likely to immunize infants universally against
hepatitis B if they (1) agreed with the recommendations (90% vs 54%, P <
.01), (2) practiced in a health maintenance organization setting vs private
group practice (92% vs 79%, P < .05), or (3) practiced in settings with
predominantly low-income patients (89% vs 78%, P = .01). Pediatricians who
universally immunize infants against hepatitis B virus were in practice an
average of 1.7 years longer than those who do not (13.3 years vs 11.6
years, P = .01). In multivariate analyses, the most powerful predictor of
universal immunization was agreement with the recommendations. Among those
who disagreed with the recommendations, the most common reasons for
disagreement included the following: (1) the long-term efficacy of
hepatitis B vaccine is not proved--54%; (2) an additional immunization
would make the visits too costly--53%; and (3) three shots would be too
much at one visit--53%. CONCLUSIONS: A majority (81.6%) of our sample of
California pediatricians universally immunize infants against hepatitis B;
however, a significant minority (18.4%) do not agree with the
recommendations and do not plan to implement them. Many of their objections
are being addressed through combination vaccine development and ongoing
research; however, alternative policies and additional research should also
be considered.
