Newborn hepatitis B immunization rates in primary care practices
J. G. Bertolino
Family Practice Residency Program, Latrobe Area Hospital, Pa, USA.
OBJECTIVES: To assess the hepatitis B immunization rate and to identify the
reasons for an incomplete immunization series in newborns and infants seen
in primary care practices. DESIGN: An inception cohort study enrolling
newborns and infants and assessing their hepatitis B immunization status at
9 and 18 months of age. SETTING: Six primary care offices, most in rural
environments. PATIENTS: All newborns and infants seen at 1 of 6 offices.
INTERVENTION: Infants born between January 1, 1993, and September 30, 1994,
were followed up through June 30, 1995. Hepatitis B immunization status and
the reasons for an incomplete status were recorded at each visit. MAIN
OUTCOME MEASURES: Hepatitis B immunization rates at 9 and 18 months of age,
and the reasons for immunization failure. RESULTS: The immunization rates
of infants aged 9 and 18 months were 60% and 77%, respectively. The most
common reasons for inadequate immunization of the 247 infants followed up
through age 18 months were patient transfer (7%), failing to return for a
scheduled visit (4%), and guardians refusing the immunization (4%). Failure
to return for a scheduled visit was the reason for the incomplete
immunization in 13% of the 9-month-old infants. Immunization of these
patients was the most important factor in the higher immunization rate at
18 months of age. By the age of 18 months, 95% of all infants had received
at least 2 doses of the hepatitis B immunization. CONCLUSIONS: A hepatitis
B newborn immunization rate of 77% by age 18 months was achieved in a
primary care office setting. Barriers to complete immunization by the age
of 18 months include patient transfer, patient failure to return, and
parental refusal of immunization.
