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Hepatitis B Vaccination Practices in Hospital Newborn Nurseries Before and After Changes in Vaccination Recommendations
Sarah J. Clark, MPH;
Michael D. Cabana, MD, MPH;
Tasneem Malik, MPH;
Hussain Yusuf, MBBS, MPH;
Gary L. Freed, MD, MPH
Arch Pediatr Adolesc Med. 2001;155:915-920.
Background Routine use of hepatitis B vaccine for low-risk newborns was suspended
on July 7, 1999, because of concern about the potential risk of thimerosal,
a mercury-containing vaccine preservative. Reinstatement of the birth dose
was recommended when a thimerosal-free vaccine became available.
Objective To explore changes in hepatitis B vaccination practices for newborns
related to the revised recommendations for low-risk infants (in this study,
the terms newborn and infant
are used interchangeably).
Design A telephone survey of a random sample of 1000 US hospitals.
Participants Nurse managers, nursery directors, and staff nurses of the newborn nurseries.
Main Outcome Measures Nursery vaccination practices before and after July 7, 1999, and the
availability and use of thimerosal-free vaccine.
Results Interviews were conducted with 773 (87%) of 886 eligible hospitals.
Before July 7, 1999, 78% of the hospitals reported vaccination practices that
were consistent with recommendations at that time, although only 47% vaccinated
all low-risk infants at birth. After July 7, 1999, almost all hospitals discontinued
vaccination of low-risk infants, in accordance with the recommendation change;
however, there was a 6-fold increase in the number of hospitals that were
not vaccinating all high-risk infants. After the introduction of thimerosal-free
vaccine, only 39% of the hospitals reported vaccinating all low-risk infants.
Conclusions Most hospital nurseries altered their newborn hepatitis B vaccination
practices consistent with changes in national recommendations. However, unintended
consequences included the failure of some hospitals to continue vaccinating
all high-risk infants and the delay in reintroducing vaccination for low-risk
newborns after the introduction of a thimerosal-free vaccine. Assessments
of the appropriateness of this country's response to the threat of thimerosal
in vaccines should consider these findings.
From the Child Health Evaluation and Research Unit, Division of General
Pediatrics, University of Michigan, Ann Arbor (Ms Clark and Drs Cabana and
Freed); and the National Immunization Program, Centers for Disease Control
and Prevention, Atlanta, Ga (Ms Malik and Dr Yusuf).
Corresponding author and reprints: Sarah J. Clark, MPH, Division
of General Pediatrics, University of Michigan, 300 N Ingalls Bldg, Room NI6E06,
Ann Arbor, MI 48109-0456 (e-mail: saclark{at}med.umich.edu).
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