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Maternal Characteristics and Hospital Policies as Risk Factors for Nonreceipt of Hepatitis B Vaccine in the Newborn Nursery

O'Leary, Sean T. MD, MPH*,†,‡; Nelson, Christina MD, MPH; Duran, Julie MPH‡,§

The Pediatric Infectious Disease Journal: January 2012 - Volume 31 - Issue 1 - p 1–4
doi: 10.1097/INF.0b013e3182345995
Original Studies

Background: A birth dose of hepatitis B vaccine (HBV) is a primary focus of the Advisory Committee on Immunization Practices' strategy to eliminate transmission of hepatitis B virus in the United States. We sought to assess the impact of maternal characteristics and hospital policy on the receipt of a birth dose of HBV.

Methods: A retrospective cohort study was performed using data from the 2008 Colorado birth registry. Hospital policy was assessed by state health department personnel. Univariate and multivariate logistic regression analyses were used to examine the association of maternal characteristics and hospital policy with nonreceipt of HBV.

Results: A total of 64,425 infants were identified in the birth cohort, of whom 61.6% received a birth dose of HBV. Higher maternal education and income were associated with nonreceipt of HBV (master's degree vs. eighth grade or less: adjusted odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.49–1.85; >$75,000 vs. <$15,000: adjusted OR = 1.21, 95% CI = 1.13–1.30). Lack of a hospital policy stipulating a universal birth dose strongly predicted nonreceipt of a birth dose of HBV (policy with no birth dose vs. policy with a birth dose: adjusted OR = 2.21, 95% CI = 2.13–2.30).

Conclusions: Maternal characteristics such as higher education and income are associated with nonreceipt of the HBV during the perinatal period. To effectively reduce risk of perinatal hepatitis B transmission, hospitals should stipulate that all infants are offered HBV and ensure that these policies are implemented and followed.

From the *Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO; †Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, CO; ‡Disease Control and Environmental Epidemiology Division, Colorado School of Public Health, Denver, CO; and §Colorado Department of Public Health and Environment, Denver, CO.

Accepted for publication August 16, 2011.

Presented (portions of this work) at (1) the Annual Meeting of the Infectious Diseases Society of America; October 20–24, 2011; Vancouver, British Columbia; (2) the National Immunization Conference; March 28–31, 2011; Washington, DC; and (3) the Pediatric Academic Societies Annual Meeting; April 30–May 3, 2011; Denver, CO.

Dr. O'Leary was supported by Grant No. T32HP10006, Institutional National Research Service Award for Research Training in Primary Medical Care, United States Department of Health and Human Services, from the Health Resources Services Administration (HRSA). Dr. Nelson was supported by Grant No. D33HP02610 for Preventive Medicine Residencies, from the Health Resources and Services Administration (HRSA). The authors have no other funding or conflicts of interest to disclose.

The contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA.

Address for correspondence: Sean T. O'Leary, MD, MPH, Department of Pediatrics, University of Colorado, Mail Stop F443, 13199 E Montview Blvd, Ste 300, Aurora, CO 80045. Email: sean.o'leary@childrenscolorado.org.

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© 2012 Lippincott Williams & Wilkins, Inc.