Universal hepatitis B immunization.

Abstract

OBJECTIVE: To determine the practices of US nurseries, neonatal intensive care units (NICUs), and pediatricians regarding universal hepatitis B vaccination. DESIGN: Descriptive cross-sectional survey. PARTICIPANTS: One hundred forty term nurseries, 152 NICUs, and 157 pediatricians. Selection procedure. Nurseries and NICUs were systematically sampled from the 1992 American Hospital Association Guide to provide equal sampling from each region of the country. Pediatricians were systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state. RESULTS: The response rates were 95% (n = 133) for term nurseries, 95% (n = 144) for NICUs, and 83% (n = 131) for pediatricians. Sixty-two nurseries (47%) provide routine hepatitis B vaccine (HBV) to their infants. Eighty-five NICUs (59%) routinely vaccinate their preterm infants; 62 (73%) initiate the series just before discharge; and 11 (13%) do so at birth. Principal reasons for not vaccinating include cost and a preference to allow the primary-care physician to initiate the series. One hundred ten (85%) pediatricians provide universal hepatitis B vaccination. Principal reasons for not vaccinating include cost and parents opting against vaccination. CONCLUSIONS: More than half of NICUs provide HBV routinely to their preterm infants, predominantly just before hospital discharge. A minority of NICUs are initiating vaccination at birth, which may provide suboptimal seroconversion. Although less than half of participating term nurseries are routinely vaccinating before discharge, 85% of pediatricians do initiate HBV by two months of age. The principal reasons for not providing vaccine are financial.