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July 1995, Vol 149, No. 7 >
Article | July 1995

California Pediatricians' Knowledge of and Response to Recommendations for Universal Infant Hepatitis B Immunization FREE

David L. Wood, MD, MPH; Philip Rosenthal, MD; Debra Scarlata, MS
Arch Pediatr Adolesc Med. 1995;149(7):769-773. doi:10.1001/archpedi.1995.02170200059009.
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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.(Arch Pediatr Adolesc Med. 1995;149:769-773)

REFERENCES

1 +
Alter MJ, Hadler SC, Margolis HS, et al.  The changing epidemiology of hepatitis B in the United States: need for alternative vaccination strategies . JAMA . 1990;;263:1218-1222.
2 +
Szmuness W, Stevens CE, Harley EJ, et al.  Hepatitis B vaccine: demonstration of efficacy in a controlled clinical trial in a high-risk population in the United States . N Engl J Med . 1980;;303:833-841.
3 +
Margolis HS, Alter MJ, Hadler SC.  Hepatitis B: evolving epidemiology and implications for control . Semin Liver Dis . 1991;;11:34-92.
4 +
Immunization Practices Advisory Committee (ACIP).  Protection against viral hepatitis . MMWR Morb Mortal Wkly Rep . 1990;;39:1-26.
5 +
Committee on Infectious Diseases.  Universal hepatitis B immunization . Pediatrics . 1992;;89:795-800.
6 +
Immunization Practices Advisory Committee (ACIP).  Hepatitis B: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination . MMWR Morb Mortal Wkly Rep . 1991;;40:1-25.
7 +
Clay LS.  Universal hepatitis B immunization: a policy challenge . J Nurse Midwifery . 1993;;38:129-131.
8 +
Ganiats TG, Bowersox MT, Ralph LP.  Universal neonatal hepatitis B immunization—are we jumping on the bandwagon too early? J Fam Pract . 1993;;36:147-149.
9 +
Hall CB, Halsey NA.  Control of hepatitis B . Pediatrics . 1992;;90:274-277.
10 +
Dickinson CJ, Olson B.  Hepatitis B vaccine: should we give it a shot? Hepatology . 1993;;18:458-460.
11 +
American Academy of Pediatrics. 1993 Fellowship Directory . Elk Grove Village, Ill: American Academy of Pediatrics; 1992;.
12 +
SAS User's Guide: Basics, Version 5 Edition . Cary, NC: SAS Institute Inc; 1985;.
13 +
Freed GL, Bordley WC, Clark SJ, Konrad TR.  Universal hepatitis B immunization of infants: reactions of pediatricians and family physicians over time . Pediatrics . 1994;;93:747-751.
14 +
Sun Z, Zhu Y, Stjernsward J, et al.  Design and compliance of HBV vaccination trial on newborns to prevent hepatocellular carcinoma and 5-year results of its pilot study . Cancer Detect Prev . 1991;;14:313-318.
15 +
Tabor E, Cairns J, Gerety RJ, Bayley AC.  Nine-year follow-up study of plasma-derived hepatitis B vaccine in rural African setting . J Med Virol . 1993;;40:204-209.
16 +
Stevens CE, Toy PT, Taylor PE, Lee T, Yip HY.  Prospects for control of hepatitis B virus infections . Pediatrics . 1992;;90:170-173.
17 +
Lo K-W, Lee SD, Tsai Y-T, Chan CY, Chen GH, Yeh CL.  Long-term immunogenicity and efficacy of hepatitis B vaccine in infants born to HBeAg-positive HBsAg-carrier mothers . Hepatology . 1988;;8:1647-1650.
18 +
Hadler SC, Francis DP, Maynard JE, et al.  Long-term immunogenicity and efficacy of hepatitis B vaccine in homosexual men . N Engl J Med . 1986;:315: 209-214.
19 +
Wainwright RB, McMahon BJ, Bulkow LR, Parkinson AJ, Harpster AP.  Protection provided by hepatitis B vaccine in a Yupik Eskimo population . Arch Intern Med . 1991;;151:1634-1636.
20 +
California Senate Bill SB 371, 1992; Calif Stat, ch 1134, §3; Ins Code, §10123.5.
21 +
Coser RL.  Authority and decision making in a hospital: a comparative analysis . Am Sociol Rev . 1958;;23:56-64.
22 +
West DJ, Calandra GB, Hesley TM, Foli V, Miller WJ.  Control of hepatitis B through routine immunization of infants: the need for flexible schedules and new combination vaccine formulations . Vaccine . 1993;;11( (suppl) ):S21-S27.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Alter MJ, Hadler SC, Margolis HS, et al.  The changing epidemiology of hepatitis B in the United States: need for alternative vaccination strategies . JAMA . 1990;;263:1218-1222.
2 +
Szmuness W, Stevens CE, Harley EJ, et al.  Hepatitis B vaccine: demonstration of efficacy in a controlled clinical trial in a high-risk population in the United States . N Engl J Med . 1980;;303:833-841.
3 +
Margolis HS, Alter MJ, Hadler SC.  Hepatitis B: evolving epidemiology and implications for control . Semin Liver Dis . 1991;;11:34-92.
4 +
Immunization Practices Advisory Committee (ACIP).  Protection against viral hepatitis . MMWR Morb Mortal Wkly Rep . 1990;;39:1-26.
5 +
Committee on Infectious Diseases.  Universal hepatitis B immunization . Pediatrics . 1992;;89:795-800.
6 +
Immunization Practices Advisory Committee (ACIP).  Hepatitis B: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination . MMWR Morb Mortal Wkly Rep . 1991;;40:1-25.
7 +
Clay LS.  Universal hepatitis B immunization: a policy challenge . J Nurse Midwifery . 1993;;38:129-131.
8 +
Ganiats TG, Bowersox MT, Ralph LP.  Universal neonatal hepatitis B immunization—are we jumping on the bandwagon too early? J Fam Pract . 1993;;36:147-149.
9 +
Hall CB, Halsey NA.  Control of hepatitis B . Pediatrics . 1992;;90:274-277.
10 +
Dickinson CJ, Olson B.  Hepatitis B vaccine: should we give it a shot? Hepatology . 1993;;18:458-460.
11 +
American Academy of Pediatrics. 1993 Fellowship Directory . Elk Grove Village, Ill: American Academy of Pediatrics; 1992;.
12 +
SAS User's Guide: Basics, Version 5 Edition . Cary, NC: SAS Institute Inc; 1985;.
13 +
Freed GL, Bordley WC, Clark SJ, Konrad TR.  Universal hepatitis B immunization of infants: reactions of pediatricians and family physicians over time . Pediatrics . 1994;;93:747-751.
14 +
Sun Z, Zhu Y, Stjernsward J, et al.  Design and compliance of HBV vaccination trial on newborns to prevent hepatocellular carcinoma and 5-year results of its pilot study . Cancer Detect Prev . 1991;;14:313-318.
15 +
Tabor E, Cairns J, Gerety RJ, Bayley AC.  Nine-year follow-up study of plasma-derived hepatitis B vaccine in rural African setting . J Med Virol . 1993;;40:204-209.
16 +
Stevens CE, Toy PT, Taylor PE, Lee T, Yip HY.  Prospects for control of hepatitis B virus infections . Pediatrics . 1992;;90:170-173.
17 +
Lo K-W, Lee SD, Tsai Y-T, Chan CY, Chen GH, Yeh CL.  Long-term immunogenicity and efficacy of hepatitis B vaccine in infants born to HBeAg-positive HBsAg-carrier mothers . Hepatology . 1988;;8:1647-1650.
18 +
Hadler SC, Francis DP, Maynard JE, et al.  Long-term immunogenicity and efficacy of hepatitis B vaccine in homosexual men . N Engl J Med . 1986;:315: 209-214.
19 +
Wainwright RB, McMahon BJ, Bulkow LR, Parkinson AJ, Harpster AP.  Protection provided by hepatitis B vaccine in a Yupik Eskimo population . Arch Intern Med . 1991;;151:1634-1636.
20 +
California Senate Bill SB 371, 1992; Calif Stat, ch 1134, §3; Ins Code, §10123.5.
21 +
Coser RL.  Authority and decision making in a hospital: a comparative analysis . Am Sociol Rev . 1958;;23:56-64.
22 +
West DJ, Calandra GB, Hesley TM, Foli V, Miller WJ.  Control of hepatitis B through routine immunization of infants: the need for flexible schedules and new combination vaccine formulations . Vaccine . 1993;;11( (suppl) ):S21-S27.

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