Fragmentation of health services remains a major barrier to achieving universal childhood vaccination. In a follow-up study to one performed 2 years ago, we1 demonstrate that one solution for achieving higher vaccination rates is accessibility to vaccines for children at the site at which routine health care is performed.
In accordance with the Advisory Committee on Immunization Practices recommendations for universal infant immunization with hepatitis B vaccine,2 Duke University Medical Center (DUMC), Durham, NC, began in February 1993 to offer hepatitis B vaccine to all infants prior to their being discharged from the hospital at birth. The recommendations of the Advisory Committee on Immunization Practices are that doses 2 and 3 of the hepatitis B vaccine be given at 1 to 2 and 6 to 18 months of age, respectively.
During the period of the original study at the DUMC pediatric practice, all children who were recipients of