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Newborn Hepatitis B Immunization Rates in Primary Care Practices

John G. Bertolino, MD, MSPH
Arch Pediatr Adolesc Med. 1996;150(11):1173-1176. doi:10.1001/archpedi.1996.02170360063010.
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Objectives:  To assess the hepatitis B immunization rate and to identify the reasons for an incomplete immunization series in newborns and infants seen in primary care practices.

Design:  An inception cohort study enrolling newborns and infants and assessing their hepatitis B immunization status at 9 and 18 months of age.

Setting:  Six primary care offices, most in rural environments.

Patients:  All newborns and infants seen at 1 of 6 offices.

Intervention:  Infants born between January 1, 1993, and September 30, 1994, were followed up through June 30, 1995. Hepatitis B immunization status and the reasons for an incomplete status were recorded at each visit.

Main Outcome Measures:  Hepatitis B immunization rates at 9 and 18 months of age, and the reasons for immunization failure.

Results:  The immunization rates of infants aged 9 and 18 months were 60% and 77%, respectively. The most common reasons for inadequate immunization of the 247 infants followed up through age 18 months were patient transfer (7%), failing to return for a scheduled visit (4%), and guardians refusing the immunization (4%). Failure to return for a scheduled visit was the reason for the incomplete immunization in 13% of the 9-month-old infants. Immunization of these patients was the most important factor in the higher immunization rate at 18 months of age. By the age of 18 months, 95% of all infants had received at least 2 doses of the hepatitis B immunization.

Conclusions:  A hepatitis B newborn immunization rate of 77% by age 18 months was achieved in a primary care office setting. Barriers to complete immunization by the age of 18 months include patient transfer, patient failure to return, and parental refusal of immunization.Arch Pediatr Adolesc Med. 1996;150:1173-1176

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