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The Centers for Disease Control and Prevention fund state and local immunization programs to identify infants born to hepatitis B virus (HBV)–infected women for case management. Among infants who become infected with HBV, 90% develop chronic HBV infection and, when chronically infected, have a 25% risk of developing cirrhosis and liver cancer.1 Infants can become infected with HBV in 2 ways: (1) during delivery to an infected woman or (2) from an infected household contact.
Implementing routine hepatitis B vaccination of all newborns before hospital discharge serves as a safety net to eliminate perinatal and early childhood HBV transmission. Studies show that before perinatal HBV-prevention programs were implemented, 61% to 66% chronically HBV-infected children were born to uninfected mothers and were most likely infected by a household member, which underlines the importance of vaccinating all newborns.2 - 3 In addition, medical errors in perinatal HBV prevention (such as transcription errors of maternal HBV results and failure to administer the appropriate prophylaxis at birth to newborns) have been identified.4 Although the administration of both the hepatitis B vaccine and hepatitis B immune globulin is recommended for infants born to HBV-infected mothers, the hepatitis B vaccine given alone at birth is 70% to 95% effective in preventing HBV transmission.1
All delivery hospitals may obtain hepatitis B vaccine for newborns who are eligible for the federal Vaccines for Children Program (VFC) at no cost. In the hospital setting, this includes children who are eligible for Medicaid, uninsured, or American Indian/Alaskan Natives. Some immunization programs use local, state, or other federal funds to provide hepatitis B vaccine for newborns who are not eligible for VFC, regardless of insurance status. This removes logistical challenges for delivery hospitals, such as maintaining both public and private stocks of hepatitis B vaccine.
We examined the relationship between newborn hepatitis B vaccination rates and having a health department policy to provide the newborn hepatitis B vaccine dose to both infants who were and were not eligible for VFC (universal policy). In the fall of 2003, the Centers for Disease Control and Prevention surveyed the 56 federally funded immunization city and state grantees regarding 2002 hepatitis B vaccine supply policies for delivery hospitals. The survey response rate was 96%. Newborn hepatitis B vaccination coverage rates for infants born in 2002 were obtained from the National Immunization Survey.5 However, data were only available for 53 of the 54 respondents. Newborn hepatitis B vaccination coverage rates, defined herein as hepatitis B vaccine administered within 2 days of life, for infants born in 2002 in jurisdictions with universal policies and jurisdictions without such policies were compared. Medians were compared using the Wilcoxon rank-sum test.
Twenty-eight of 53 programs (53%) reported having a universal policy to provide hepatitis B vaccines to delivery hospitals for a newborn dose to all infants. For programs with universal newborn hepatitis B vaccine policies, the median newborn coverage rate was 65.2% (range, 21.4%-83.3%). In programs without such policies, the median newborn coverage rate was 43.3% (range, 9.9%-65.4%; P < .05).
This finding suggests that provision of the hepatitis B vaccine to delivery hospitals for all newborns increases coverage rates significantly. Limitations to this analysis include the possibility that there may be other characteristics of programs with universal policies that may affect newborn hepatitis B vaccination coverage.
Newborn hepatitis B vaccination has not achieved the high level of coverage needed to provide optimum protection. Only 50% of 3-day-old newborns were immunized against hepatitis B in 2003-2005.6 Because routine administration of hepatitis B vaccine to all newborns before hospital discharge is the cornerstone of the national strategy to eliminate HBV transmission, more work is needed to achieve higher coverage. Vaccine supply may be a useful tool to improve newborn hepatitis B vaccination rates.
Correspondence: Ms Jacques-Carroll, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E52, Atlanta, GA 30333 (crv1@cdc.gov).
Author Contributions:Study concept and design: Malik. Acquisition of data: David. Analysis and interpretation of data: Jacques-Carroll, Wang, Zhao, and David. Drafting of the manuscript: Jacques-Carroll and Wang. Critical revision of the manuscript for important intellectual content: Jacques-Carroll, Wang, Zhao, Malik, and David. Statistical analysis: Zhao. Administrative, technical, and material support: Jacques-Carroll, Malik, and David. Study supervision: Jacques-Carroll and Wang.
Financial Disclosure: None reported.
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
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