In 1991, the Advisory Committee on Immunization Practices recommended
universal vaccination of infants against hepatitis B virus (HBV), with series
initiation within days of birth.
To determine HBV vaccine coverage in a low-income urban population and
to examine whether HBV immunization within the first month of life affects
subsequent vaccine receipt.
Cohort study based on immunization records collected in the Pediatric
Large public housing development in Chicago, Ill.
All 1143 children who were born between 1991 and 1997 and enrolled between
1993 and mid-1998, with follow-up to age 35 months.
Main Outcome Measures
On-time vaccine receipt of HBV vaccine doses, diphtheria-tetanus-pertussis
vaccine (DTP) dose 1, and the 4:3:1 series (4 doses of DTP vaccine, 3 doses
of poliomyelitis vaccine, and 1 dose of measles-containing vaccine), analyzed
On-time HBV vaccination increased quickly following new guidelines and
reached a plateau of about 50% coverage for those born in or after 1995. Since
1994, more children (64%) received the first HBV vaccine dose on time than
any other vaccine. Children who received a dose of HBV vaccine during their
first month of life were more likely to receive the first DTP vaccine dose
on time (60.1%) than those who did not get an HBV vaccine dose during the
first month (36.4%; χ2 = 53.7; P<.001).
Children who received the first HBV vaccine dose during their first month
were more likely than those receiving it at age 1 to 2 months to complete
3 HBV doses by 19 months (70.6% vs 51.1%; χ2 = 11.6; P = .001) and to complete the 4:3:1 series by age 19 months
(49.8% vs 37.9%; χ2 = 4.0; P = .05).
In this inner-city population, HBV vaccine has been received at rates
similar to those of other vaccines within 3 years of issuance of new recommendations.
Of note, immunization with HBV vaccine at birth was associated with timely
receipt of other vaccines and, therefore, may have the potential to increase
vaccination among groups less likely to be up-to-date on early childhood vaccines.