Context In July 1999, due to concerns about thimerosal content, the American
Academy of Pediatrics (AAP) and the Public Health Service (PHS) recommended
suspending hepatitis B virus (HBV) vaccination at birth except for mothers
who had positive or unknown hepatitis B surface antigen (HBsAg) status. In
September 1999, the Centers for Disease Control and Prevention recommended
that hospitals resume HBV vaccination at birth with a new thimerosal-free
vaccine. Whether the 2 changes in recommendations within 3 months led to less-than-optimal
compliance in hospital nurseries is unknown.
Objective To determine hospital HBV vaccination policy before the recommendation
for delay of HBV vaccination and 1 year later.
Design, Setting, and Participants Survey of all 46 hospitals with obstetric services and neonatal nurseries
in Cook County, Illinois.
Main Outcome Measures Hepatitis B virus immunization practices before July 1999 and in August
2000; hospital factors associated with routine HBV immunization and compliance
with AAP and PHS recommendations.
Results Before July 1999, 74% of surveyed hospital nurseries offered HBV vaccine
to all neonates; only 39% did so in August 2000. Being located in the Chicago
city limits (88% vs 57%; P = .02) and having an academic
affiliation (93% vs 66%; P = .05) were positively
associated with routine neonatal immunization before July 1999. Both academic
affiliation and city location were associated with routine immunization in
August 2000 (71% vs 25% [P = .003] and 60% vs 14%
[P = .002], respectively) and with compliance with
recommendations for suspension (57% vs 25% [P = .03]
and 56% vs 10% [P = .001]).
Conclusions We documented a 35% decrease in hospital nurseries that routinely offered
HBV immunization 1 year after the AAP and PHS recommendations were made. Special
efforts may be required to make at-birth administration of HBV vaccination