KEYWORDS:
Hepatitis B, Assessments, Continuous Quality Assurance (CQI), Valid doses, VFC/AFIX

BACKGROUND:
The NYC Department of Health and Mental Hygiene (DOHMH) Bureau of Immunization Assessment Unit observed that children had a third or final dose of HepB administered < 6 months of age. Assessing completeness of HepB has been based on counting the number of doses regardless of age. Because the age of the 3rd dose has significance in ensuring long-term immunity, the Assessment Unit decided to factor age into its assessments.

OBJECTIVE(S):
The Assessment Unit amended its algorithm to identify 2-year-olds who had 3 or 4 doses of HepB prior to 6 months of age to understand the magnitude of the problem and to identify the children in need of an additional dose.

METHOD(S):
The NYC DOHMH revised the algorithm and re-analyzed data using the CDC’s Epi-Info analysis program to include a minimum age of 6 months for a valid 3rd or 4th dose of HepB in 15 assessments conducted in 2002. Rates for 3 doses vs. 3 valid doses of HepB were compared. Children who lacked 3 valid doses were identified for recall.

RESULT(S):
Coverage for 3 HepBs decreased significantly (p<.05) when using the criteria for valid doses. (Average decrease, 6%; range 0% to 17%.) Factors associated with a decrease included the prevalence of a birth dose, the use of combination vaccine and/or chart documentation. Providers were generally unaware of the problem but initiated QI review and strategies to avoid reoccurrence.

CONCLUSIONS(S):
In assessing coverage for HepB, completion rates based on 3 valid doses may differ significantly from that of 3 dates. Since the purpose of assessment is to ensure protection against vaccine preventable diseases, it is essential that algorithms (CASA and other programs) adhere to the recommended schedule.

LEARNING OBJECTIVES:
In assessing coverage for HepB, completion rates based on 3 valid doses may differ significantly from that of 3 dates. Since the purpose of assessment is to ensure protection against vaccine preventable diseases, it is essential that algorithms (CASA and other programs) adhere to the recommended schedule.