Assessment of Hepatitis B Birth Dose Program Participation in New York State

Background:
The New York State Department of Health (NYSDOH) Hepatitis B Hospital Birth Dose Program was established in 2003 to remove financial barriers and allow hospitals to administer the birth dose of hepatitis B vaccine. However, the rate of birth dose administration in New York State (NYS) remains low.

Objectives:
To better understand the factors contributing to the low birth dose rate, a survey of key decision makers at birthing hospitals was conducted to describe and quantify barriers impeding full program participation and the perceived effectiveness of potential remedies.

Methods:
A survey was electronically distributed to Medical Directors and Nurse Managers of Newborn Nursery Units at all birthing facilities in NYS. Participants were asked to voluntarily complete a brief, self-administered survey. The survey asked about standing orders, perceived barriers to administering the hepatitis B birth dose and perceived effectiveness of potential strategies to address these barriers.

Results:
The overall survey response rate was 95%, with the majority completed by pediatric and obstetric staff. Nearly all (97.9%) of hospitals have adopted a universal birth dose policy but only 44.1% of hospitals use non-patient specific standing orders. The most common barriers to birth dose administration cited were parental refusal, plans for the pediatrician to give the vaccine in the office and parental fear of vaccinations in newborns. Respondents felt that parental and provider education on hepatitis B vaccine would address these barriers.

Conclusions:
Perinatal hepatitis B prevention remains a vital public health focus and efforts to educate providers will continue. The results indicate that prenatal education of parents about hepatitis B vaccine and vaccine safety in general will likely help to decrease parental refusal and improve hepatitis B birth dose rates.