Hepatitis B Vaccine Birth Dose Promotion and Policy Evaluation

Background:
A 2002 survey indicated 25% of Nebraska birthing hospitals had a policy to offer hepatitis B vaccine to all newborns prior to discharge. The National Immunization Survey showed 13% of Nebraska newborns, born January 2003 - June 2005, received this vaccination within 24 hours.

Setting:
During 2006 – 2007, the Immunization Task Force - Metro Omaha (ITF) conducted a promotional campaign to convert birthing facilities in Omaha, then extended it statewide, to promote routine hepatitis B vaccination for all Nebraska newborns.

Population:
Nebraska newborns, and the hospitals where they were delivered, were targets of the campaign.

Project Description:
In 2006, the ITFengaged in educational activities within their service area to promote birthing hospital adherence to national Hepatitis B birth dose vaccination recommendations. Advocates promoted birth dose policies to medical staffs at Omaha area birthing facilities, Grand Rounds seminars were held, and the ITF infectious disease consultant delivered educational presentations to delivery and medical staffs at selected hospitals. By September 2006, a study at one Omaha hospital (with over 2500 births annually) showed 100% use of Hepatitis B birth dose compared to 22% in November 2005. In June 2007, the Task Force extended the campaign and a survey process statewide. Mailings to all 65 Nebraska birthing facilities included educational materials and a simple survey postcard. A subsequent phone survey conducted in December 2007 contacted non-responding facilities, as well as contacts who previously reported no birth dose policy.

Results/Lessons Learned:
Survey results showed that 65% of state birthing facilities had a policy and standing orders in place by December 2007, estimated to affect nearly 90% of Nebraska newborns. Barriers identified for hospitals without policies included no insurance coverage for inpatient administration, physician perception of no need, and concern about record access.