Risk Factors for Non-Receipt of Hepatitis B Vaccine In the Newborn Nursery

Background: Administration of a birth dose of hepatitis B vaccine (HBV) is a primary focus of the ACIP's (Advisory Committee on Immunization Practices) strategy to eliminate transmission of hepatitis B virus in the United States.

Objectives: To assess 1) maternal characteristics associated with non-receipt of HBV; 2) the effect of hospital policy on the likelihood of receipt of a birth dose of HBV.

Methods: We performed a retrospective cohort study using the Colorado birth registry for the year 2008. Hospital policy was assessed by employees of the state health department. Univariate and multivariate logistic regression analyses were used to examine the association of maternal demographic characteristics and hospital policy with non-receipt of HBV.

Results: 64,425 infants were identified in the birth cohort, of whom 39,703 (61.6%) received a birth dose of HBV. Infants born to non-Hispanic white mothers were significantly more likely to not receive HBV compared to other racial/ethnic groups (adjusted odds ratio (AOR) 1.15, 95% CI 1.10-1.20). Higher maternal education was also associated with non-receipt of HBV (adjusted OR, master's degree vs 8^th grade or less, 1.66, 95% CI 1.49-1.85), as was private insurance coverage (AOR 1.48 compared to Medicaid, 95% CI 1.40-1.55). Lack of a hospital policy stipulating a birth dose strongly predicted non-receipt of a birth dose of HBV (AOR, no stipulation (60.7% of facilities) vs policy with a stipulation of a birth dose (30.4% of facilities), 2.21, 95% CI 2.13, 2.30).

Conclusions: Maternal characteristics such as higher income, higher education, and white race are associated with non-receipt of the HBV during the perinatal period. A written hospital policy for prevention of perinatal hepatitis B that does not stipulate that all infants are offered HBV is insufficient. To be effective, hospital policies must include a birth dose. Hospitals and states should strongly consider adopting such policies in order to eliminate perinatal hepatitis B virus transmission.