Risk Factors Associated with Missed Hepatitis B Vaccine Birth Dose, Arizona, 2009

Background: In 2005, the Centers for Disease Control and Prevention revised the Advisory Committee on Immunization Practices recommendations to include administering hepatitis B vaccine (hepB) to all newborns before hospital discharge and administering appropriate immunoprophylaxis to infants born to hepatitis B surface antigen (HBsAg) positive mothers or mothers of unknown HBsAg status. 

Objectives: This study evaluated which maternal and child health risk factors predicted whether a child did not receive (“missed”) the first dose of hepB within three days of birth (i.e., birth dose).

Methods: Medical records from a random sample of 476 children born in Arizona in 2009 were reviewed.  Bivariate and multivariate analyses yielded unadjusted Mantel-Haenszel odds ratios and adjusted Wald odds ratios.

Results: Sixty-eight percent of the study population received the birth dose.  Logistic regression modeling included the predictors race, insurance type, and complications of labor/delivery.  After adjusting for the mother’s race, children of mothers with private insurance were approximately twice as likely (adjusted odds ratio [AOR] = 1.8, 95% confidence interval [CI] = 1.08 – 3.04) to miss the birth dose than those of mothers with insurance of another type (e.g., Medicaid) and children of mothers who experienced complications during labor/delivery were more than twice as likely (AOR = 2.3, 95% CI = 1.38 – 3.83) to miss the birth dose than those of mothers who did not experience complications. 

Conclusions: Children born to mothers with private insurance and children born to mothers who had complications during labor/delivery were significantly less likely to receive the birth dose than children born to mothers with insurance from a non-private source and who did not have complications during labor and delivery, respectively.  Educating this population and their providers on best vaccine practices will warrant successful completion of the hepatitis B vaccine series in infants after the initial birth dose.