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Administration of a birth dose of hepatitis B vaccine (HBV) is a primary focus of the national strategy to eliminate transmission of hepatitis B virus in the United States. Our objectives were to determine: 1) maternal characteristics associated with non-receipt of HBV; and 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. Data on hospital policy were gathered by members of Colorado Department of Public Health and Environment’s Perinatal Hepatitis B Prevention Unit. Hospital policy was grouped into three categories: having a policy regarding hepatitis B but not stipulating a universal birth dose of HBV, policy including a universal birth dose, and no policy. Univariate and multivariate logistic regression analyses were used to examine non-receipt of HBV by maternal characteristics and hospital policy.

Results:

A total of 39,703 infants in the cohort (61.6%) received a birth dose of HBV. Infants born to non-Hispanic white mothers were significantly more likely not to receive HBV compared to Hispanics (adjusted odds ratio (OR) 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 8th grade or less, 1.67, 95% CI 1.49-1.86). Infants of mothers who were privately insured were less likely to receive HBV compared to Medicaid (adjusted OR 1.47, 95% CI 1.40-1.55). Hospital policy strongly predicted non-receipt of a birth dose of HBV (adjusted OR, policy without universal dose vs policy with universal dose, 2.21, 95% CI 2.13, 2.30, no policy vs policy with universal dose, 1.40, 95% CI 1.32, 1.47).

Conclusion:

Maternal characteristics such as higher education, private insurance, and white race are associated with non-receipt of HBV in the newborn nursery. Having a written hospital policy for hepatitis B vaccination without a universal birth dose is insufficient and could be detrimental. Hospitals and states should strongly consider adopting universal birth dose policies in order to eliminate perinatal HBV transmission.