Risk factors associated with missed hepatitis B vaccine birth dose, Arizona, 2009

Background: This study evaluated which maternal and child health risk factors predicted whether a child did not receive, or “missed”, the birth dose of hepatitis B vaccine (HBV) within three days of birth based on recommendations from the 2005 Advisory Committee on Immunization Practices (ACIP). Methods: 476 medical records were reviewed from a random sample of children born in Arizona in 2009. Bivariate and multivariate analyses yielded unadjusted Mantel-Haenszel and adjusted Wald odds ratios, respectively. Results: 68% of the study population received the birth dose. The final logistic regression model included the predictors race, insurance type, and complications of labor or delivery. Children of mothers with private insurance were approximately twice as likely [OR = 1.8, 95% CI = 1.08–3.04] to miss the birth dose than those of mothers with insurance of another type (e.g., Medicaid) and those who experience complications during labor or delivery were more than twice as likely (adjusted odds ratio [OR = 2.3, 95% CI = 1.38–3.83] to miss the birth dose when compared to no complications, after adjusting for the mother's race. Conclusions: Children born to mothers with private insurance and who had complications during labor or 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 on best vaccine practices will warrant successful completion of the hepatitis B vaccine series in infants after the initial birth dose.