Newborn Hepatitis B Vaccine Coverage and Maternal Characteristics that Prevent Vaccination at Birth in Sedgwick County, Kansas 2005-2012

INTRODUCTION: Hepatitis B virus (HBV) affects approximately 2 billion people globally. HBV infection in a pregnant woman poses a serious risk to her infant at birth.  Perinatal HBV transmission can be prevented by providing Hepatitis B vaccine to new born infants within 12 hours of birth according to the Advisory Committee on the Immunization Practices (ACIP) guidelines.  The Healthy People 2020 has set an effective coverage goal of at birth dose of hepatitis B vaccine at 85%. The Kansas Department of Health and Environment (KDHE) support the recommendation by ACIP and has set goals in concert with the HP2020 goals. The 2011 U.S. National Immunization survey estimated that only 77.7% (±7.4%) of infants born in Kansas received the Hepatitis B birth dose. County level data is however lacking.This study is the first to explore maternal characteristics and at-birth HBV vaccination coverage rates in Sedgwick County, Kansas.

METHODS: This is a cross-sectional study of vital records data. We included infants born in Sedgwick County, Kansas from 2005-2012. Infants born weighing less than 2,000 grams and subjects missing data from characteristics of interests were excluded from analysis.  Binary logistic regression models were used to determine the effect of maternal characteristics on the administration of HBV vaccine. Statistical significance was assessed at a type 1 error rate of less than or equal to 5%.

RESULTS: A total of 61,951 births were selected over the period of interest. In 2005 versus 2012, there was a significant decrease in the proportion of at-birth HBV vaccinations in Sedgwick County (92% to 88%, P<0.001). The likelihood of vaccination (OR) had significant associations for maternal education level, race, and payment source. Adjusted odds ratios (AOR) showed that Hispanic mothers had significantly increased odds of vaccinating their newborns against HBV in every year (AOR ranged from 1.59[95% CI 1.22-2.09]  to 2.10[95% CI 1.57-2.81]) compared to white non-Hispanic. A decreasing trend in the odds of vaccination was observed for higher levels of education. That is, compared to women who had graduate level education, women some college, high school, or had not finished high school we increasinly more like in all the years of observation to vaccinate their children. Women with state insurance were less likely than those with private insurance  to vaccinate. This trend was consistent over the years of observation.

CONCLUSION: Contrary to expectations per the ACIP recommendations and HP2020 goals, HBV vaccination in Sedgwick County has declined over the years. Maternal characteristic found to have been associated with newborn HBV vaccination include: race, educational level, and payment source. Sedgwick County Health Department officials can partner with other departments of affiliates to investigate groups low vaccination races, create appropriate interventions, and assess policy changes needed to increase overall vaccination rates.