Compliance with hepatitis B immunisation commenced in hospital

Abstract

Introduction: The UK implements a selective immunisation programme for hepatitis B virus (HBV), screening all pregnant women antenatally and targeting high-risk groups. At the time of this audit, babies considered to be at environmental risk of HBV were scheduled to be immunised at birth, 2 and 4 months. This included all babies of women booked to deliver within the Women’s Reproductive Health Service at the Princess Royal Maternity (PRM). The objective was to audit, through retrospective cohort analysis, compliance with the hepatitis B immunisation schedule in this group of babies. Methods: The study cohort included all babies who had received their first dose of hepatitis B vaccine at the PRM during the period 01/02/2005–01/03/2006. Infants considered to be at high risk of perinatal transmission were excluded. Sources of information were a database of infants notified directly to public health from the PRM, the Scottish Immunisation Recall System (SIRS), a database of infants born to drug misusing women at PRM and pharmacy records at PRM. Databases were compared to identify infants given one or more doses of hepatitis B vaccine. Results: A total of 203 infants were given a first dose of hepatitis B vaccine in the PRM and notified directly to public health. A further 36 infants were notified to SIRS by their GP. During the same study period, 274 doses of vaccine were dispensed by the pharmacy at PRM. One hundred and fifty-four (67%) infants were born to mothers who were known to be drug misusers. Only 52.8% of infants given their first dose of hepatitis B vaccination at the PRM completed the course (defined as more than three doses) and are therefore fully protected against HBV. In the drug-misusing population, the results were no better, with only 54.5% of infants completing the course. Conclusions: There are both clinical and practical reasons for poor compliance with hepatitis B vaccination, which include communication problems (including notification to public health), the mobility of the population, poor parental understanding, the increasing complexity of the childhood immunisation programme and problems with implementing selective rather than universal immunisation. An improved notification system, standardised consent form and parental information leaflet have been introduced. The cycle of audit will be completed after the changes have been implemented. The relationship between angiotensin-converting enzyme (ACE) genotype, serum ACE concentration and markers of asymmetrical growth restriction in premature infants