First Dose Of Hepatitis Research Articles

Time interval distribution of hepatitis B vaccine immunization among infants in China from 2017 to 2021

ABSTRACT Infant hepatitis B vaccine coverage in China is high, with over 95% of infants immunized; however, high vaccine coverage can often mask low timeliness. The vaccination interval between the second and third doses is not clearly defined by immunization guidelines in China. This retrospective cohort study assessed the time interval distribution of hepatitis B vaccination among a cohort of randomly selected live births from the Centers for Disease Control and Prevention across four provinces or municipalities in China between January 2017 and December 2021. Among the infants analyzed, 163,224 received the first dose of hepatitis B vaccine with 146,905 (90.0%) and 135,757 (83.2%) infants receiving the second and third doses, respectively. A total of 132,577 (90.2%) infants received the second dose between 28 and 61 days after the first dose. Of the 119,437 (88.0%) infants that completed the hepatitis B series between 61 and 214 days after the second dose 87,067 (64.1%) infants were vaccinated with the third dose between 151 and 180 days after the second dose. The time interval distribution varied across the four provinces or municipalities (p < .001). Of the 58,077 infants who completed the hepatitis B vaccine series, 36,377 (62.6%) infants used the same type of hepatitis B vaccine for all three doses. Overall, the timeliness of hepatitis B vaccination for infants was lower than expected, with regional disparities observed. This highlights the need for improved timeliness through the introduction of a defined timeframe for the last two doses of vaccine and training for obstetricians and related personnel.

Hepatitis A Vaccination Coverage Among People With Chronic Liver Disease in England (HEALD): Protocol for a Retrospective Cohort Study.

Hepatitis A outbreaks in the United Kingdom are uncommon. Most people develop mild to moderate symptoms that resolve, without sequelae, within months. However, in high-risk groups, including those with underlying chronic liver disease (CLD), hepatitis A infection can be severe, with a higher risk of mortality and morbidity. The Health Security Agency and the National Institute of Health and Care Excellence recommend preexposure hepatitis A vaccination given in 2 doses to people with CLD, regardless of its cause. There are currently no published reports of vaccination coverage for people with CLD in England or internationally. This study aims to describe hepatitis A vaccination coverage in adults with CLD in a UK primary care setting and compare liver disease etiology, sociodemographic characteristics, and comorbidities in people who are and are not exposed to the hepatitis A vaccine. We will conduct a retrospective cohort study with data from the Primary Care Sentinel Cohort of the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub database, which is nationally representative of the English population. We will include people aged 18 years and older who have been registered in general practices in the Research and Surveillance Centre network and have a record of CLD between January 1, 2012, and December 31, 2022, including those with alcohol-related liver disease, chronic hepatitis B, chronic hepatitis C, nonalcohol fatty liver disease, Wilson disease, hemochromatosis, and autoimmune hepatitis. We will carefully curate variables using the Systematized Nomenclature of Medicine Clinical Terms. We will report the sociodemographic characteristics of those who are vaccinated. These include age, gender, ethnicity, population density, region, socioeconomic status (measured using the index of multiple deprivation), obesity, alcohol consumption, and smoking. Hepatitis A vaccination coverage for 1 and 2 doses will be calculated using an estimate of the CLD population as the denominator. We will analyze the baseline characteristics using descriptive statistics, including measures of dispersion. Pairwise comparisons of case-mix characteristics, comorbidities, and complications will be reported according to vaccination status. A multistate survival model will be fitted to estimate the transition probabilities among four states: (1) diagnosed with CLD, (2) first dose of hepatitis A vaccination, (3) second dose of hepatitis A vaccination, and (4) death. This will identify any potential disparities in how people with CLD get vaccinated. The Research and Surveillance Centre population comprises over 8 million people. The reported incidence of CLD is 20.7 cases per 100,000. International estimates of hepatitis A vaccine coverage vary between 10% and 50% in this group. This study will describe the uptake of the hepatitis A vaccine in people with CLD and report any disparities or differences in the characteristics of the vaccinated population. PRR1-10.2196/51861.

Vaccination coverage survey of children aged 1–3 years in Beijing, China, 2005–2021

BackgroundThe routine immunization program for children is a primary strategy and a core part of vaccination. Achieving and maintaining high level of vaccination coverage are important to reduce morbidity and mortality caused by vaccine-preventable diseases. In Beijing, annual coverage surveys have been conducted since 2005. It is necessary and possible to assess the level and trend of routine vaccination coverage of children in Beijing as well as the disruption of coronavirus disease 2019 (COVID-19) pandemic and provide the reference for the further improve the vaccination coverage. MethodsThe data of 61,521 children aged 1–3 years in the vaccination coverage surveys during 2005–2021 were analyzed by Beijing Center for Disease Control and Prevention. Descriptive epidemiological method was used to analyze the data and the difference of vaccination coverage within the time period. ResultsMore than 99 % of participants had immunization cards and electronic immunization records. The concordance rate of both records were also over 99 %. During 2011–2019, the rates of on-time and in-time vaccination of each routine vaccine reached 96 % or more and increased significantly (all P values <0.05), compared with that of 2005–2010. All rates of the investigated vaccine, except for Bacillus Calmette-Guérin vaccine (BCG) and the first dose of hepatitis B vaccine (HepB), decreased in 2020–2021 significantly (all P values <0.05). For the causes of failing to vaccinate on time, delayed vaccination accounted for 47.82 %. The top two vaccines to be missed were the first dose of hepatitis A vaccine and the 4th dose of diphtheria-tetanus-acellular pertussis vaccine, accounting for 21.41 % and 20.79 %, respectively. The main reason for zero-dose/drop-out vaccination was “Guardians regarded the immunization service time as inappropriate”, accounting for 72.27 %. ConclusionThe coverage level and service quality of routine immunization in Beijing were relatively high. However, as influenced by COVID-19 epidemics, both on-time and in-time vaccination rates decreased significantly, except for BCG and HepB. Under the background of COVID-19 pandemic, the keys to maintain high level of vaccination coverage include flexible immunization service time to ensure the guardians bringing their children for vaccination timely, and more attention from providers to the doses after children’s first birthday.

Impact of timing on protection of combined immunoprophylaxis in preventing mother-to-child transmission of hepatitis B virus: a retrospective study

Objective: To evaluate the impact of timing combined immunoprophylaxis on mother-to-child transmission (MTCT) of the hepatitis B virus (HBV) in pregnant women living with hepatitis B. Methods: A retrospective cohort study was included HBsAg-positive pregnant women who delivered full-term at Tianjin Third Central Hospital from January 2019 to December 2021. The objective of this study is to determine whether early administration of hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccination after birth can further improve protection. Result: A total of 694 pregnant women living with hepatitis B were included; 93 infants from these mothers were lost to follow-up [including moving (n = 21), emigrating (n = 26), changing contact information (n = 27), and other reasons (n = 19)], leaving 601 infants for analysis. The incidence in babies born to mothers with hepatitis B was 1.50% (9/601). Based on the different timing of combined immunoprophylaxis administration after birth, 601 infants were divided into two groups (within 2 h and within 2–12 h). The incidence in babies born to mothers with hepatitis B were 0.32% (1/308) and 2.73% (8/293) for infants who received combined immunoprophylaxis within 2 h and between 2 and 12 h of birth, respectively (p = 0.037). The infection incidence of infants born to HBeAg-positive mothers and HBeAg-positive mothers who did not receive antiviral treatment during pregnancy was lower in the 2-h group compared to the 2–12 h group (0.72% vs. 5.84%, p = 0.04 and 1.20% vs. 9.46%, p = 0.047). Conclusion: Using combined immunoprophylaxis as soon as possible (within two hours of birth) may protect against MTCT of HBV more.

Epidemiological survey of hepatitis B and analysis of hepatitis B vaccine coverage rate among children aged 1-14 years in Lhasa in 2006, 2014 and 2020

In 2006, 2014 and 2020, the positive rates of HBsAg in 560, 384 and 402 children aged 1 to 14 years were 4.5%, 2.6% and 2.5%, respectively, with no statistically significant differences (P>0.05). The positive rate of anti-HBs was highest in 2014 (57.8%) and lowest in 2006 (34.1%) (P<0.05). The positive rate of anti-HBc was highest in 2006 (15.7%), and decreased in 2014 (7.8%) and 2020 (5.7%) (P<0.001). The timely rate of the first dose of hepatitis B vaccine for children in Lhasa in 2006, 2014 and 2020 was 7.7% (43/560), 50.3% (193/384) and 94.8% (381/402), respectively. The overall vaccination rates were 15.4% (86/560), 35.2% (135/384) and 96.0% (386/402), respectively, showing a trend of gradual increases (χtrend values were 718.63 and 589.59, both P values<0.001).

Predictors of Uptake and Completion of Hepatitis B Vaccine amongst Health Care Personnel in a Rural Teaching Hospital in South-South Nigeria

Hepatitis B and C viral infections are amongst the most critical occupation-related infections in the hospital workplace. This study assesses the determinants of uptake and completion of hepatitis B vaccine amongst health care personnel (HCP) in a tertiary health facility in South-South, Nigeria. This study employs a descriptive cross-sectional study design, and data were collected using a quantitative method. Pre-tested, semi-structured interviewer-administered questionnaires were administered to 280 HCP. The IBM SPSS version 21.0 was used for data analysis. About half of HCP had received the first dose of the hepatitis B vaccine, with less than half of that number completing the third dose. It is significantly higher amongst the core healthcare professionals than the non-healthcare professionals. There is a high drop-out rate in the hepatitis B vaccination process which was more amongst the non-clinical group than the clinical. The short duration of work (1-5 years) is a significant predictor of initiation of the vaccination process, while good knowledge of hepatitis B and C viruses was a strong predictor for complete uptake. This study reveals a fair uptake of the first dose of hepatitis B vaccine amongst HCP with a high drop-out rate and a concomitant low completion of the vaccine course amongst respondents. Priority should be given to ensure planned programmes that will help enhance optimal uptake of hepatitis B vaccine amongst HCP.

Hepatitis B prevalence in pregnant women in China: Progress and realities.

To combat the burden of hepatitis B virus (HBV) infection, the Chinese government introduced national HBV vaccination in 1992. Childhood HBV vaccination was integrated into routine childhood immunisation, but initially the costs were met by parents; later, an alliance with GAVI in 2002, and subsequently the Chinese government, provisioned free three-dose hepatitis B vaccine to all new-borns [1]. Vaccination is guided by the National Immunization Schedule, and the first dose of hepatitis B vaccine (the birth dose) is administered within 24 hours of birth [2].

Evaluation of immunogenicity after first dose of hepatitis B vaccine in newborns with very low birth weight

ABSTRACT Objective Hepatitis-B virus (HBV) infection is an important health problem worldwide. HBV vaccine application varies according to the birth weight and gestational week in the neonatal period. This study aimed to reconsider delaying the administration of the HBV vaccine because the birth weight of newborns was very low. Methods The newborns with very low birth weight in the study group were babies weighing less than 2000 g in the postnatal first month and at the time of administering HBV vaccine. Babies born at term from mothers who did not receive an HBV vaccine, had negative hepatitis B surface antibody levels, and were given HBV vaccine at birth were included in the study as a control group. The antibody levels against HBV vaccine were compared between these two groups. Results The retrospective study included 60 participants (32 men and 28 women) grouped as control first vaccine weight (first vaccine weight was >2000 g, control group, n = 30) and case vaccine weight (first vaccine weight was <2000 g, case group, n = 30). The mean birth weight was 2976 ± 84.8 g and 1054 ± 44.5 g in the control and case groups, respectively. The first vaccine weight was 2030–3780 g and 960–1900 g in the control and case groups, respectively. The mean antibody level was 297.8 ± 76.3IU/mL and 309.7 ± 56.3IU/mL in the <1500 g and >1500 g groups, respectively. No significant difference was found in hepatitis antibody levels between the groups. Conclusion Further studies in larger samples are needed to confirm the efficacy and efficiency of postponement of hepatitis B vaccination in babies with a birth weight of <2000 g.

Adherence to multidose Hepatitis B vaccination in a Tertiary Care Centre: A Retrospective Cohort Study

Background: Globally out of 200 crore population who are getting exposed to the hepatitis B virus (HBV),about 350 million are chronically carrying it resulting in 0.5 to 1.2 million deaths each year . These mortalitiesare due to chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Horizontal transmission in earlychildhood and parental transmission at any age are the important routes of transmission. This study wasconducted with following objectives.(a) To assess the prevalence of adherence to Hepatitis vaccination.(b) To associate this adherence with demographic factors.Methodology: After receiving approval from the Institutional Ethics Committee a record based retrospectivecohort study was conducted at Gastroenterology and Hepatology OPD of IMS and SUM Hospital,Bhubaneswar. Data regarding all the patients who have received First dose of Hepatitis Vaccine from January2019 to December 2019 were followed up till June 2020 to find out how many of them have revisited toobtain second dose as well as third dose of vaccine. Their demographic characteristics collected from theimmunisation register. Data was entered and analysed using SPSS vs 21 using appropriate statistics.Results and conclusion: Total 1134 subjects have received the first dose of Hepatitis B vaccine. Meanage of the participants is 36±15yrs. First dose taken by 453(39.9%) people, 324(28.6%) had completed theschedule by taking the final dose of vaccine. Hardly one third of the patients adheres to the schedule andcompletes it. Inadequate vaccination makes the patients vulnerable to risks of Hepatitis B and its morbidities.

Reasons for Vaccine Rejection in 0 to 2 Years Old Children Registered to Family Health Centers in Konya

AbstractObjective According to the 2017 report of the World Health Organization (WHO), ∼1.5 million people die from vaccine preventable diseases. The WHO is working to generate and popularize effective vaccination programs. However, the concept of “vaccine rejection,” which first started in Europe and United States, has started to make an impact in Turkey during the past 10 years. It is therefore seen as a growing danger in future. This study was conducted to determine, detect, and prevent the reasons of vaccine rejection that have increased in recent years.Methods A cross-sectional study was conducted between June and December at 2015. In all districts of Konya (n = 31), it was aimed to reach all 242 families who rejected vaccination to their 0 to 2 years old babies. Families having more than one child refused to vaccinate all of their children. A questionnaire consisting of 47 questions was prepared by the researchers, using the standard trainings of the Ministry of Health and the literature. A total of 172 families agreed to participate in this study. The questionnaire was applied to the parents using the telephone interview technique. Data were presented as mean ± standard deviation and percentage.Results About 41.3% (n = 71) of the mothers were high school graduates, 50.6% (n = 87) of their fathers were university graduates. About 82.6% (n = 142) of the participants received examination, treatment and follow-up services from family physicians and family health personnel. About 20.9% (n = 36) of the children were the only children of the family. About 55.8% (n = 96) of the families also refused the vaccination for other children. About 83.7% (n = 144) of the unvaccinated children had infants/children follow-up care. While all participants stated that vaccines had side effects, 31.4% (n = 54) of these believed that vaccines cause autism or paralysis in infants. About 62.2% (n = 107) of their mothers did not receive tetanus vaccine during pregnancy. The highest rate of nonvaccination was with the second dose of hepatitis A vaccine, which 96.5% (n = 166) refused. The most accepted vaccine was the first dose of hepatitis B vaccine, which was refused by 18.0% (n = 31). About 79.7% (n = 137) of the participants did not know the reason for the vaccination and 95.9% (n = 165) thought that the vaccines were not required. All participants received information from the health personnel about the vaccines. While 9.9% (n = 17) of the families thought that vaccines cause infertility, 44.8% (n = 77) did not receive vaccination because the vaccines were produced abroad.Conclusion A growing number of families refuse to have their babies vaccinated. The production of vaccines abroad is a major cause of insecurity. There are also beliefs that vaccines cause infertility. Vaccine production in Turkey should be accelerated and public education about vaccines should be reviewed. Training provided to families about vaccines should also be reviewed.

Assessment of The Coverage Rate of Expanded Program Of Immunization Among Five Years Children In Tikrit City – Iraq

Background: Childhood immunization is the initiation of immunity through the application of vaccines .It is considered important for improving child survival .Immunization is a primary health care preventive measure and remain the most cost-effective public health intervention to reduce child morbidity and mortality attributed to infectious diseases.Subjects and method:Cross sectional study was conducted on five year children who attended (8) kindergarten in Tikrit city and their information from PHCC sector.Children were selected by cluster sample then simple random from each cluster. The study was conducted in the period from November 2019 to August 2020.Results: The study revealed a significant inverse relation was observed between household crowding and socioeconomic status children's parents. The percentageoffull immunized children ( 40.90%) these children were considered as having had complete immunization, but more than half of the children had one or more than one missed doses and were considered as is having had partial immunization(56.25%).The number of unvaccinated children were five children (2.84%). complete immunization of children were found among male (54.77%), while complete immunization among children female were (28.26%)and there strong association statistically. The partial immunization among male children were (39.28%) and female were (71.74%) the coverage rate of vaccination among immunized children the coverage rate was (97.2%).The highest for immunized children was for the vaccines Bacillus Calmette Guerin (BCG*)+OP90+first dose of Hepatitis B Virus vaccine (HBV1)(92.04%) while the lowest rate (6.0%) was for the vaccines OPV2booster+MMR+TETRA (DTaP +IVP ).Conclusion: this study concluded that the highly percentage of partially immunized children in kindergarten ((56.25%).

Hepatitis B Birth Dose Effects on Childhood Immunization in the U.S.

The Advisory Committee on Immunization Practices recommends administering the first dose of hepatitis B vaccine at birth, making it the first vaccine that many children receive. However, few studies examine whether children who miss the birth dose are at increased risk of vaccination delay. This study investigates birth dose as a determinant of up-to-date immunization status at age 18 months, considering 7 core childhood vaccine series: diphtheria, tetanus, and acellular pertussis; polio; measles, mumps, and rubella; Haemophilus influenzae type B; varicella; hepatitis B; and pneumococcal conjugate vaccine. Cross-sectional data were collected in 2017 by National Immunization Survey-Child, a nationally representative survey of children aged 19-35 months living in the U.S., and were analyzed in 2019. The primary outcome was combined 7-vaccine series (4:3:1:3:3:1:4) up-to-date status at 18 months. Doubly robust estimates of association were calculated using survey logistic regression and propensity scores estimated with boosted classification and regression trees. Children who received the birth dose had 2.01 (95% CI=1.74, 2.33) times the odds of being up-to-date on the combined 7-vaccine series as children who did not. ORs for all the 7 individual vaccine series were positive, ranging from 1.59 (95% CI=1.28, 1.97) for measles, mumps, and rubella to 4.97 (95% CI=3.97, 6.24) for hepatitis B. Receiving the birth dose is positively associated with up-to-date status later in childhood, highlighting the importance of starting vaccination early. The association is insensitive to confounding by factors observed in National Immunization Survey-Child, but investigation of unobserved factors such as vaccine hesitancy could provide critical information to guide intervention strategy.

Hepatitis B vaccination at birth: reduces perinatal transmission successfully

Hepatitis B virus (HBV) infection is one of the most important global health problem including Bangladesh. HBV carrier rate was found between 2-7% in many studies. After acute infection, chance of chronicity in adult is only 10%, but in neonate that is 90%. Out of these, 25% were suffering from acute liver failure &amp; hepatocellular carcinoma and ultimate result is premature death. Chronic Hepatitis B Virus infection is not curable, only suppressing the activity with available treatment. So, prevention is better than cure. Active immunization is the single most important and effective preventive measure against HBV infection. Bangladesh introduced hepatitis B vaccination in children through Expanded Program on Immunization in 2005 which includes 3 doses without any birth dose. World Health Organization, Centre for disease control &amp; prevention and American academy of pediatrics recommends since perinatal or early postnatal transmission is the most important source of chronic HBV infection globally, all infants should receive their first dose of hepatitis B vaccine as soon as possible after birth, ideally within 24 hours or before discharging the mother from hospital. Now a days, 10 million Bangladeshis are suffering from HBV and 3.5% mother are infected with that virus. From another study, 21.5% pregnant woman having core antibody of HBV as many of them were unvaccinated. Faulty pregnancy and donor screening as well as inaccurate method of testing also responsible for perinatal transmission in Bangladesh. So, we are missing lots of HBV everyday in our daily practice. After implementation of birth dose, many countries reduced perinatal transmission and prevalence rate of HBV successfully.

Hepatitis B birth vaccination, cohort study, Tunisia 2000–2017

ABSTRACT We aimed to compare the efficiency of the first dose of Hepatitis B (HB) vaccine: at Birth versus at 3 months and to evaluate the efficacy of HB vaccine. We conducted a cohort study in the governorate of Monastir. Vaccinated Cohort (VC) included populations receiving the first dose at 3 months (Protocol 1), and at birth (HepB-BD) (Protocol 2). First dose was followed by at least two doses. We collected, from January 2000 to December 2017, cases diagnosed by serological markers (hepatitis B surface antigen (HBsAg) and anti-HBc). We calculated Absolute Risk (AR) per 100,000 PY and the Relative risk reduction (RRR). Twenty-five cases were notified among VC and 1501 cases among not vaccinated cohort (NVC). Twenty-three cases were notified among the cohort receiving the first dose at 3 months and two cases in Protocol 2. The AR per 100,000 PY was 5.67 (CI95%: 3.36–7.99) in Protocol 1 and 0.11 (CI95%: 0.001–0.26) in Protocol 2. The RRR was 77% (95% CI: 66; 85) in Protocol 1 and 99.4% (95% CI: 97.8; 99.9) in Protocol 2. We identified 4 HB cases for children aged between 5 and 11 who benefited from protocol 1 (born between 2000 and 2006) and zero cases for children of the same age group benefiting from protocol 2 (born between 2011 and 2017). The annual number of HB has decreased from 112 in 2000 to 48 in 2017. We predicted 40 new cases of HB in 2030. HepB-BD was 99.4% effective at preventing HB. The continuity of HepB-BD worldwide would achieve WHO‘s goal of eliminating HB as a threat to health by 2050. Abbreviations AR: Absolute Risk; ARR: Absolute Risk Reduction; G1: Group1; G2: Group2; HB: Hepatitis B; HepB-BD: Hepatitis B Birth Dose; MENA: Middle East and North Africa; NNV: Number Needed to Vaccine; HIV: Human Immunodeficiency Virus; NVC: Not Vaccinated Cohort; PY: Person Year; RRR: Relative Risk Reduction; RR: Relative Risk; VC: Vaccinated Cohort; WHO: World Health Organization

286. Hepatitis B Vaccine Compliance: Comparing 2-Dose and 3-Dose Vaccines

BackgroundLess than 1 in 3 US adults who initiated the 3-dose (0, 1, 6 months) hepatitis B vaccine series have completed it. HepB-CpG (Heplisav-B; Dynavax) is a new licensed adjuvanted vaccine that requires only 2 doses (0, 1 month). As part of a cluster study performed at Kaiser Permanente Southern California, we compared compliance with second dose and series completion for HepB-CpG vs. comparator vaccine (Engerix-B; GlaxoSmithKline) recipients.MethodsThe cohort included adults not on dialysis who received their first dose of hepatitis B vaccine in family or internal medicine departments from 8/7/2018 to 2/1/2019. Second dose compliance was assessed for the full cohort, but series completion was assessed for a subset vaccinated from August 7, 2018 to September 30, 2018 to allow at least 6 months’ follow-up. Compliance rates were estimated using the Kaplan Meier method. Adjusted hazard ratios (aHR) were estimated using Cox proportional hazard regression with robust variance to account for within medical center correlation, adjusting for age, race/ethnicity, census block income and education, prior healthcare utilization, and factors that trigger alerts for hepatitis B vaccination (diabetes and testing for sexually transmitted infections).ResultsThere were 6500 HepB-CpG and 7733 comparator vaccine recipients (1,442 and 2,604 prior to September 30, 2018). Rates of second dose compliance at 60 days were 32.9% for HepB-CpG and 29.1% for comparator vaccine, and rates of series completion at 210 days were 56.9% and 20.6%. There was no significant difference in second dose compliance (aHR 1.14, 95% CI: 0.91, 1.47), but HepB-CpG recipients were 5 times more likely to complete the series (aHR 5.17; 95% CI: 3.84, 6.98). Second dose compliance and series completion were significantly less likely among Blacks compared with Whites and significantly more likely among Asians, adults ≥60 years compared with those < 30 years, and adults living in census blocks with a median annual income of $40,000–69,000 compared with < $40,000.ConclusionOverall, second dose compliance was similar, but series completion was better for HepB-CpG recipients than comparator vaccine recipients, suggesting that the 2-dose vaccine could lead to improvements in coverage and protection against hepatitis B virus.Disclosures All authors: No reported disclosures.

108. HEPATITIS B VACCINATION IN DUKE UNIVERSITY AND DUKE REGIONAL HOSPITAL NEWBORN NURSERIES

Background Vertical transmission continues to be a mode of Hepatitis B virus (HBV) infection despite implementation of prenatal maternal screening. HBV vaccination induces seroprotection in 98% of term infants. The CDC recommends that all infants should receive the first dose of hepatitis B vaccine at birth or within the first 12- 24 hours of life before they leave the hospital. Nevertheless, HBV vaccination rates prior to discharge were sub-optimal in the Duke newborn nurseries, which consist of the main Duke University Hospital (DUH) nursery and the community-based Duke Regional Hospital (DRH) nursery. Aim Statement We aimed to increase all HBV vaccination rates from a baseline of 94% to 96% at the DUH and from 88% to 90% at the DRH nurseries within 1 year. Interventions Baseline HBV vaccination rates were obtained from the electronic medical record (EMR) by using the 12 months preceding first intervention. The first intervention educated clinicians and nurses on the updated CDC guidelines by displaying posters in work areas. The second intervention aimed to increase project awareness among nursing staff in the nursing newsletter. The third intervention was an interdisciplinary effort among the nursing, physician, and pharmacy teams to coordinate administration of the HBV vaccine with the routine administration of vitamin K injection and erythromycin eye ointment at delivery. Measures After each intervention, a PDSA cycle was completed, assessing vaccination rates over the next three months on average. We assessed the effect on nursing workflow through a survey as a balancing measure. Results At both DUH and DRH nurseries respectively, we saw the rates of HBV vaccination increase slightly from baseline rates of 88% and 94% to 92% and 95% after the first two cycles. The third intervention at DUH resulted in a robust response in vaccination rates (up-trending to 95.8% in the month of November). Rates have been above the means for 7 and 10 consecutive months for DUH and DRH since the project began. Conclusions and Next Steps We have demonstrated a trend in improvements in HBV vaccination rates in the DUH and DRH newborn nurseries over several PDSA cycles. Most notably, the multi-disciplinary intervention of administering HBV with the vitamin K injection and erythromycin eye ointment at DUH had a marked impact. Continued multi-disciplinary efforts to improve HBV vaccination in the newborn nursery at both hospitals will optimize the care of newborn infants in prevention of HBV.

Barriers to timely administration of birth dose vaccines in The Gambia, West Africa

ObjectiveAlthough vaccine coverage in infants in sub-Saharan Africa is high, this is estimated at the age of 6–12 months. There is little information on the timely administration of birth dose vaccines. The objective of this study was to assess the timing of birth dose vaccines (hepatitis B, BCG and oral polio) and reasons for delayed administration in The Gambia. MethodsWe used vaccination data from the Farafenni Health and Demographic Surveillance System (FHDSS) between 2004 and 2014. Coverage was calculated at birth (0–1 day), day 7, day 28, 6 months and 1 year of age. Logistic regression models were used to identify demographic and socio-economic variables associated with vaccination by day 7 in children born between 2011 and 2014. ResultsMost of the 10,851 children had received the first dose of hepatitis B virus (HBV) vaccine by the age of 6 months (93.1%). Nevertheless, only 1.1% of them were vaccinated at birth, 5.4% by day 7, and 58.4% by day 28. Vaccination by day 7 was associated with living in urban areas (West rural: adjusted OR (AOR)=6.13, 95%CI: 3.20–11.75, east rural: AOR=6.72, 95%CI: 3.66–12.33) and maternal education (senior-educations: AOR=2.43, 95%CI: 1.17–5.06); and inversely associated with distance to vaccination delivery points (≧2km: AOR=0.41, 95%CI: 0.24–0.70), and Fula ethnicity (AOR=0.60, 95%CI: 0.40–0.91). ConclusionVaccine coverage in The Gambia is high but infants are usually vaccinated after the neonatal period. Interventions to ensure the implementation of national vaccination policies are urgently needed.

Exploration of management method on neonatal first dose of security vaccination

Objective To explore a novel management method of neonatal first dose of vaccination, and aim to promote the vaccination rate and ensure the safety of vaccination. Methods The results of neonatal first dose of Hepatitis B and BCG vaccine of 955 newborns under the novel management method were analyzed from January to April, 2014. Results With the novel management method, 898 newborns were inoculated Hepatitis B vaccine and the vaccination rate reached 94.03%. 890 newborns were inoculated BCG vaccine and vaccination rate was 93.19%. The differences were not statistically significant in different months (χ2=2.106, 5.221; P>0.05). The novel management method helped to promote the vaccination rate and safety rate was 100%. Conclusions The novel management method can promote the vaccination rates and the safety of the neonatal first dose of Hepatitis B and BCG vaccine. This novel method should be expanded to the neonatal vaccination to ensure the vaccination of newborns. Key words: Infant, newborn; Vaccines; Immunization programs; Vaccination management

Immunisation schedule of the Spanish Association of Paediatrics: 2015 Recommendations

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.

Weight-Based Policy of Hepatitis B Vaccination in Very Low Birth Weight Infants in Taiwan: A Retrospective Cross-Sectional Study

BackgroundThe current recommendation of giving the first dose of hepatitis B vaccine to very low birth weight (VLBW) infants at 30 days of chronologic age usually is not practical, because most VLBW infants are not medically stable at that age. We use an alternative body-weight-based protocol, and evaluate its efficacy in an endemic area under a universal immunization program.MethodsThe immunogenicity of the current hepatitis B vaccination strategy in 155 VLBW preterm infants was evaluated at age 2 to 13 years, with parental consent. All of the infants were born between 1995 and 2006, and received their first dose of hepatitis B vaccine when they reached 2,000–2,200 g, irrespective of chronological age. Hepatitis B immunoglobulin (HBIG) was given at birth to infants born to HBsAg(+)/HBeAg(+) mothers.ResultsAll 155 of the recruited children were HBsAg and anti-HBc negative. The anti-HBs seropositivity rate (geometric mean titer) was 84.1% (146.5 mIU/mL) for children under 3 years, 73.5% (68.8 mIU/mL) for 4- to 7-year-olds, 27.7% (55.4 mIU/mL) for 8- to 11-year-olds and 20% (6.0 mIU/mL) for children ≥12 years of age. More than 90% of these children received the first vaccination after 30 days of age, half (51%) at 60 to 90 days, and 29 children (18.6%) after 90 days of age. Of the 26 infants born to HBsAg(+) mothers, 6/6 infants of HBeAg(+) mothers received HBIG at birth, and 12/20 infants of HBeAg(−) mothers received HBIG. None of the 26 infants became infected.ConclusionsDelaying hepatitis B vaccinations in VLBW preterm infants until they reach a weight of 2,000 g, with the administration of HBIG at birth for infants of HBsAg(+) mothers provided adequate immunogenicity and protection in a highly endemic area. Weight-based policy of hepatitis B vaccination is an effective and practical alternative strategy for VLBW infants.