Medical Providers' Attitudes and Practices Regarding the Hepatitis B Vaccine Universal Birth Dose in New Jersey Delivery Hospitals, 2011–2012

BACKGROUND:  The Advisory Committee for Immunization Practices recommends that all newborns receive a dose of hepatitis B vaccine before hospital discharge to prevent hepatitis B virus (HBV) infection from an infected mother during delivery or from an infected close contact to the child. According to the 2011 National Immunization Survey, New Jersey (NJ) ranked 49^thamong all states for birth dose vaccination rates (NJ: 47.3%; nationwide: 68.6%). We evaluated attitudes and practices of healthcare professionals in NJ delivery hospitals regarding the universal birth dose and knowledge of relevant hospital policies.

METHODS: Pediatricians, family practitioners, obstetricians/gynecologists, nurses, and midwives from NJ hospitals were asked to participate in an electronic survey that assessed knowledge of hospital policies and procedures and barriers to birth dose administration through use of standard and specialty-specific questions. Participants were identified through professional societies and outreach to hospital infection preventionists. 

RESULTS: The survey was completed by 191 providers. Approximately 7% of participants correctly estimated NJ birth dose rates; 69% were aware of written hospital policies for vaccination before discharge. Three percent indicated that vaccination consent is obtained before delivery. Eighty-four percent recommended that birthing classes include birth dose discussions; however, only 14% of pediatricians and 34% of obstetricians/gynecologists reported always discussing birth dose with parents before admission. Approximately 70% of participants indicated that pediatricians have the most influential role in the decision-making to administer the birth dose before discharge. Pediatricians indicated the following reasons for not providing the birth dose: parental refusal (70%), ease of monitoring immunizations in private practice (70%), and belief that it was not necessary for most of their patients (60%). Among pediatricians, 49% reported that obstetricians/gynecologists never communicated the maternal HBV status before admission, and 23.5% reported no communication after admission. Birth dose was rarely discussed between pediatricians and obstetricians/gynecologists; 69% of pediatricians reported that obstetricians/gynecologists never discussed the birth dose before admission, and 56% reported no communication after admission, even for HBV-positive mothers.

CONCLUSIONS: Our results demonstrate lack of knowledge among providers regarding NJ birth dose rates and hospital policies. Although our results might not be generalizable to all providers, further outreach to providers (e.g., in-person seminars, written materials) and to parents (e.g., birthing classes) is necessary. As other studies have demonstrated, hospitals that obtain consent before delivery achieve better vaccination rates. NJ delivery hospitals might consider adoption of similar protocols. Additionally, increasing communication between parents, pediatricians and obstetricians/gynecologists both before and after admission can help improve birth dose rates.