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BACKGROUND: Philadelphia has some of the highest immunization up-to-date (UTD) rates in the country, with 74% of 19-35 month olds completing their standard 18 month vaccination series and 78% completing the hepatitis B (HBV) birth dose within 3 days of birth (NIS 2012). However, in recent years Philadelphia HBV birth dose rates have plateaued while rates in other jurisdictions have increased. Ready access to electronic birth information on the approximately 20,000 infants born in the city annually allows for assessment of association between maternal and child factors with lack of vaccination.
METHODS: Analysis was conducted on Philadelphia residents born 2011- 2012. Two models were fitted with logistic regression to evaluate association between maternal characteristics and HBV birth dose (model 1) and future on time UTD vaccination status (model 2). Infants weighing less than 2000 grams were eliminated from model 1, because these infants are recommended to delay their first HBV dose according to ACIP guidelines. UTD status for the 3rd DTaP dose by seven months of age was used as an indicator for future on time vaccination status in model 2. An analysis of HBV birth dose completion by birth hospital was also conducted for births 2008-2012.
RESULTS: Model 1 included 34,400 of 36,308 eligible children and 83% received a birth dose. Model 2 included 35,404 of 38,033 eligible children and 70% were UTD for their DTaP vaccination. In this period, 5,871 children did not have a birth dose reported, but 68% were UTD for their DTaP vaccination at seven months. Children of married, more highly educated mothers who smoked during pregnancy, and breastfed were significantly less likely to receive a birth dose. However, children of non-white mothers with ≥ 5 prenatal visits were significantly more likely to receive a birth dose. Children of married, more highly educated mothers ≥ 22 years old with ≥ 5 prenatal visits, who were on WIC, and breastfed had a significantly higher probability of being UTD for DTaP. Having a non-white mother accounted for the most children being not UTD for DTaP, but having a mother who smoked during pregnancy also significantly increased probability of being not UTD. Mean HBV birth dose completion rates from 2008-2012 varied between birth hospitals (range: 70%-90%).
CONCLUSIONS: Birth hospital and maternal characteristics collected at birth can be used to identify infants at-risk for not completing vaccinations. These characteristics can be used to target families for immunization outreach and education programs.