BACKGROUND: (Children born to mothers with hepatitis B infection have a 40% risk of becoming infected if timely immunoprophylaxis is not given. Hepatitis B immune globulin and first dose of vaccine within 12 hours of birth is recommended. Following third dose of vaccine, post-vaccine serological testing (PVST) is suggested by 18 months to ensure immunity and lack of infection. The aim of this study was to identify factors affecting vaccination and PVST completion.)
METHODS: (Children of women with hepatitis B infection born from 2012-2014 reported to Kansas Department of Health and Environment (KDHE) through disease reporting and birth certificate surveillance were included. Follow-up time for analysis of vaccine completion was 18 months while PVST was 24 months. Maternal age, race, ethnicity, presence of insurance, county residence, and type of physician at birth were analyzed to determine effect on vaccine completion and PVST. Records were excluded if the infant no longer resided in Kansas or was lost to follow up.)
RESULTS: (Between 2012 and 2014, 170 infants born to mothers with hepatitis B infection were reported to KDHE; 92% completed the hepatitis B vaccine series. Children of non-Asian mothers compared to Asian mothers (adjusted risk ratio 4.80, 95% CI: 1.19-19.31) and children in rural counties compared with children in urban counties (risk ratio 3.08, 95% CI: 1.10-8.61) were more likely to not complete the three vaccine doses. Children uninsured at birth were more likely to not complete hepatitis B vaccine series compared with children with medical coverage (public or private) (adjusted risk ratio 3.60, 95% CI: 1.32-9.87). Between 2012 and 2013, 122 infants born to mothers with hepatitis B infection were reported to KDHE; 56% completed PVST. Uninsured children were more likely to not receive PVST compared to children who had medical coverage (adjusted risk ratio 2.26, 95% CI: 1.08-1.85). Maternal age, ethnicity, and type of physician at birth were not associated with vaccine series or PVST completion.)
CONCLUSIONS: (Infants without health insurance at birth were three times more likely to not complete vaccine series and PVST and infants residing in rural communities were more likely to not complete the vaccine series, suggesting access to and cost of care may be barriers. Racial disparities were observed. Further investigation into access to care, race, and socioeconomic status for children of mothers with hepatitis B infection is planned. Education about the availability of public services may increase vaccination completion and receipt of PVST.)