Reactions of Pediatricians to a New Centers for Disease Control Recommendation for Universal Immunization of Infants With Hepatitis B Vaccine

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Abstract
Despite immunization programs targeting high-risk groups, the incidence of hepatitis B has risen 37% over the last decade with 300000 new infections and 5000 related deaths now occurring annually in the United States. As a new strategy to control the spread of hepatitis B, the Advisory Committee on Immunization Practices of the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. There was no other federal effort to disseminate this recommendation. On February 14, 1992, the American Academy of Pediatrics (AAP) issued a similar recommendation. The time between the CDC and AAP recommendations presented the opportunity to determine the singular effect on clinical practice of the CDC's dissemination effort. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization. All 778 pediatricians in North Carolina were surveyed by mail 2 to 3 months after publication of the new CDC recommendation. Descriptive statistics, χ2 analysis, and logistic regression were used to assess the relationship of variables hypothesized to predict physician awareness of and/or agreement with the new recommendation. The response rate was 78%. Although 82% of pediatricians who administer immunizations were aware of the new recommendation, only 32% believed it was warranted in their practices. Twenty-six percent of respondents expect more than half of parents to refuse three injections at a single well-child visit, a possible result of adding this vaccine to the primary immunization series. Additionally, 29% expect nurses to resist giving three injections at one visit. It is concluded that current CDC efforts are insufficient to effect change in clinical practice. Practical concerns of physicians and their patients regarding multiple injections and other issues must be considered when formulating new immunization recommendations if their implementation is to be successful.

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