Hepatitis B Vaccination Practices in Hospital Newborn Nurseries Before and After Changes in Vaccination Recommendations

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Abstract
Background Routine use of hepatitis B vaccine for low-risk newborns was suspended on July 7, 1999, because of concern about the potential risk of thimerosal, a mercury-containing vaccine preservative. Reinstatement of the birth dose was recommended when a thimerosal-free vaccine became available. Objective To explore changes in hepatitis B vaccination practices for newborns related to the revised recommendations for low-risk infants (in this study, the termsnewbornandinfantare used interchangeably). Design A telephone survey of a random sample of 1000 US hospitals. Participants Nurse managers, nursery directors, and staff nurses of the newborn nurseries. Main Outcome Measures Nursery vaccination practices before and after July 7, 1999, and the availability and use of thimerosal-free vaccine. Results Interviews were conducted with 773 (87%) of 886 eligible hospitals. Before July 7, 1999, 78% of the hospitals reported vaccination practices that were consistent with recommendations at that time, although only 47% vaccinated all low-risk infants at birth. After July 7, 1999, almost all hospitals discontinued vaccination of low-risk infants, in accordance with the recommendation change; however, there was a 6-fold increase in the number of hospitals that were not vaccinating all high-risk infants. After the introduction of thimerosal-free vaccine, only 39% of the hospitals reported vaccinating all low-risk infants. Conclusions Most hospital nurseries altered their newborn hepatitis B vaccination practices consistent with changes in national recommendations. However, unintended consequences included the failure of some hospitals to continue vaccinating all high-risk infants and the delay in reintroducing vaccination for low-risk newborns after the introduction of a thimerosal-free vaccine. Assessments of the appropriateness of this country's response to the threat of thimerosal in vaccines should consider these findings.