Hepatitis B Vaccine Birth Dose Uptake Unimpacted By COVID-19 Pandemic

Y. Tony Yang, ScD, LLM, MPH

Credit: George Washington University Nursing

Despite notable disruptions to routine childhood vaccinations during the COVID-19 pandemic, findings from a recent study suggest hepatitis B birth dose vaccination efforts improved from 2017-2022.¹

The analysis of newborn hepatitis B vaccination records from the Washington, DC Department of Health Vital Statistics Division revealed a decline in refusal of hospital-administered birth doses of the vaccine, likely attributable to revised Advisory Committee on Immunization Practices (ACIP) hepatitis B vaccination guidelines. Released in 2018, the revision recommends universal hepatitis B vaccination within 24 hours of birth for medically stable infants weighing ≥2000 grams and removes “permissive” language for delaying the birth dose until after hospital discharge.^1,2

“The 2018 guideline changes were followed by the COVID-19 pandemic in 2020, causing reduced uptake of routine childhood vaccines,” Y. Tony Yang, ScD, LLM, MPH, associate dean for health policy and population science and endowed professor in health policy at the George Washington University School of Nursing, and colleagues wrote.¹ “It is uncertain whether the pandemic affected the rate of hospital-administered birth doses of the hepatitis B vaccination.”

According to the World Health Organization, an estimated 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections each year. Perinatal transmission from mother to child at birth is common, and the development of chronic infection is frequent in infants infected from their mothers or before the age of 5 years. Although it is preventable with a vaccine, newborn hepatitis B vaccination rates have historically been lower than desired, necessitating updated ACIP guidance.^2,3

To assess the rate of hospital-administered birth doses of the hepatitis B vaccination after the revised ACIP guidelines and during the COVID-19 pandemic, investigators conducted a retrospective, repeated, cross-sectional study leveraging electronic records for newborn hepatitis B vaccinations from the DC Department of Health Vital Statistics Division from January 1, 2017, to December 31, 2022. The analysis was restricted to births at 6 local hospitals with documented hepatitis B vaccine refusal status and a valid birth date. Investigators assessed the percentage of hepatitis B vaccine refusals across the entire cohort and stratified by the mother’s self-reported race.¹

Of the 76,194 recorded births, investigators excluded 757 nonhospital births, 639 with missing refusal information, and 135 lacking a valid date, leaving 74,660 for analysis. Among the cohort, 40.8% of mothers were Black; 41.4% were White; and 17.9% were categorized as other races.¹

Investigators noted the overall hepatitis B refusal rate decreased from 12.1% of 10,982 births in 2017 to 3.5% of 11,304 births in 2022, with the most substantial declines occurring in 2019 and 2020. Further analysis of weekly refusal rates revealed a gradual decline beginning in early 2018, with a more significant decrease in late 2019 and early 2020 before stabilizing in mid-2020.¹

By race, White mothers had the greatest initial refusal rates, with 14.7% refusing the vaccine in 2017 compared to 11.2% of Black mothers and 8.8% of mothers of other races. However, mothers who identified as White had the earliest decline, with refusal decreasing to 12.1% in 2018 versus Black mothers, who increased to 11.6%, and mothers of other races, who stayed the same at 8.8%.¹

From 2018 through 2022, investigators pointed out overall refusal rates of mothers of all races decreased. Although Black mothers and those of other races had similar trends in refusals over time, mothers in the “other race” cohort consistently had lower refusal rates than Black and White mothers.¹

Investigators recognized multiple limitations to these findings, including missing data on maternal HBsAg status, infant birth weight, and medical stability; limited generalizability due to the focus on the Washington, DC, area; and the inability to determine a specific cause of the decline in refusals observed over the study period.¹

“Despite the pandemic disrupting routine childhood vaccinations,5 hepatitis B vaccination efforts remained strong, with sustained low refusal rates in 2021 and 2022, especially for hospital-based birth doses,” investigators concluded.¹ “Further research is needed to investigate the role of the hospital setting in sustaining hepatitis B vaccination rates during the pandemic.”

References

1. ^{Yang YT, Leslie TF, Delamater PL. Hepatitis B Vaccine Refusal Trends in Washington, DC, Newborns, 2017-2022. JAMA Netw Open. 2024;7(7):e2421202. doi:10.1001/jamanetworkopen.2024.21202}
2. ^{Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1):1–31. doi:http://dx.doi.org/10.15585/mmwr.rr6701a1}
3. ^{World Health Organization. Hepatitis B. Newsroom. April 9, 2024. Accessed July 11, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b}