Progress toward integrating hepatitis B vaccine into routine infant immunization schedules in the United States, 1991 through 1994

Objective. We assessed progress toward universal infant immunization against hepatitis B, which was first recommended in November 1991. Methods. Multiple data sources were used to describe vaccination policies and trends in infant hepatitis B vaccine coverage. Results. As of June 1993, 51% of the 63 local, state, and territorial immunization programs recommended hepatitis B vaccination of all newborns shortly after birth. The number of first dosages of hepatitis B vaccine administered to infants in public sector clinics increased rapidly from late 1992 to 1993, and at the end of 1993 was approximately two thirds the number of first dosages of other infant antigens. In a nationwide survey of hospital nurseries 47% offered hepatitis B vaccine to all newborns. Of 3982 sampled newborns in these hospitals, 36.2% had been vaccinated before discharge. In San Francisco and Connecticut, where public health officials encouraged hospitals to offer hepatitis B vaccination, first-dose coverage at discharge was 82.3% in 1994 and 69.1% in 1993, respectively. Coverage was higher in healthier infants and lower in infants of older or bettereducated mothers. Results from the National Health Interview Survey demonstrate that three-dose completion at 12 months of age increased from less than 1% of children born in 1989 to 40% of children born in the fourth quarter of 1992. Vaccination at birth increased from less than 1% of infants born in 1989 to 32% of infants born in the second half of 1993. Conclusions. Infant hepatitis B vaccination has expanded rapidly since national recommendations were made; however, universal coverage has not been achieved.