Hospitals' responses to universal infant hepatitis B vaccination recommendations

To assess the extent to which hospitals in a midwestern state with low acute hepatitis B virus (HBV) morbidity offered hepatitis B (Hep B) vaccine to all infants, whether offering infants Hep B vaccine was associated with hospital geographic location or size, as measured by the number of births, and how hospital staff resolved key programmatic issues. The managers of hospital newborn nurseries (N = 110) were surveyed by mail. The written response rate was 72%; all of the nonresponders were interviewed by telephone. The outcome measured was the number of hospitals offering Hep B vaccine to all infants by geographic region and hospital size. Sixty-five percent of the hospitals routinely offered Hep B vaccine to all infants; these hospitals accounted for 80% of reported Wisconsin births. In univariate analysis, the decision to offer infants Hep B vaccine was associated with both hospital size and hospital location. After controlling for size, hospitals in the northeastern region were eight times more likely (relative risk, 8.21; 95% confidence interval, 1.30, 51.79) to offer infants Hep B vaccine than hospitals in the southeastern (referent) region. Regional differences in reported rates of acute HBV infection do not explain this finding, because morbidity in the northeastern region (1 per 100,000) is among the lowest in Wisconsin. Although more than 80% of hospitals with Hep B vaccination programs required written informed consent for vaccination, had standing orders for administering Hep B vaccine to infants whose mothers' hepatitis B surface antigen (HBsAg) test results were known, and had mechanisms to notify the infants' physicians that the infants had been vaccinated, only 38% had standing orders for testing mothers whose HBsAg test results were unknown.