Connecticut Epidemiologist Newsletter • July 2023 • Volume 43, No 5
Hepatitis B Vaccination Birth Dose Administrations by Hospital or Birthing Facility – Connecticut, 2022
Background
Hepatitis B virus is transmitted by direct contact with the HBsAg (hepatitis B surface antigen)-positive blood or mucosal fluid of a person who is acutely or chronically infected (1). The virus can be transmitted from an infected pregnant person to their baby during childbirth, due to the blood exchange that happens between mother and baby (2). As many as 90% of hepatitis B infections that occur in infants progress to chronic infection. While people with chronic infection are often asymptomatic, they are capable of infecting others. Chronic infection may also lead to liver disease including chronic hepatitis, cirrhosis, liver failure and hepatocellular carcinoma (1).
To protect newborns from hepatitis B infection, in the U.S., medically stable infants with a birth weight of at least 2,000 grams are recommended to receive a first dose of hepatitis B vaccine within 24 hours of birth. Infants born to mothers whose HBsAG status is positive or unknown are recommended to receive the hepatitis B birth dose within 12 hours of birth (1).
The Connecticut Vaccine Program (CVP) is Connecticut’s (CT) state and federally funded program that supplies vaccines to CT providers for administration to children under the age of 19 years at no cost (CT Statute 19a-7f) (3) including the Hepatitis B vaccine. The administration of vaccine is reportable to CT WiZ (CT Statute 19a-7 updated by PA22-118 Sec. 493) (3) and pediatric providers must account for all doses supplied to them by CT DPH.
CT WiZ is Connecticut’s secure web-based Immunization Information System (IIS) that meets national standards for effective tracking and documenting of the administration of vaccinations (4). CT WiZ creates a consolidated immunization record that is useful to clinicians caring for a patient and members of the public who need access to their records. Data from CT Wiz can also be used to assess population-level vaccine coverage including the percentage of infants that have received a birth dose of hepatitis B vaccine as recommended.
Methods
Data on infants born in CT in 2022 and currently residing in the state were extracted from CT WiZ on April 6, 2023, including hepatitis B vaccination and birth facility information. Birth weight was established by linking CT WiZ records with birth certificates using the state birth certificate identification number.
Infants born in a Connecticut hospital or birthing center were identified. For these infants, the day of life that the first hepatitis B vaccination was administered was calculated with the day of birth being designated as day 0. Infants who had a dose administered on day 0 or 1 were classified as having had an on-time hepatitis B vaccine birth dose. The percentage of infants with an on-time birth dose was calculated for the state overall and by each hospital or birthing center and compared to the 90% target recommended by the Immunization Action Coalition (IAC) (5) as adapted by DPH. Infants with a known low birth weight (less than 2,000 grams) were excluded from analyses.
Results
A total of 32,766 Connecticut resident infants were born in a Connecticut hospital or birthing center in 2022, of which 31,866 (97.2%) weighed at least 2,000 grams at birth, 877 (2.7%) weighed less than 2,000 grams and 33 (0.1%) did not have birth weight available.
Figure 1 summarizes the day of life that the first dose of hepatitis B vaccination was given for 31,899 infants, excluding those reported to be less than 2,000 grams at birth. A total of 87.8% of infants had an on-time hepatitis B birth dose (65.9 % on the day of birth and 21.9% on the first full day of life). There was no hepatitis B vaccination record for 3.4% of infants.
Figure 2 shows the percentage of infants with an on-time hepatitis B birth dose by birth hospital or birthing center. On-time hepatitis B birth dose coverage ranged from 40.0%–96.4%. Fifteen out of the 24 hospitals or birthing centers met the 90% target.
Discussion
These data suggest that adherence to the hepatitis B birth dose guidance is relatively high in Connecticut at 87.8% although still below the 90% target. However, there is considerable variation across hospitals and birthing centers.
Birthweight was available for almost all infants and therefore it was possible to exclude infants who were less than 2,000 grams at birth. However, other factors that could affect guidance on vaccination timing, such as not being clinically stable at birth or the HBsAG status of the mother, could not be considered.
In this analysis on-time hepatitis B birth dose is defined as administration by the end of the first day of life rather than 24 hours because CT WiZ records the date, but not the time, of vaccine dose administered. This would result in overestimating the percentage of infants vaccinated on-time. It may also appear that a child has not had an on-time birth dose if the hepatitis B birth dose record does not match up with other vaccine reports for a child causing duplicate patient records. Infants whose parents opted them out of CT WiZ are not included in this analysis. The percent of children born in 2022 that opted out of CT Wiz was less than 0.5%.
Hospital policy and parental wishes may affect whether a hepatitis B birth dose is administered at a time that is consistent with current guidance. Hospitals with a lower percentage of infants that have an on-time hepatitis B birth dose are encouraged to review their policy concerning the administration of hepatitis B vaccine to newborn infants and ensure that is consistent with current guidance.
Reported by
Durante AJ, Sharova N, Kudish KK. CT Department of Public Health Immunization Program
References
1.Centers for Disease Control and Prevention. (2021, August 18). Epidemiology and Prevention of Vaccine-Preventable Diseases – Chapter 10: Hepatitis B. Retrieved on June, 7 2023 from https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html.
2.Hepatitis B Foundation. What is Hepatitis B. Retrieved June 7, 2023 from https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/.
3.Connecticut Department of Public Health. Immunization Laws and Regulations. Retrieved June 7, 2023 from https://portal.ct.gov/immunization/laws-and-regulations?language=en_US.
4.Connecticut Department of Public Health. All About CT WiZ. Retrieved June 7, 2023 from https://portal.ct.gov/immunization/public-landing-page/all-about-ct-wiz?language=en_US.
5.Immunize.org. Hepatitis B Birth Dose Honor Roll. Retrieved June 7, 2023 from https://www.immunize.org/honor-roll/birthdose/
This page last updated 07/17/2023