PC1135: Adherence to AAP Recommendations for Birth Dose of Hepatitis B Vaccination at a Large Birthing Hospital in Houston, Texas

Purpose/Objectives: Perinatal infection with Hepatitis B virus (HBV) becomes chronic in 90% of cases with subsequent risk of developing serious liver disease. To prevent perinatal infection, American Academy of Pediatrics (AAP) has vaccine recommendations for 3 groups of newborns weighing ≥ 2,000 grams: (1) maternal hepatitis B surface antigen (HBsAg) positive: administration of HBV vaccine and immune globulin by 12 hours of life (HoL); (2) maternal HBsAg negative: administration of HBV vaccine by 24 HoL; and (3) maternal HBsAg unknown: administration of HBV vaccine by 12 HoL (and HBV immune globulin by hospital discharge if status remains unknown). These timings maximize effectiveness of the HBV vaccine in preventing vertical transmission. Given overall poor compliance with current HBV vaccination recommendations demonstrated by the National Immunization Survey, we hypothesized insufficient adherence to these guidelines at a large women’s and children’s center, especially in intensive care settings.

Design/Methods: This was a retrospective cohort study of newborns born from January 2019-December 2021 at Texas Children’s Hospital in Houston, Texas (n=19,047). All newborns ≥2,000 grams were included and stratified by maternal HBsAg result within 1 week of admission (negative, unknown, or positive by 12 HoL) (Table 1). Univariate analysis was used to identify factors associated with timely receipt of the HBV vaccine and/or immune globulin.

Results: Among infants with the highest risk of perinatal transmission due to positive maternal HBsAg (n=39), 7.7% did not receive the HBV vaccine or immune globulin within 12 HoL (Table 1). In infants of mothers with negative HBsAg (n=18,933), 22.1% did not receive the HBV vaccine by 24 HoL, and 6.7% did not receive it prior to discharge. In infants of mothers with unknown HBsAg by 12 HoL (n=75), 74.7% of infants did not receive the HBV vaccine within 12 HoL, and 8% did not receive it prior to discharge (Table 2). Infants not receiving the vaccine prior to discharge (6.7% n=1,281) were more likely to be Caucasian (p < 0.001), English-speaking (p < 0.001), and not receive vitamin K or erythromycin (p < 0.001). Overall deviation from vaccination guidelines was highest in newborns admitted to intensive care units, and similar vaccination rates occurred in the period before and during the SARS-CoV-2 pandemic.

Conclusion/Discussion: Current newborn HBV vaccination practices are not meeting AAP recommendations. Newborns with maternal HBV positive or unknown status are at highest risk of vertical transmission; therefore, system-level interventions to improve timely vaccination should target these groups first, especially in intensive care settings. With only 71.2% of newborns with negative maternal HBsAg receiving the HBV vaccine within 24 HoL, further research into the best implementation strategies for the current AAP recommendations is needed. Dialog to increase HBV vaccine acceptance with individual families will also be required to improve overall rates.