Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis B immunisation service

Abstract

Aims-To determine the eVectiveness of a selective hospital based hepatitis B immunisation programme and the barriers to be overcome in obtaining a successful outcome. Methods-Retrospective case note review of 265 infants born over a five year period to hepatitis B carrier mothers at a university aYliated hospital in Hackney, London. Results-A total of 242 infants (91%) were fully vaccinated; 217 (82%) had serology; 31 required booster doses. Percentages failing to reach second, third vaccinations, and serology on schedule rose exponentially (7%, 18%, 33% respectively). Mobility was high (25%) and significantly aVected outcome. A total of 95% Hackney resident babies were fully vaccinated compared with 78% non-residents. Uptake of routine immunisations was higher in Hackney residents than non-residents and greater in those who were eligible for hepatitis B vaccine. Name changes occurred in 35%. Translation requirements were high (85% for Turkish, Vietnamese, and Asian families). Requirements for specific postnatal counselling of mothers and hepatology referral fell significantly during the course of the study. Only seven of 22 babies born in 1995 in Tower Hamlets compared with 53 of 58 Hackney babies received a full vaccination course in non-hospital based primary care. Conclusion-In inner city areas with high prevalence of hepatitis B carriage, mobility, and diverse ethnicity, a dedicated centralised immunisation service can be highly eVective, provided that adequate support services (translation, counselling, and parental referral) are available.

UK vaccination schedule: persistence of immunity to hepatitis B in children vaccinated after perinatal exposure

“…A recent review of 85 English children with diagnosed chronic HBV infection (59 of whom were born in England) emphasised that horizontal transmission of HBV infection is a rare event compared with vertical transmission with incomplete primary immunisation 16. Administering overdue primary immunisations at the preschool age could, therefore, only impact on the low risk of horizontal transmission, unlike timely uptake of the infant course,15 a goal that has been shown to be achievable within the NHS 1718…”

Should universal hepatitis B immunisation be introduced in the UK?

“…[4][5][6] Some are excellent. [7][8][9] Cases like the one that made my colleague groan are uncommon-over 90% of at-risk babies receive vaccine and immunoglobulin at birth. 10 A universal programme may be less likely to miss anybody; but to prevent such cases vaccination would have to start at birth, like the new US policy.…”

Is fragmentation of schedules hampering the uptake of hepatitis B vaccine?

“…Our audit confirms the well known pattern of high initial uptake followed by exponential decline as reported in previous audits. 2 This has been ascribed to poor parental understanding about the importance of completion of the full course. 2 However, we found out that out of 11 cases who had the 1st dose but missed subsequent doses, three (27%) had moved out of the area, three (27%) did not receive appropriate notification (due to change of name or address), and five (46%) felt that there were too many attendances to complete the immunisation.…”

“…A diphtheria/tetanus/acellular pertussis-Haemophilus influenzae type b vaccine (DTaP-Hib), introduced to the UK in 1999, was associated with poor primary Hib responses 1 and a resurgence of Hib disease in the population. 2 Consequently, in 2003, the UK Department of Health undertook a campaign to immunise children aged 6 months-4 years with an additional dose of Hib. We have previously shown a significant rise in Hib titres following an additional Hib dose, given before one year, in infants with very low primary responses.…”