The hepatitis B birth‐dose immunisation: Exploring parental refusal

Abstract

Background Hepatitis B virus (HBV) immunisation is the first vaccine of infant life and one of the most commonly refused immunisations on the Australian Immunisation Schedule. Aims To quantify the frequency of declined HBV immunisation birth‐doses, investigate reasons for refusal, and determine information sources used by parents. Materials and Methods A cross‐sectional study using a questionnaire was conducted on postnatal women who declined their newborn's HBV birth‐dose immunisation during December 2016–July 2017 at an Australian tertiary referral hospital. Mothers who were non‐English‐speaking, unwell or medically unstable, or otherwise unavailable were excluded. Results One hundred and thirty‐seven of the 1574 (8.7%) eligible reviewed infants had HBV immunisation birth‐doses documented as declined; 113 mothers consented to complete the questionnaire. The most common reasons for declining the dose were: ‘baby too young’ (55.8%); preference for two, four and six‐month HBV immunisations only (56.6%); perceived low risk of contracting HBV (45.1%); and a fear of ‘overloading’ their baby's immune system (42.5%). General practitioners or nurses/midwives (43.3%) and the internet/media (33.6%) were the predominant information sources consulted, and 58.4% felt satisfied with the information they received antenatally. Eighty‐eight of 113 mothers (77.9%) would still consider future immunisations for their infant. Conclusions The majority of postnatal women decline HBV birth‐dose immunisation for their newborns citing age‐related safety concerns and vaccine misconceptions. Informal information sources such as the internet and media are often consulted. Addressing the need for antenatal and health professional education toward the birth‐dose may be instrumental in improving uptake.

Factors Associated with The Rejection of Child Immunization: A Systematic Review

“…Submission of good and correct information about vaccines in appropriate ways, and trust in health personnel influences acceptance of vaccines (Gilmartin et al, 2019). In Nigeria, where health services are poor, interpersonal health personnel are also low, causing people to feel intimidated to receive vaccines and feel humiliated, making high resistance to immunization.…”

“…Rejection of HBV vaccine in neonatal occurs in Australia because of doubt about the safety of vaccines for newborns because they think babies are still vulnerable to receive the vaccine. In addition, parents also assume the baby has a natural immunity that will continue to form, so giving a vaccine will be very excessive for infant immunity (Gilmartin et al, 2019).…”

Improving On-time Administration of the Initial Hepatitis B Vaccine in the NICU

“…2,3 However, some units struggle to achieve on-time administration, potentially related to system processes, provider opinion, and/or parental preference or refusal. [4][5][6][7] Newborns admitted to neonatal intensive care units (NICUs) are at risk for immunization delays. 8,9 These delays occur for infants born prematurely and term infants admitted with congenital anomalies or other problems.…”