Hepatitis B vaccination practices in hospital newborn nurseries before and after changes in vaccination recommendations

Arch Pediatr Adolesc Med. 2001 Aug;155(8):915-20. doi: 10.1001/archpedi.155.8.915.


Background: Routine use of hepatitis B vaccine for low-risk newborns was suspended on July 7, 1999, because of concern about the potential risk of thimerosal, a mercury-containing vaccine preservative. Reinstatement of the birth dose was recommended when a thimerosal-free vaccine became available.

Objective: To explore changes in hepatitis B vaccination practices for newborns related to the revised recommendations for low-risk infants (in this study, the terms newborn and infant are used interchangeably).

Design: A telephone survey of a random sample of 1000 US hospitals.

Participants: Nurse managers, nursery directors, and staff nurses of the newborn nurseries.

Main outcome measures: Nursery vaccination practices before and after July 7, 1999, and the availability and use of thimerosal-free vaccine.

Results: Interviews were conducted with 773 (87%) of 886 eligible hospitals. Before July 7, 1999, 78% of the hospitals reported vaccination practices that were consistent with recommendations at that time, although only 47% vaccinated all low-risk infants at birth. After July 7, 1999, almost all hospitals discontinued vaccination of low-risk infants, in accordance with the recommendation change; however, there was a 6-fold increase in the number of hospitals that were not vaccinating all high-risk infants. After the introduction of thimerosal-free vaccine, only 39% of the hospitals reported vaccinating all low-risk infants.

Conclusions: Most hospital nurseries altered their newborn hepatitis B vaccination practices consistent with changes in national recommendations. However, unintended consequences included the failure of some hospitals to continue vaccinating all high-risk infants and the delay in reintroducing vaccination for low-risk newborns after the introduction of a thimerosal-free vaccine. Assessments of the appropriateness of this country's response to the threat of thimerosal in vaccines should consider these findings.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Data Collection
  • Female
  • Forecasting
  • Guideline Adherence / statistics & numerical data*
  • Hepatitis B / prevention & control*
  • Hepatitis B Vaccines / administration & dosage*
  • Humans
  • Infant, Newborn
  • Male
  • Nurseries, Hospital / standards*
  • Nurseries, Hospital / statistics & numerical data
  • Population Surveillance
  • Practice Guidelines as Topic
  • Sensitivity and Specificity
  • Surveys and Questionnaires
  • United States
  • Vaccination / standards
  • Vaccination / trends*


  • Hepatitis B Vaccines