Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec 7;6(12):ofz518.
doi: 10.1093/ofid/ofz518. eCollection 2019 Dec.

Retrospective Review of Documentation Practices of Hepatitis B Immunoglobulin, Birth Dose, and Vaccination at the Hospital of Birth, in Thai Nationals and Migrants in Northern Thailand

Free PMC article

Retrospective Review of Documentation Practices of Hepatitis B Immunoglobulin, Birth Dose, and Vaccination at the Hospital of Birth, in Thai Nationals and Migrants in Northern Thailand

M Bierhoff et al. Open Forum Infect Dis. .
Free PMC article


Background: Vaccination remains the mainstay of prevention of hepatitis B virus (HBV) including birth dose and hepatitis B immunoglobulins (HBIGs). National estimates of vaccination coverage exclude migrants. The objective of this study is to investigate documentation practices of HBV-related infant vaccinations in Northern Thailand including migrants.

Methods: This is a retrospective review of hospital records of women who birthed infants in 2015 at Maharaj Nakorn Hospital, Chiang Mai (CM) or on the Thailand-Myanmar border, Tak.

Results: Of 2522 women, 987 were from CM (861 Thai nationals, 126 migrants) and 1535 were from Tak (651 Thai residence and 884 Myanmar residence). In CM, documentation for the birth dose vaccine (999 of 999, 100%) and HBIG was complete. In Tak, documentation was 1441 of 1549 (93%) for birth dose and 26 of 34 (76.5%) for HBIG, with missed opportunities including home delivery, delay in obtaining hepatitis B e-antigen status, and limitations of the records. Expanded Program of Immunization (EPI) documentation of 3 follow-up vaccinations dwindled with subsequent doses and distance, and complete documentation of 3 HBV EPI vaccines at the hospital of birth was low, 41.5% (1056 of 2547), but equitable for Thai or migrant status.

Conclusions: This review provides strong support for excellent documentation of HBIG and birth dose vaccination in urban and rural settings, and in migrants, consistent with Thailand's vaccination policy and practice. Documentation of the 3 HBV EPI at the hospital of birth decreases with sequential doses, especially in families further away. Innovative data linkage is required to prove coverage and identify gaps.

Keywords: childhood; EPI; coverage; hepatitis B; immunization.


Figure 1.
Figure 1.
Study flow chart.
Figure 2.
Figure 2.
Map of clinic sites and hepatitis B vaccination documentation at birth hospitals, according to residence. (A) Outside of Chaing Mai; (B) Regional Chiang Mai; (C) Chiang Mai District; (D) Wang Pha Myanmar residence; (E) Wang Pha Thailand residence; (F) Maw Ker Thai Myanmar residence; (G) Maw Ker Thai Thailand residence. Clarification: Pie charts represent hepatitis B virus (HBV) vaccination at the birth hospital per clinic site and per area of residence for Chiang Mai and country of residence for Tak. Birth dose, birth dose HBV vaccination; EPI, Expanded Program on Immunization consisting of 3 vaccinations.

Similar articles

See all similar articles


    1. Pan CQ, Duan ZP, Bhamidimarri KR, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol 2012; 10:452–9. - PubMed
    1. Chen SC, Toy M, Yeh JM, et al. Cost-effectiveness of augmenting universal hepatitis B vaccination with immunoglobulin treatment. Pediatrics 2013; 131:e1135–43. - PMC - PubMed
    1. Lee C, Gong Y, Brok J, et al. Hepatitis B immunisation for newborn infants of hepatitis B surface antigen-positive mothers. Cochrane Database Syst Rev 2006; Cd004790. - PubMed
    1. Pan CQ, Duan Z, Dai E, et al. ; China Study Group for the Mother-to-Child Transmission of Hepatitis B Tenofovir to prevent hepatitis B transmission in mothers with high viral load. N Engl J Med 2016; 374:2324–34. - PubMed
    1. World Health Organization. Global Hepatitis Report 2017. Geneva: World Health Organization; 2017.