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Diane S. Lauderdale, PhD; Ronda J. Oram, MD; Karen P. Goldstein, MD, MPH; Robert S. Daum, MD

JAMA. 1999;282:1725-1730.

Context  In 1991, the Advisory Committee on Immunization Practices recommended universal vaccination of infants against hepatitis B virus (HBV), with series initiation within days of birth.

Objective  To determine HBV vaccine coverage in a low-income urban population and to examine whether HBV immunization within the first month of life affects subsequent vaccine receipt.

Design  Cohort study based on immunization records collected in the Pediatric Immunization Program.

Setting  Large public housing development in Chicago, Ill.

Participants  All 1143 children who were born between 1991 and 1997 and enrolled between 1993 and mid-1998, with follow-up to age 35 months.

Main Outcome Measures  On-time vaccine receipt of HBV vaccine doses, diphtheria-tetanus-pertussis vaccine (DTP) dose 1, and the 4:3:1 series (4 doses of DTP vaccine, 3 doses of poliomyelitis vaccine, and 1 dose of measles-containing vaccine), analyzed by year.

Results  On-time HBV vaccination increased quickly following new guidelines and reached a plateau of about 50% coverage for those born in or after 1995. Since 1994, more children (64%) received the first HBV vaccine dose on time than any other vaccine. Children who received a dose of HBV vaccine during their first month of life were more likely to receive the first DTP vaccine dose on time (60.1%) than those who did not get an HBV vaccine dose during the first month (36.4%; ² = 53.7; P<.001). Children who received the first HBV vaccine dose during their first month were more likely than those receiving it at age 1 to 2 months to complete 3 HBV doses by 19 months (70.6% vs 51.1%; ² = 11.6; P = .001) and to complete the 4:3:1 series by age 19 months (49.8% vs 37.9%; ² = 4.0; P = .05).

Conclusions  In this inner-city population, HBV vaccine has been received at rates similar to those of other vaccines within 3 years of issuance of new recommendations. Of note, immunization with HBV vaccine at birth was associated with timely receipt of other vaccines and, therefore, may have the potential to increase vaccination among groups less likely to be up-to-date on early childhood vaccines.

Author Affiliations: Departments of Health Studies (Dr Lauderdale) and Pediatrics (Drs Oram, Goldstein, and Daum), University of Chicago, Chicago, Ill.

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