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Hepatitis B Birth Dose Effects on Childhood Immunization in the U.S.

      Introduction

      The Advisory Committee on Immunization Practices recommends administering the first dose of hepatitis B vaccine at birth, making it the first vaccine that many children receive. However, few studies examine whether children who miss the birth dose are at increased risk of vaccination delay. This study investigates birth dose as a determinant of up-to-date immunization status at age 18 months, considering 7 core childhood vaccine series: diphtheria, tetanus, and acellular pertussis; polio; measles, mumps, and rubella; Haemophilus influenzae type B; varicella; hepatitis B; and pneumococcal conjugate vaccine.

      Methods

      Cross-sectional data were collected in 2017 by National Immunization Survey-Child, a nationally representative survey of children aged 19–35 months living in the U.S., and were analyzed in 2019. The primary outcome was combined 7-vaccine series (4:3:1:3:3:1:4) up-to-date status at 18 months. Doubly robust estimates of association were calculated using survey logistic regression and propensity scores estimated with boosted classification and regression trees.

      Results

      Children who received the birth dose had 2.01 (95% CI=1.74, 2.33) times the odds of being up-to-date on the combined 7-vaccine series as children who did not. ORs for all the 7 individual vaccine series were positive, ranging from 1.59 (95% CI=1.28, 1.97) for measles, mumps, and rubella to 4.97 (95% CI=3.97, 6.24) for hepatitis B.

      Conclusions

      Receiving the birth dose is positively associated with up-to-date status later in childhood, highlighting the importance of starting vaccination early. The association is insensitive to confounding by factors observed in National Immunization Survey-Child, but investigation of unobserved factors such as vaccine hesitancy could provide critical information to guide intervention strategy.
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      REFERENCES

        • Mast EE
        • Margolis HS
        • Fiore AE
        • et al.
        A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents.
        MMWR Recomm Rep. 2005; 54: 1-31
      1. HHS, CDC. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2019.www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Published 2019. Accessed March 20, 2019.

        • Hill HA
        • Elam-Evans LD
        • Yankey D
        • Singleton JA
        • Kang Y
        Vaccination coverage among children aged 19–35 months—United States, 2016.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 1171-1177
        • Kurosky SK
        • Davis KL
        • Krishnarajah G
        Completion and compliance of childhood vaccinations in the United States.
        Vaccine. 2016; 34: 387-394
        • Yusuf HR
        • Daniels D
        • Smith P
        • Coronado V
        • Rodewald L
        Association between administration of hepatitis B vaccine at birth and completion of the hepatitis B and 4:3:1:3 vaccine series.
        JAMA. 2000; 284: 978-983
        • Wu JN
        • Li DJ
        • Zhou Y
        Association between timely initiation of hepatitis B vaccine and completion of the hepatitis B vaccine and national immunization program vaccine series.
        Int J Infect Dis. 2016; 51: 62-65
        • Lauderdale DS
        • Oram RJ
        • Goldstein KP
        • Daum RS
        Hepatitis B Vaccination among children in inner-city public housing, 1991–1997.
        JAMA. 1999; 282: 1725-1730
        • Wagner AL
        • Eccleston AM
        • Potter RC
        • Swanson RG
        • Boulton ML
        Vaccination timeliness at age 24 months in Michigan children born 2006–2010.
        Am J Prev Med. 2018; 54: 96-102
        • Wilson P
        • Taylor G
        • Knowles J
        • et al.
        Missed hepatitis B birth dose vaccine is a risk factor for incomplete vaccination at 18 and 24 months.
        J Infect. 2019; 78: 134-139
        • Zhao Z
        • Murphy TV
        Which newborns missed the hepatitis B birth dose vaccination among U.S. children?.
        Prev Med. 2013; 57: 613-617
        • Jarrett C
        • Wilson R
        • O'Leary M
        • Eckersberger E
        • Larson HJ
        • SAGE Working Group on Vaccine Hesitancy
        Strategies for addressing vaccine hesitancy - a systematic review.
        Vaccine. 2015; 33: 4180-4190
        • Kim SS
        • Frimpong JA
        • Rivers PA
        • Kronenfeld JJ
        Effects of maternal and provider characteristics on up-to-date immunization status of children aged 19 to 35 months.
        Am J Public Health. 2007; 97: 259-266
        • Smith PJ
        • Chu SY
        • Barker LE
        Children who have received no vaccines: who are they and where do they live?.
        Pediatrics. 2004; 114: 187-195
        • Luman ET
        • McCauley MM
        • Shefer A
        • Chu SY
        Maternal characteristics associated with vaccination of young children.
        Pediatrics. 2003; 111: 1215-1218
        • Opel DJ
        • Taylor JA
        • Mangione-Smith R
        • et al.
        Validity and reliability of a survey to identify vaccine-hesitant parents.
        Vaccine. 2011; 29: 6598-6605
        • Luman ET
        • McCauley MM
        • Stokley S
        • Chu SY
        • Pickering LK
        Timeliness of childhood immunizations.
        Pediatrics. 2002; 110: 935-939
        • Oster NV
        • Williams EC
        • Unger JM
        • et al.
        Sociodemographic, clinical and birth hospitalization characteristics and infant hepatitis B vaccination in Washington State.
        Vaccine. 2019; 37: 5738-5744
      2. HHS, National Center for Immunization and Respiratory Diseases (NCIRD). The2017 National Immunization Survey–Child [data set]. https://ftp.cdc.gov/pub/Vaccines_NIS/NISPUF17.DAT. Published 2018. Accessed January 10, 2019.

      3. HHS, National Center for Immunization and Respiratory Diseases (NCIRD). National Immunization Survey–Child: a user's guide for the 2017 public-use data file. Chicago, Illinois: NORC at the University of Chicago.www.cdc.gov/vaccines/imz-managers/nis/downloads/NIS-PUF17-DUG.pdf. Published 2018. Accessed March 19, 2019.

        • Wolter KK
        • Smith PJ
        • Khare M
        • et al.
        Statistical methodology of the National Immunization Survey, 2005–2014.
        Vital Health Stat. 2017; 1: 1-107
        • Rosenbaum PR
        • Rubin DB
        The central role of the propensity score in observational studies for causal effects.
        Biometrika. 1983; 70: 41-55
        • Robins JM
        • Hernán MA
        • Brumback B
        Marginal structural models and causal inference in epidemiology.
        Epidemiology. 2000; 11: 550-560
        • Ridgeway G
        • Kovalchik SASA
        • Griffin BA
        • Kabeto MU
        Propensity score analysis with survey weighted data.
        J Causal Inference. 2015; 3: 237-249
        • Dugoff EH
        • Schuler M
        • Stuart EA
        Generalizing observational study results: applying propensity score methods to complex surveys.
        Health Serv Res. 2014; 49: 284-303
        • McCaffrey DF
        • Ridgeway G
        • Morral AR
        Propensity score estimation with boosted regression for evaluating causal effects in observational studies.
        Psychol Methods. 2004; 9: 403-425
        • Friedman JH
        Stochastic gradient boosting.
        Comput Stat Data Anal. 2002; 38: 367-378
        • Funk MJ
        • Westreich D
        • Wiesen C
        • Stürmer T
        • Brookhart MA
        • Davidian M
        Doubly robust estimation of causal effects.
        Am J Epidemiol. 2011; 173: 761-767
        • Lee BK
        • Lessler J
        • Stuart EA
        Improving propensity score weighting using machine learning.
        Stat Med. 2010; 29: 337-346
        • Lumley T
        Analysis of complex survey samples.
        J Stat Soft. 2004; 9: 1-19
        • National Immunization Program
        • National Center for Infectious Diseases
        • CDC
        Hepatitis B vaccination—United States, 1982–2002.
        MMWR Morb Mortal Wkly Rep. 2002; 51 (563): 549-552
        • Fiks AG
        • Alessandrini EA
        • Luberti AA
        • Ostapenko S
        • Zhang X
        • Silber JH
        Identifying factors predicting immunization delay for children followed in an urban primary care network using an electronic health record.
        Pediatrics. 2006; 118: e1680-e1686
        • Larson HJ
        • Jarrett C
        • Eckersberger E
        • Smith DMD
        • Paterson P
        Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012.
        Vaccine. 2014; 32: 2150-2159
        • Yu W
        • Liu D
        • Zheng J
        • et al.
        Loss of confidence in vaccines following media reports of infant deaths after hepatitis B vaccination in China.
        Int J Epidemiol. 2016; 45: 441-449
        • Smith PJ
        • Humiston SG
        • Marcuse EK
        • et al.
        Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the health belief model.
        Public Health Rep. 2011; 126: 135-146
        • Wolter KM
        • Pineau VJ
        • Skalland B
        • et al.
        Total survey error assessment for sociodemographic subgroups in the 2012 U.S. National Immunization Survey.
        (eds.)in: Biemer PP de Leeuw E Eckman S Total Survey Error in Practice. John Wiley & Sons, Hoboken, NJ2017: 433-456
        • Danchin MH
        • Costa-Pinto J
        • Attwell K
        • et al.
        Vaccine decision-making begins in pregnancy: correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake.
        Vaccine. 2018; 36: 6473-6479
        • Szilagyi PG
        • Bordley C
        • Vann JC
        • et al.
        Effect of patient reminder/recall interventions on immunization rates: a review.
        JAMA. 2000; 284: 1820-1827
        • Akmatov MK
        • Kretzschmar M
        • Krämer A
        • Mikolajczyk RT
        Timeliness of vaccination and its effects on fraction of vaccinated population.
        Vaccine. 2008; 26: 3805-3811
        • Guerra FA
        Delays in immunization have potentially serious health consequences.
        Pediatr Drugs. 2007; 9: 143-148