Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
July 1995

California Pediatricians' Knowledge of and Response to Recommendations for Universal Infant Hepatitis B Immunization

Author Affiliations

From the Ahmanson Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, Calif (Drs Wood and Rosenthal); RAND, Santa Monica, Calif (Dr Wood); and Amgen Corporation, Thousand Oaks, Calif (Ms Scarlata).

Arch Pediatr Adolesc Med. 1995;149(7):769-773. doi:10.1001/archpedi.1995.02170200059009

Objective:  To assess California pediatricians' level of agreement with and implementation of universal infant hepatitis B immunization.

Research Design:  Mailed questionnaire in the summer and fall of 1993 to a random sample of 1030 California pediatricians to determine whether they universally immunize infants with hepatitis B vaccine. The response rate was 71%.

Results:  More than 81% said they universally immunize infants against hepatitis B infection; however, 18.3% stated that they do not. Pediatricians were more likely to immunize infants universally against hepatitis B if they (1) agreed with the recommendations (90% vs 54%, P<.01), (2) practiced in a health maintenance organization setting vs private group practice (92% vs 79%, P<.05), or (3) practiced in settings with predominantly low-income patients (89% vs 78%, P=.01). Pediatricians who universally immunize infants against hepatitis B virus were in practice an average of 1.7 years longer than those who do not (13.3 years vs 11.6 years, P=.01). In multivariate analyses, the most powerful predictor of universal immunization was agreement with the recommendations. Among those who disagreed with the recommendations, the most common reasons for disagreement included the following: (1) the long-term efficacy of hepatitis B vaccine is not proved—54%; (2) an additional immunization would make the visits too costly—53%; and (3) three shots would be too much at one visit—53%.

Conclusions:  A majority (81.6%) of our sample of California pediatricians universally immunize infants against hepatitis B; however, a significant minority (18.4%) do not agree with the recommendations and do not plan to implement them. Many of their objections are being addressed through combination vaccine development and ongoing research; however, alternative policies and additional research should also be considered.(Arch Pediatr Adolesc Med. 1995;149:769-773)