Missed hepatitis B birth dose vaccine is a risk factor for incomplete vaccination at 18 and 24 months

Published:October 04, 2018DOI:


      • Delays in childhood vaccinations may be able to be traced back to birth.
      • In this study,fewer than 50% of babies who missed the birth dose of hepatitis B vaccine were fully vaccinated at age 2.
      • It is important to develop patterns of timely vaccination to prevent serious downstream consequences.
      • Medical providers should start talking with parents about childhood vaccinations long before a woman becomes pregnant.



      To determine whether missing the HepB birth dose vaccine is a risk factor for incomplete vaccination later in childhood.


      This was a retrospective cohort study of infants born over one year at an academic medical center. The “not vaccinated at birth” group consisted of all infants who did not receive the HepB birth dose vaccine by seven days of life, while the “vaccinated at birth” group included infants who did receive the birth dose. The primary outcome was vaccination status at 18 months of age, determined from the state vaccination registry.


      Infants “not vaccinated at birth” had lower vaccination rates. At 18 months, 44% of the “vaccinated at birth” group received all recommended vaccines, compared with 23% of the “not vaccinated at birth” group (p < 0.001); at 24 months, rates were 65% and 45%, respectively (p < 0.001). Over 80% of the variability in vaccination completions were related to a single latent variable, which is most likely vaccine hesitancy/refusal.


      Infants who miss the HepB birth dose vaccine are at risk for under-immunization by 18 and 24 months of age. This suggests that parents likely form opinions about vaccines long before the birth of their child; therefore, efforts to influence attitudes must begin earlier.

      Graphical abstract



      AAP (American Academy of Pediatrics), ACIP (Advisory Committee on Immunization Practices), CDC (Centers for Disease Control and Prevention), DTaP (Diphtheria, Tetanus & acellular Pertussis), HepB (Hepatitis B Virus), Hib (Haemophilus influenza type b), IPV (Inactivated Poliovirus), MMR (Measles, Mumps and Rubella), NCIR (North Carolina Immunization Registry), NV (“not vaccinated at birth”), PCV13 (Pneumococcal Conjugate), RV (Rotavirus), VAR (Varicella), YV (“vaccinated at birth”)
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