Effect of state vaccine-financing strategy on hepatitis B immunization in hospital nurseries

Objective. - Changes in recommendations for newborn hepatitis B vaccination offer an opportunity to examine the association between newborn hepatitis B vaccination in hospital nurseries and state vaccine-financing strategies, which include the Vaccines for Children (VFC) program alone, an enhanced VFC program, and universal purchase. Methods. - We conducted a cross-sectional telephone survey of nursery directors from a national random sample of 290 hospital nurseries. Results. - Directors at 207 (71%) of 290 eligible nurseries responded. After the end of the temporary suspension of the hepatitis B vaccine birth dose, 59 (29%) of the 207 nurseries did not return to their previous policy and adopted a less strict policy for offering this vaccination to low-risk infants. In logistic regression analysis, compared with nurseries in states with VFC-only financing, nurseries in states with universal purchase financing were more likely to return a strict policy of routinely offering hepatitis B vaccination (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.11-0.78), and nurseries in states with enhanced VFC financing were less likely to return to a strict policy of routinely offering hepatitis B vaccination (OR, 3.00; 95% CI, 1.14-7.88). The presence of residents or students in the nursery was associated with a lower likelihood of not returning to a strict policy of routinely offering hepatitis B vaccination (OR, 0.32; 95% CI, 0.10-0.97). Conclusions. - State vaccine-financing strategy for the birth dose of hepatitis B vaccine is associated with nursery policy to routinely offer this vaccine in the nursery. The temporary change in national hepatitis B vaccination recommendations in 1999 served as a window of opportunity for the adoption of new hospital nursery policies and showed the effects of state vaccine financing on the adoption of newborn immunization recommendations.