Fewer mothers in Washington, D.C., refused to have their newborns receive an initial birth dose of the hepatitis B vaccine (Engerix-B, Recombivax HB) in recent years, according to a retrospective study.

Data from the D.C. Department of Health revealed that 12.1% of mothers refused to have their newborns vaccinated against hepatitis B while in the hospital in 2017, declining to 8.4% in 2019 and decreasing further to 3.5% in 2022, Y. Tony Yang, ScD, LLM, MPH, of George Washington University in Washington, D.C., and colleagues reported in a research letter appearing in JAMA Network Open.

“Historically, newborn hepatitis B vaccination rates have been lower than desired, with [national] coverage of the birth dose below 77% among children born during 2017 and 2018,” the study authors observed.

“The clinical relevance of these findings is substantial and multi-faceted,” Yang told MedPage Today. “The decrease in hepatitis B vaccine refusals aligns with the Healthy People 2030 target of 90% coverage, indicating improved protection against hepatitis B for newborns.”

“Despite the pandemic disrupting routine childhood vaccinations, hepatitis B vaccination efforts remained strong, with sustained low refusal rates in 2021 and 2022, especially for hospital-based birth doses,” the authors wrote. “This contrasts with the broader decline in routine vaccinations, suggesting that the inpatient setting may have contributed to maintaining high hepatitis B birth dose coverage.”

“The hospital setting may provide a unique opportunity to ensure high vaccination rates, even during challenging times like the COVID-19 pandemic,” Yang pointed out.

In 2018, the CDC’s Advisory Committee on Immunization Practices (ACIP) revised its hepatitis B vaccination guidelines to recommend universal hepatitis B vaccination, regardless of the mother’s hepatitis B infection status, within 24 hours of birth for all medically stable infants weighing 2,000 grams or more, followed by completion of the three- or four-dose vaccine series by 18 months of age.

However, the COVID-19 pandemic emerged shortly after the new guidelines were issued. During the pandemic, there was an overall drop in uptake of routine childhood vaccines, not only due to lockdowns or decreased access to healthcare, but also as a result of vaccine misinformation.

“The study demonstrates that clear guidelines and consistent implementation can lead to significant improvements in vaccination rates,” Yang pointed out.

Researchers noted some race-based trends emerged during the study period. White mothers had high hepatitis B vaccine refusal rates in 2017 (14.7%), but this dropped to 4.2% by 2020 and decreased to 3.5% in 2022. Black mothers had a lower refusal rate than white mothers in 2017 (11.2%) but this also fell from 2020 through 2022 to 3.7%. Those identifying as other races had lower overall refusal rates over the study period from 8.8% in 2017 but decreasing to 2.8% in 2022.

“The equitable decline in refusal rates across racial groups implies that the intervention — likely the updated ACIP guidelines — had a positive impact across different populations,” Yang noted. “These findings support the effectiveness of the 2018 ACIP guideline changes.”

Approximately 1,000 new cases of perinatal hepatitis B infection are identified in the U.S. every year. Even though it’s recommended that all pregnant women be tested for hepatitis B, maternal hepatitis B status is frequently unknown — hence the CDC’s recommendation for universal vaccination. The hepatitis B vaccine is 75% to 95% effective in preventing perinatal hepatitis B transmission when given within 24 hours of birth.

Researchers looked at a total of 74,660 births from 2017 through 2022. Of these, 41.4% of mothers were white, 40.8% of mothers were Black, and 17.9% were of other races.

The study authors acknowledged limitations of their study, including missing data on maternal hepatitis B surface antigen status, infant birth weight, and medical stability. Also, the focus on Washington, D.C., may limit generalizability to other regions, suggesting a need for similar studies in different geographic areas.