Vaccine Administration in Children’s Hospitals

OBJECTIVES: To examine inpatient vaccine delivery across a national sample of children’s hospitals. METHODS: We conducted a retrospective cohort study examining vaccine administration at 49 children’s hospitals in the Pediatric Health Information System database. Children <18 years old admitted between July 1, 2017, and June 30, 2019, and age eligible for vaccinations were included. We determined the proportion of hospitalizations with ≥1 dose of any vaccine type administered overall and by hospital, the type of vaccines administered, and the demographic characteristics of children who received vaccines. We calculated adjusted hospital-level rates for each vaccine type by hospital. We used logistic and linear regression models to examine characteristics associated with vaccine administration. RESULTS: There were 1 185 667 children and 1 536 340 hospitalizations included. The mean age was 5.5 years; 18% were non-Hispanic Black, and 55% had public insurance. There were ≥1 vaccine doses administered in 12.9% (95% confidence interval: 12.8–12.9) of hospitalizations, ranging from 1% to 45% across hospitals. The most common vaccines administered were hepatitis B and influenza. Vaccine doses other than the hepatitis B birth dose and influenza were administered in 1.9% of hospitalizations. Children had higher odds of receiving a vaccine dose other than the hepatitis B birth dose or influenza if they were <2 months old, had public insurance, were non-Hispanic Black race, were medically complex, or had a length of stay ≥3 days. CONCLUSIONS: In this national study, few hospitalizations involved vaccine administration with substantial variability across US children's hospitals. Efforts to standardize inpatient vaccine administration may represent an opportunity to increase childhood vaccine coverage.

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The transmission dynamics of hepatitis B in the UK: a mathematical model for evaluating costs and effectiveness of immunization programmes

Epidemiology and Infection ◽

10.1017/s0950268800058970 ◽

1996 ◽

Vol 116 (1) ◽

pp. 71-89 ◽

Cited By ~ 50

Author(s):

J. R. Williams ◽

D. J. Nokes ◽

G. F. Medley ◽

R. M. Anderson

Keyword(s):

Mathematical Model ◽

Hepatitis B ◽

Vaccine Coverage ◽

Vaccine Dose ◽

Transmission Dynamics ◽

Costs And Benefits ◽

Vaccination Strategies ◽

The Uk ◽

The Impact ◽

Immunization Programmes

SummaryComplex hepatitis B (HBV) epidemiology makes it difficult to evaluate and compare effectiveness of different immunization policies. A method for doing so is presented using a mathematical model of HBV transmission dynamics which can represent universal infant and adolescent vaccination strategies and those targeted at genito-urinary (GU) clinic attenders and infants born to infectious mothers. Model structure, epidemiological underpinning, and parameterization, are described. Data from the UK National Survey of Sexual Attitudes and Lifestyles is used to define patterns of sexual activity and GU clinic attendance; data deficiencies are discussed, in particular that of UK seroprevalence of HBV markers stratified by age, sex, and risk factors. General model predictions of endemic HBV marker prevalence in homosexual and heterosexual populations seem consistent with published UK data. The simulations exhibit non-linearities in the impact of different vaccination strategies. Estimated number of carriers prevented per vaccine dose for each strategy provides a measure of costs and benefits, varying temporally over the course of a programme, and with level of vaccine coverage. Screening before vaccination markedly increases payback per dose in homosexuals but not in heterosexuals; mass infant vaccination gives the poorest effectiveness ratio and vaccination of infants after antenatal screening the best; in general, increasing vaccine coverage yields lower pay-back per dose. The model provides a useful framework for evaluating costs and benefits of immunization programmes, but for precise quantitative comparison more UK epidemiological data is urgently needed.

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Improving adherence to hepatitis B vaccine administration recommendations in two newborn nurseries

BMJ Open Quality ◽

10.1136/bmjoq-2020-001282 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001282

Author(s):

Sarah Germana ◽

Govind Krishnan ◽

Matthew McCulloch ◽

Jane Trinh ◽

Sophie Shaikh

Keyword(s):

Hepatitis B ◽

Community Hospital ◽

Hepatitis B Vaccine ◽

Medical Centre ◽

Vaccine Administration ◽

Vaccination Rates ◽

The Usa ◽

Birth Dose ◽

Healthy People 2020 ◽

The University

Administration of the birth dose of hepatitis B vaccine is an important step in reducing perinatally acquired hepatitis B infection, yet the USA is below the Healthy People 2020 goal for rate of administration.In response to updated Advisory Committee on Immunisation Practices recommendations to administer the dose within 24 hours of birth, we used quality improvement methodology to implement changes that would increase the vaccination rates of healthy newborns in our nurseries. The goal was to improve the proportion of infants who receive the hepatitis B vaccine within 24 hours of birth to >90% within a 2-year period, with a secondary goal of increasing vaccination rates prior to discharge from the nursery to >95%.Multiple Plan–Do–Study–Act (PDSA) cycles were performed. Initial cycles focused on increasing nurse and provider awareness of the updated timing recommendations. Later cycles targeted nursing workflow to facilitate timely administration of the vaccine. We implemented changes at our university medical centre and community hospital newborn nurseries.At the university medical centre nursery, both primary and secondary goals were met; the rate of hepatitis B vaccine administration within 24 hours increased from 81.7% to 96.2%, with vaccine administration prior to discharge increasing from 93.4% to 97.9%. In the community hospital nursery, the baseline rate of hepatitis B vaccine administration within 24 hours was 78.1%, and this increased to 85.8% with the interventions, falling short of the target of >90%. Vaccine administration prior to discharge increased from 87.2% to 92.0%, also not meeting the secondary target of 95%.Interventions that facilitated workflow had additional benefit beyond education alone to improve timing and rates of hepatitis B vaccine administration in both a university medical centre and community hospital nursery.

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Sustained Improvement in Administration of the Hepatitis B Vaccine Birth Dose: A Quality Improvement Initiative

American Journal of Medical Quality ◽

10.1177/1062860617732635 ◽

2017 ◽

Vol 33 (3) ◽

pp. 313-320 ◽

Cited By ~ 4

Author(s):

Sheri L. Nemerofsky ◽

Bolanle Akingboye ◽

Claudia Ferguson ◽

Dawn Africa

Keyword(s):

Quality Improvement ◽

Hepatitis B ◽

New York State ◽

Hepatitis B Vaccine ◽

York State Department ◽

Quality Improvement Initiative ◽

Vaccine Administration ◽

Vaccine Recommendations ◽

Birth Dose ◽

Control Limits

The New York State Department of Health recommends the administration of the hepatitis B vaccine birth dose within 12 hours of life (HOL) for all full-term babies irrespective of maternal hepatitis B status. The primary and secondary aims of the project were to improve the timeliness of vaccine administration and increase the total number of infants vaccinated prior to discharge. Multiple Plan-Do-Study-Act cycles were performed. Statistical process charts of percentages of vaccination within 12 HOL and prior to discharge were constructed with 3-σ (data within 3 standard deviations from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Administration within 12 HOL improved from 13% to ≥65% within 6 months, and has been sustained for >1 year. Vaccine administration prior to discharge increased from 94% to 98%. Quality improvement methods can rapidly improve adherence to newborn vaccine recommendations and these effects are sustainable.

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Hepatitis B Birth Dose Vaccination among Vietnamese Children: Implications for the Expanded Program on Immunization

BioMed Research International ◽

10.1155/2019/3453105 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Hao Nguyen Si Anh ◽

Hoang-Long Vo ◽

Long Hoang Bao ◽

Hien Tran Minh ◽

Ha Tran Thi Thu ◽

...

Keyword(s):

Socioeconomic Status ◽

Birth Weight ◽

Hepatitis B ◽

Rural Areas ◽

Vaccine Coverage ◽

Herd Immunity ◽

Vulnerable Groups ◽

Prevalence Rates ◽

Birth Dose ◽

Expanded Program On Immunization

Background. This study assesses the prevalence of Vietnamese children receiving the hepatitis B (HepB) vaccine birth dose and explores its associated socioeconomic factors. Methods. We used the data of the Multiple Indicator Cluster Survey, 2014. We estimated the overall percentage of HepB birth dose vaccination among 0–23-month-old children and its percentages according to selected characteristics. Multiple logistic regression was applied. Results. 62.8% of children received the HepB vaccine birth dose. The prevalence rates by selected factors ranged from 35.3% to 76.7%. The categories with the lowest prevalence rates were children who had low birth weight (41.6%), had a mother aged less than 20 years (35.3%), had a mother with primary or less education (42.7%), belonged to ethnic minorities (30.3%), resided in rural areas (59.9%), and were in the 1st quintile of mother’s socioeconomic status (38.6%). Receiving HepB vaccine birth dose was associated with child’s birth weight, mother’s age, mother’s education, socioeconomic status, and ethnicity. Conclusions. This study identified vulnerable groups, upon which policy-makers should focus their efforts to equitably and sustainably tackle birth dose HepB vaccine coverage as well as the full vaccination coverage, thereby promoting long-lasting herd immunity in this country.

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