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Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis B immunisation service


AIMS To determine the effectiveness of a selective hospital based hepatitis B immunisation programme and the barriers to be overcome in obtaining a successful outcome.

METHODS Retrospective case note review of 265 infants born over a five year period to hepatitis B carrier mothers at a university affiliated hospital in Hackney, London.

RESULTS A total of 242 infants (91%) were fully vaccinated; 217 (82%) had serology; 31 required booster doses. Percentages failing to reach second, third vaccinations, and serology on schedule rose exponentially (7%, 18%, 33% respectively). Mobility was high (25%) and significantly affected outcome. A total of 95% Hackney resident babies were fully vaccinated compared with 78% non-residents. Uptake of routine immunisations was higher in Hackney residents than non-residents and greater in those who were eligible for hepatitis B vaccine. Name changes occurred in 35%. Translation requirements were high (85% for Turkish, Vietnamese, and Asian families). Requirements for specific postnatal counselling of mothers and hepatology referral fell significantly during the course of the study. Only seven of 22 babies born in 1995 in Tower Hamlets compared with 53 of 58 Hackney babies received a full vaccination course in non-hospital based primary care.

CONCLUSION In inner city areas with high prevalence of hepatitis B carriage, mobility, and diverse ethnicity, a dedicated centralised immunisation service can be highly effective, provided that adequate support services (translation, counselling, and parental referral) are available.

Key messages

Key messages

  • Even in inner city areas over 90% of infants can receive full hepatitis B immunisation

  • Mobility (changes of address) and poor understanding impede uptake

  • Effective antenatal screening and counselling, availability of translation, and hepatology referral services may all improve uptake

  • Despite problems of accessibility and cost, a centralised service is technically efficient at immunising babies against hepatitis B in inner city areas with high prevalence rates

  • hepatitis B
  • immunisation
  • inner city
  • barriers to immunisation

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