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Is fragmentation of schedules hampering the uptake of hepatitis B vaccine?
  1. S Mukherjee1,
  2. S Jayakumar2,
  3. N Sharief3
  1. 1Dept of Paediatrics, Basildon & Thurrock University Hospital, UK
  2. 2Child Development Centre, Thurrock Community Hospital, UK
  3. 3Dept of Paediatrics, Basildon & Thurrock University Hospital, UK
  1. Correspondence to:
    Dr S Mukherjee
    Department of Paediatrics, Basildon & Thurrock University Hospital, Nethermayne, Basildon SS16 5NL, UK;

Statistics from

The rising number of recommended childhood vaccines can be challenging for parents for two reasons—up to eight clinic visits for immunisation alone in the first 18 months (including BCG and hepatitis B), and the concern regarding the number of injections given per visit.1 This in turn may affect the uptake of newer, but nevertheless important vaccines such as hepatitis B (HB).

We reviewed the uptake of HB and other childhood immunisations of 23 at risk infants born to HbsAg positive mothers in a district general hospital over a four year period (January 1999 to January 2003) and studied the reasons for immunisation failure. Maternal case notes, the local community computer database, and GP records were retrospectively reviewed. Families were contacted whenever possible to determine the reasons behind the non-compliance. Table 1 shows the results.

Table 1

 Uptake of HB and other childhood immunisations of 23 at risk infants born to HbsAg positive mothers

Our audit confirms the well known pattern of high initial uptake followed by exponential decline as reported in previous audits.2 This has been ascribed to poor parental understanding about the importance of completion of the full course.2

However, we found out that out of 11 cases who had the 1st dose but missed subsequent doses, three (27%) had moved out of the area, three (27%) did not receive appropriate notification (due to change of name or address), and five (46%) felt that there were too many attendances to complete the immunisation.

The relatively high uptake of DPT/MenC/Hib and even MMR in comparison to HB suggest that this specific immunisation failure may be partly due to fragmentation as reported by 46% of the parents.

We feel that this low uptake of HB immunisation could be circumvented by giving second and third dose of hepatitis B along with the 1st and 2nd doses of DPT/MenC/Hib (at 8 and 12 weeks of age), either as a combination vaccine or as a separate vaccine.3 The fourth dose of HB can be combined with MMR. We feel that there is a need for a larger national audit to address this issue as it can have an important implication on the immunisation schedule.


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  • Competing interests: none declared

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