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Children's Health

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Despite some concerns, most primary care doctors recommend early childhood hepatitis B vaccination

Vaccination against hepatitis B virus (HBV) has been recommended as part of routine early childhood immunizations since 1991. Although most primary care physicians (PCPs) believe HBV vaccination is important, some concerns remain as barriers to administering this vaccine in a timely manner, according to a study supported by the Agency for Health Care Policy and Research (HS08068). For example, some physicians prefer to administer the vaccine during adolescence instead of infancy, and others believe that the low incidence of HBV among their patients doesn't warrant routine vaccination.

University of Pittsburgh researchers, Richard Kent Zimmerman, M.D., M.P.H., and Tammy A. Mieczkowski, M.A., conducted a telephone survey of 1,236 PCPs in 1995, most of whom practiced in urban areas. They asked the physicians to rate the importance of immunizing all young children against HBV. Most (78 percent) rated this immunization as important, 7 percent believed it unimportant, and 15 percent gave it an intermediate rating. These ratings were not associated with practice location, since 70 percent of rural physicians and 78 percent of urban physicians gave immunization high ratings. However, specialty mattered. About 85 percent of pediatricians, 70 percent of general practitioners, and 65 percent of family physicians gave high ratings for the importance of early childhood HBV vaccination.

When asked the percentage of children younger than age 2 in their practices for whom they recommended HBV vaccine, 82 percent of PCPs reported that they recommended it for all infants. However, the frequency and types of concerns about HBV vaccination during infancy varied by specialty. About 37 percent of physicians had no concerns; 26 percent were concerned about unproven duration of vaccine efficacy; 18 percent thought it too expensive; 8 percent thought HBV had low prevalence in their practice population; 7 percent preferred administering it to adolescents, not infants; and 5 percent thought it just added up to too many injections. Finally, the percentage of PCPs who recommended HBV vaccination ranged from 69 percent in mountain States to 91 percent in New England and mid-Atlantic States.

More details are in "How important is early childhood hepatitis B vaccination? A survey of primary care physicians," by Dr. Zimmerman and Ms. Mieczkowski, in the November 1998 Journal of Family Practice 47(5), pp. 370-374.

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