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Hepatitis B

PEDIATRICS Vol. 110 No. 5 November 2002, pp. 929-934

Hepatitis B Vaccination Among Adolescents in 3 Large Health Maintenance Organizations

Idalia M. González, MD, MPH*, Francisco M. Averhoff, MD, MPH{ddagger}, Mehran S. Massoudi, PhD, MPH{ddagger}, Hussain Yusuf, MBBS, MPH{ddagger}, Frank DeStefano, MD, MPH{ddagger}, Piotr Kramarz, MD{ddagger}, Julie E. Maher, PhD, MS§, John P. Mullooly, PhD§, Colleen Chun, MD§, Robert L. Davis, MD, MPH||, Steven B. Black, MD and Henry R. Shinefield, MD the Vaccine Safety Datalink Team

* Epidemiology Program Office, assigned to the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
{ddagger} National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
§ Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
|| Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington
Division of Research, Kaiser Permanente of Northern California, Oakland, California

--> Objective. In 1995, the Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis B (HB) vaccination of all unvaccinated 11- to 12-year-old adolescents. Little is known about the implementation of these recommendations in a managed care setting. The objective of this study was to determine the impact of ACIP recommendations on HB vaccination among adolescents in 3 managed care settings.

Methods. We assessed HB vaccination coverage among adolescents who were enrolled in 3 large health maintenance organizations (HMOs) and who turned 13 years old after the 1995 ACIP recommendations. Children who were 8 to 10 years of age during May 1993 and were continuously enrolled through December 1998 were eligible. We used the HMOs’ computerized immunization tracking system to collect HB vaccination dates. The percentage of adolescents who received 3 doses of HB vaccine was determined.

Results. In HMOs A, B, and C, coverage levels for 3 doses of HB vaccine were 43.4%, 65.5%, and 25.7%, respectively, among 13-year-olds in 1998 compared with 26.1%, 50.4%, and 5.5% among 13-year-olds in 1996. Between the ages of 11 and 13 years, coverage rates among adolescents aged 13 in 1998 rose more than the coverage among adolescents aged 13 in 1996. The proportion of 13-year-olds in 1998 who received the first dose of HB vaccine by December 1998 was much higher at 89.6%, 65.2%, and 56.6% in HMOs A, B, and C, respectively, compared with the proportion who completed the 3-dose series (43.4%, 65.5%, and 25.7%, respectively).

Conclusions. After the 1995 ACIP recommendations, HB vaccination coverage levels among 13-year-olds increased in each of the HMOs, suggesting adherence with national recommendations. Differences among the 3 HMOs may reflect differences in internal policies. More effective strategies may be needed to achieve the Healthy People 2010 goal of 90% vaccination coverage rates among adolescents.

Key Words: hepatitis B vaccine • adolescence • health maintenance organizations • managed care • vaccination • immunization

Abbreviations: HBV, hepatitis B virus • ACIP, Advisory Committee on Immunization Practices • HB, hepatitis B • AAP, American Academy of Pediatrics • VFC, Vaccines for Children • HMO, health maintenance organization • VSD, Vaccine Safety Datalink • CDC, Centers for Disease Control and Prevention

Received for publication Feb 12, 2002; Accepted Jun 13, 2002.




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