Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Missed HepB Birth Dose Vaccine as Risk Factor

J Infect; ePub 2018 Oct 4; Wilson, et al

Infants who miss the hepatitis B (HepB) birth dose vaccine are at risk for under-immunization by 18 to 24 months of age, a recent study found. The retrospective cohort included infants born over 1 year at an academic medical center. The “not vaccinated at birth” group consisted of all infants who did not receive the HepB birth dose vaccine by 7 days of life, while the “vaccinated at birth” group included infants who did receive the birth dose. The primary outcome was vaccination status at 18 months of age. Researchers found:

  • Infants in the “not vaccinated at birth” group had lower vaccination rates.
  • At 18 months, 44% of the “vaccinated at birth” group received all recommended vaccines vs 23% of the “not vaccinated at birth” group.
  • >80% of the variability in vaccination completions were related to a single latent variable, the most likely being vaccine hesitancy or refusal.


Wilson P, Taylor G, Knowles J, et al. Missed hepatitis B birth dose vaccine is a risk factor for incomplete vaccination at 18 and 24 months. [Published online ahead of print October 4, 2018]. J Infect. doi:10.1016/j.jinf.2018.09.014.


This study shows how important that first parental exchange on immunizations is for achieving vaccination goals. When these parents are counseled on the hepatitis B immunization status, what information are they given? Many studies have demonstrated that protocols are important, but beyond that a clinician explaining why they feel the vaccine is necessary is important. I would imagine that most hospitals have the protocols in place, but do the clinicians take the time to discuss the importance of the hepatitis B vaccine for newborns both short- and long-term? —John Russell, MD