PEDIATRICS Vol. 107 No. 4 April 2001, pp. 755-758

SPECIAL ARTICLE:
Impact of the Joint Statement by the American Academy of Pediatrics/US Public Health Service on Thimerosal in Vaccines on Hospital Infant Hepatitis B Vaccination Practices

Received Oct 30, 2000; accepted Jan 24, 2001.

Marjorie B. Hurie^*, Thomas N. Saari^{, §}, and Jeffrey P. Davis^*,

From the ^* Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, Wisconsin; the  Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Wisconsin, Madison, Wisconsin; the ^§ Immunization and Infectious Diseases Committee, Wisconsin Chapter of the American Academy of Pediatrics, Madison, Wisconsin; and the  Departments of Pediatrics and Preventive Medicine, University of Wisconsin, Madison, Madison, Wisconsin.

Objective.  To determine the impact of the American Academy of Pediatrics/US Public Health Service (AAP/USPHS) joint statement on thimerosal in vaccines on hospital infant hepatitis B vaccination policies in Wisconsin.

Methods.  The nurse managers of hospital newborn nurseries (n = 110) were surveyed by mail. Nonresponders were resurveyed. Twelve hospitals no longer provided obstetric services. Of the remaining 98 hospitals, 84 (86%) responded to the initial mailing and 14 (14%) responded to the second mailing. The number of hospitals that offered hepatitis B vaccine to infants before July 1999 was compared with that in March 2000. The number of hospitals that had policies in place to vaccinate infants whose mothers' hepatitis B surface antigen status (HBsAg) was positive or unknown during the thimerosal alert (July 1999 through November 1999) was compared with that in March 2000.

Results.  Before July 1999, 81% of the hospitals representing 84% of reported Wisconsin births routinely offered hepatitis B vaccine to all infants. By March 2000, 50% of hospitals, representing 43% of births, had resumed routine infant hepatitis B vaccination. Physician decision to use a combination Haemophilus influenzae type b hepatitis B vaccine was the most frequently given reason for not reinstituting infant hepatitis B vaccination. During the thimerosal alert, 23% of hospitals did not have policies to vaccinate infants whose mothers were HBsAg-positive and 51% did not have policies to vaccinate infants whose mothers' HBsAg status was unknown. By March 2000, 6% of hospitals still did not have policies to vaccinate infants whose mothers were HBsAg-positive and 24% did not have policies to vaccinate infants whose mothers' HBsAg status was unknown.

Conclusion.  The AAP/USPHS joint statement on thimerosal in vaccines has resulted in a 38% decrease in the number of hospitals routinely offering infants hepatitis B vaccine. Although thimerosal-free hepatitis B vaccine is now available, some hospitals still do not have appropriate policies in place for vaccinating infants whose mothers' HBsAg status is positive or unknown. In the future, policymakers should include anticipated consequences that may result from changes in immunization policy in their recommendations.  Key words:  hepatitis B vaccine, infant, thimerosal, hospital.

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