"A combination of providing immunization registry access to birthing facilities and infection control education at hospitals." Alabama

"We sent a letter to all of the hospitals and simply said to resume." Arkansas

"I maintained close contact with my hospitals throughout the time the birth dose was placed on hold. When the new vaccine was available, the birth dose was reinstated. I gave the hospitals all the information I could find concerning the importance of the birth dose. I kept them informed with the progress and availability of the new vaccine–free of thimerosal." Clark County, NV

"1) Visits to all Birthing Centers, 2) E-mails/mailings updating birth dose issues, 3) Visits and mailings to OB providers, 4) Visits and mailings to immunization providers, 5) Offering VFC programs to Birth Centers. OB Providers can opt out of hospital policy or standing orders and decline the birth dose for their patients. Our staff communicating with OB providers in person has helped to get it [birth dose] reinstated. We have provided a number of educational materials to all OB providers. Indiana

[Materials given to providers include IAC's Labor & Delivery Unit and Nursery Unit Guidelines to Prevent HBV Transmission, Hepatitis B Shots Are Recommended for All New Babies, Hepatitis B Facts: Testing and Vaccination, Universal Prenatal Screening for Hepatitis B; ACIP's Protection Against Viral Hepatitis (2/9/90); Indiana's Checklist for Birthing Hospitals Perinatal Hepatitis B Policies and additional state-specific information.]

"A comprehensive intervention including letters, phone calls, visits, and other action steps." Maine

"1) Mailed numerous advisories around time of 1999 joint statement and follow-up MMWR report, 2) Conducted telephone survey after reinstatement of Massachusetts Department of Public Health policy to vaccinate all newborns at birth with hepatitis B dose #1, regardless of the mother's HBsAg status to determine if hospitals had resumed vaccination at birth and to encourage hospitals to do so if they had not already, 3) Made numerous follow-up telephone calls to hospitals that had indicated, when first surveyed, that they had not resumed the policy of administering the first dose of hepatitis B vaccine at birth, 4) Made site visits to hospitals that indicated they had not resumed the policy of administering hepatitis B dose #1 at birth." Massachusetts

"Michigan currently has 72 out of 102 delivering hospitals that have their physicians offering hepatitis B vaccine to 100% of their newborns. There has been a continuous collaboration of efforts by local health department staff, immunization field staff, and state staff and hospital staff to reinstate these policies. Many meetings, educational presentations, and continued discussion have helped some hospitals reinstate or implement these policies. Also, Michigan offers free hepatitis B vaccine to all delivering hospitals for all newborns." Michigan

"The birth dose of hepatitis B vaccine has been reinstated in some hospitals in this state. We are planning to survey all delivery hospitals in the state to determine which ones are giving hepatitis B vaccine. Results of the survey will be used to promote the vaccine in those hospitals not providing the birth dose." Mississippi

"In 1998, I conducted a chart audit at each of the larger birthing hospitals in our state (N=8), using the CDC guidelines. I therefore, had really good data to share with the doctors when they told me that "all their mothers were tested so the birth dose was not necessary," "we are a low risk state," or "they knew their patients and the patients would disclose to them any risks." ... [Because] I had good reasons and substantial data to back the positive outcomes from the birth dose... I have finally persuaded the last "big" hospital to adapt the birth dose. Once this is in place, we will have about 95% of our Montana infants being offered the birth dose.... If I hadn't had good data and been really feisty, I don't think we would have been successful!" Montana

"Having county hepatitis coordinators helped to reinstate the birth dose as standard policy. Work closely with your hospitals." Nevada

"Letter sent 11/99 from the Department of Health and Human Services to health care providers about the availability of thimerosal-free vaccine and encouraging birthing hospitals to reinstate universal vaccination of all newborns. Also, the state supplies the vaccine to hospitals for all children, not just the ones who qualify for the VFC program." New Hampshire

"We have sent two letters to birthing hospitals urging them to reinstitute the birth dose. A recent survey shows that only 21% of our hospitals routinely vaccinate at birth and another 25% leave the decision to provider preference with less than 25% of the providers offering vaccination at birth. We will soon be sending a third letter urging the birth dose." New York

"Education of medical directors and nursing staff in hospital labor and delivery and neonatal units. Sent letter with ACIP and AAP recommendations, then followed up with a telephone survey to all birthing hospitals. Special focus was given to those hospitals in indecision, and those that were not considering offering the birth dose to all newborns." North Carolina

"Timely communication, continued universal policy for vaccine distribution, reiterating importance of birth dose, and availability and prompt distribution of thimerosal-free vaccine." North Dakota

"We have had a fair degree of success. Part of the reason is that we have a program in Ohio that provides the vaccine free to all babies. We use state and 317 money to support the program. Immunization program staff contact hospitals not ordering routinely to see if there is a problem. However, there are several hospitals that have informed ODH that the pediatricians are not ordering the birth dose. We will be working with the Ohio AAP to address this." Ohio

"VFC and data on transmission. Mostly making it [administering the birth dose] not a hassle to the hospitals." Philadelphia, PA

"Communication and involvement with key people in birthing hospitals, prenatal and pediatric providers, and the state health department, as well as influential, revered individuals in the medical community who support the issue." Rhode Island

"Survey of all birthing hospitals followed by specific education regarding the transmission of perinatal hepatitis B virus." South Carolina

"1) Inservice of hospital staff, 2) Meetings with medical directors, neonatologist and nursing supervisors, 3) Follow-up calls." Virgin Islands

"In our state, a joint letter from the state health officer and AAP president was sent to all birthing hospitals notifying them of the availability of thimerosal-free hepatitis B vaccine and to encourage them to reinstitute the birth dose. Local health department staff also assisted us in spreading the message to pediatric care providers. As the hepatitis coordinator, I also presented at several meetings comprised of OB managers. In addition, our office recently completed a survey of birthing hospitals to assess maternal screening policies, hepatitis vaccination policies, and routine hepatitis B vaccination practices. When I sent them the results of the survey, I reiterated the need to reinstitute routine newborn immunization." Washington

"1) Have a physician immunization advisory group recommend the birth dose to pediatricians and family physicians. It is important to address these two groups of clinicians separately, 2) Offer to enroll hospitals in the VFC program and supply hepatitis B vaccine free for all infants born in the hospitals." Wisconsin