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,
Mehran S. Massoudi, PhD, MPH,
Hussain Yusuf, MBBS, MPH,
Frank DeStefano, MD, MPH,
Piotr Kramarz, MD,
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 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
allunvaccinated 11- to 12-year-old adolescents. Little is knownabout the implementation of these recommendations in a managed
care setting. The objective of this study was to determine theimpact
of ACIP recommendations on HB vaccination among adolescentsin 3
managed care settings.
Methods. We assessed HB vaccination coverage among adolescentswho 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. Weused
the HMOs computerized immunization tracking systemto collect HB
vaccination dates. The percentage of adolescentswho received 3 doses
of HB vaccine was determined.
Results. In HMOs A, B, and C, coverage levels for 3 doses ofHB 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-oldsin
1998 who received the first dose of HB vaccine by December1998 was
much higher at 89.6%, 65.2%, and 56.6% in HMOs A, B,and C,
respectively, compared with the proportion who completedthe 3-dose
series (43.4%, 65.5%, and 25.7%, respectively).
Conclusions. After the 1995 ACIP recommendations, HB vaccinationcoverage 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 HealthyPeople 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.
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"