393 - Infant Hepatitis B Vaccination Coverage by Race, Ethnicity and Preferred Language among Children Born in the Vaccine Safety Datalink between January 1, 2014 and April 1, 2023

Publication Number: 2382.393

Joshua T. Williams, Denver Health, Denver, CO, United States; Amy B. Stein, University of Colorado School of Medicine, Denver, CO, United States; Kristin Breslin, Denver Health, Denver, CO, United States; Misha Brtnikova, Denver Health, Denver, CO, United States; Bradley Crane, Kaiser Permanente Center for Health Research, Portland, OR, United States; Stephanie A. Irving, Kaiser Permanente Center for Health Research, Portland, OR, United States; Sungching C. Glenn, Kaiser Permanente Southern California, Pasadena, CA, United States; Bruno Lewin, Southern california permanente medical group, Los Angeles, CA, United States; Sara Tartof, Kaiser Permanente Southern California, Pasadena, CA, United States; Maria E. Sundaram, Marshfield Clinic Research Institute, Marshfield, WI, United States; Sharon Fuller, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; Teresa Schmidt, OCHIN, Portland, OR, United States; Sean T. O'Leary, University of Colorado School of Medicine, Denver, CO, United States; Daniela Canedo, Kaiser Permanente Mid-Atlantic States, Washington, DC, United States; Jason M. Glanz, Colorado School of Public Health, Denver, CO, United States; Malini DeSilva, HealthPartners Institute, Minneapolis, MN, United States; Candace C. Fuller, Harvard Pilgrim Health Care Institute, Boston, MA, United States; Ousseny Zerbo, Kaiser Permanente Northern California, Vaccine Study Center, Oakland, CA, United States; Simon J. Hambidge, University of Colorado School of Medicine & Denver Health, Denver, CO, United States

Background: Accurate reporting of race, ethnicity, and preferred language data in vaccination coverage assessments is relevant to public health workers, researchers, and the public, including for the infant hepatitis B (hepB) vaccine series.

Objective: To assess infant hepB vaccination coverage over time and by race, ethnicity, and preferred spoken language within a multi-site research collaboration.

Design/Methods: A retrospective cohort study of children at 9 geographically separated Vaccine Safety Datalink (VSD) sites born 1/1/14 – 4/1/23 with ≥1 year of continuous enrollment by age 18 months. The primary outcome was the number of hepB containing vaccine doses received by age 18 months (3 doses = fully vaccinated). Stratified analyses were conducted by hepB vaccination within 3 days of birth (i.e. "birth dose"), sex, birth year, 2024 federal race and ethnicity categories (i.e., including the "Middle Eastern or North African" (MENA) race option), and preferred spoken language (limited to: English, Spanish, Vietnamese, Chinese).

Results: The study cohort included 1,119,709 children. Overall, 976,072 (87.1%) were fully vaccinated and 909,376 (81.2%) received a hepB birth dose. Of the 909,376 children who received a hepB birth dose, 887,551 (97.6%) were fully vaccinated at 18 months. Three-dose coverage among children who received a birth dose remained >97% across birth years, with high coverage (>95%) among all sex, race and ethnicity, and preferred language groups.

Overall, 210,333 children did not get a birth dose (Table 1); in this group, 3-dose coverage at age 18 months fell from 73.2% (birth year 2014) to 55.3% (birth year 2023). For children without a birth dose, 3-dose coverage at 18 months was highest among children of Asian (84.2%) and MENA (77.5%) races and Chinese (89.6%) and Vietnamese (88.8%) languages; children identified as White race (66.3%) and who preferred English (69.1%) had the lowest 3-dose coverage at 18 months. Over time, 3-dose coverage at 18 months in children who did not receive a birth dose declined for all race and ethnicity groups (Figure 1) and for English and Spanish preferred languages (Figure 2), but not for children who preferred Vietnamese or Chinese languages (Figure 2).

Conclusion(s): From 2014-2023 in the VSD, 3-dose hepB vaccination coverage at 18 months remained high and equitable among children who received a birth dose. For children who did not receive a birth dose, 3-dose coverage at 18 months declined significantly each birth year, with notable disparities by race, ethnicity, and spoken language. Findings may inform tailored public health and immunization delivery efforts.

Table 1.
Table_1.pdfHepatitis B vaccination coverage with 95% confidence intervals by age 18 months among children born 2014-2023 within the Vaccine Safety Datalink who did not receive a birth dose of hepatitis B vaccine (n = 210,333), stratified by demographic covariates of interest and total number of doses received.

Figure 1.
Figure_1.pdfProportion of Vaccine Safety Datalink children born from 2014-2023 who did not receive a birth dose of hepatitis B vaccine who were fully vaccinated with 3 doses of hepatitis B vaccines at age 18 months, stratified by 2024 Office of Management and Budget race and ethnicity categories (alone or in combination)*.

*Abbreviations: AIAN, American Indian or Alaska Native; MENA, Middle Eastern or North African; NHPI, Native Hawaiian or Pacific Islander.

Figure 2.
Figure_2.pdfProportion of Vaccine Safety Datalink children born from 2014-2023 who did not receive a birth dose of hepatitis B vaccine who were fully vaccinated with 3 doses of hepatitis B vaccines at 18 months, stratified by four preferred language categories.

* Children were considered fully vaccinated if they received three doses of hepatitis B containing vaccines by 18 months 0 days old.
** Defined as “Other” in the electronic health record (EHR).
***Categories do not sum to 100% as they omit those missing a preferred spoken language or interpreter data or were another language.