Healthcare worker perspectives on system-level barriers to hepatitis B birth dose vaccination: An analysis in five urban U.S. hospitals

Authors

Sophia C. Shaw, Brandeis University, Waltham, MA, USA.
Jana Shaw, Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, USA.
Nicholas Allis, Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.
Telisa Stewart, Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.
Y Tony Yang, Office of Health Policy and Population Science, George Washington University School of Nursing, Washington, DC, USA.

Document Type

Journal Article

Publication Date

12-1-2025

Journal

Human vaccines & immunotherapeutics

Volume

21

Issue

1

DOI

10.1080/21645515.2025.2567043

Keywords

Hepatitis B vaccine; birth dose; hospital practices; implementation science; perinatal immunization

Abstract

Despite three decades of recommendations, hepatitis B birth dose vaccination coverage remains suboptimal at 81.5% nationally, falling short of other routine immunizations and public health targets. This study examined implementation practices across five Washington, DC birthing hospitals through semi-structured interviews with 36 healthcare workers representing professional roles. While providers demonstrated strong support for vaccination, with 94% routinely recommending the birth dose for newborns, significant system-level barriers emerged that impede optimal delivery. Only 69% consistently recommended vaccination for premature infants, revealing concerning practice variability and knowledge gaps regarding weight-based guidelines. Critical infrastructure deficiencies included widespread unawareness of vaccination tracking systems (64% uncertain), complete absence of designated vaccine champions, minimal leadership engagement, and severely limited provider training - with only 19% receiving regular education on birth dose importance and 86% lacking training to address vaccine hesitancy. Electronic reminder systems were absent (17% utilization), despite proven effectiveness. Although parent education showed better implementation with literacy-appropriate materials and multi-modal communication strategies, the disconnect between robust provider support and weak institutional systems represents a fundamental implementation failure. Addressing these modifiable barriers through systematic quality improvement initiatives, enhanced monitoring infrastructure, and comprehensive workforce development could substantially improve vaccination coverage and advance perinatal hepatitis B elimination goals.

APA Citation

Shaw, Sophia C.; Shaw, Jana; Allis, Nicholas; Stewart, Telisa; and Yang, Y Tony, "Healthcare worker perspectives on system-level barriers to hepatitis B birth dose vaccination: An analysis in five urban U.S. hospitals" (2025). GW Authored Works. Paper 8202.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8202

Department

Health Policy and Management