Retrospective Review of Documentation Practices of Hepatitis B Immunoglobulin, Birth Dose, and Vaccination at the Hospital of Birth, in Thai Nationals and Migrants in Northern Thailand
Open accessAbstract
BACKGROUND: Vaccination remains the mainstay of prevention of hepatitis B virus (HBV) including birth dose and hepatitis B immunoglobulins (HBIGs). National estimates of vaccination coverage exclude migrants. The objective of this study is to investigate documentation practices of HBV-related infant vaccinations in Northern Thailand including migrants. METHODS: This is a retrospective review of hospital records of women who birthed infants in 2015 at Maharaj Nakorn Hospital, Chiang Mai (CM) or on the Thailand-Myanmar border, Tak. RESULTS: Of 2522 women, 987 were from CM (861 Thai nationals, 126 migrants) and 1535 were from Tak (651 Thai residence and 884 Myanmar residence). In CM, documentation for the birth dose vaccine (999 of 999, 100%) and HBIG was complete. In Tak, documentation was 1441 of 1549 (93%) for birth dose and 26 of 34 (76.5%) for HBIG, with missed opportunities including home delivery, delay in obtaining hepatitis B e-antigen status, and limitations of the records. Expanded Program of Immunization (EPI) documentation of 3 follow-up vaccinations dwindled with subsequent doses and distance, and complete documentation of 3 HBV EPI vaccines at the hospital of birth was low, 41.5% (1056 of 2547), but equitable for Thai or migrant status. CONCLUSIONS: This review provides strong support for excellent documentation of HBIG and birth dose vaccination in urban and rural settings, and in migrants, consistent with Thailand's vaccination policy and practice. Documentation of the 3 HBV EPI at the hospital of birth decreases with sequential doses, especially in families further away. Innovative data linkage is required to prove coverage and identify gaps.
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Thailand has one of the strongest and most equitable childhood immunization programs for its citizens in the region, but gaps remain for ethnic minority and migrant children.
“Thailand has one of the strongest and most equitable childhood immunization programs for its citizens in the region [3, 16], but gaps remain for ethnic minority [17] and migrant children [7, 13, 18, 19].”
The 90% coverage goal is hard to reach in many low-resource settings, especially rural and marginalized migrant populations.
“a goal that is hard to reach in many low-resource settings, especially in rural [5] and marginalized migrant populations [6, 7].”
Previous studies reported 50% vaccination completion.
“compared with 50% in the previous studies [7, 22]”
The study had 80% power with alpha 0.05 to detect the expected difference in vaccination completion (0.5 at SMRU vs 0.7 at SH) with a sample of 57 participants at SH and 226 at SMRU under 4:1 allocation.
“Expecting a 4:1 proportion of participants at SMRU:SH based on the patient load at the respective facilities, a sample size of 57 participants at SH and 226 participants at SMRU would provide 80% power with an alpha of 0.05.”
A recent retrospective review showed excellent coverage of birth dose hepatitis B vaccine and HBIG, and that birth vaccination in Chiang Mai was not different between Thai and non-Thai children.
“A recent retrospective review of vaccine utilization at Maharaj Nakorn Hospital, a tertiary government hospital in Chiang Mai, and clinics in Tak province run by the Shoklo Malaria Research Unit (SMRU) showed excellent coverage of birth dose Hepatitis B vaccine and HBIG. It also showed that birth vaccination in Chiang Mai was not different between Thai and non-Thai children [7].”
Completion of the three hepatitis B doses included in the EPI for migrants in Tak province has been documented at around 50%.
“Completion of the three Hepatitis B doses included in the EPI for migrants in Tak province has been documented at around 50% [7, 22].”
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Self-citation
- Authors
- Bierhoff, M., Pinyopornpanish, K., Pinyopornpanish, K., Tongprasert, F., Keereevijit, A., Rijken, M., Chu, C. S., Nosten, F., Perfetto, J., van Vugt, M., Mcgready, R., & Angkurawaranon, C.
- Affiliations
- Mahidol University (TH)
- Chiang Mai University (TH)
- University Medical Center Utrecht (NL)
- New York University (US)
- Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Corresponding author
- Pinyopornpanish, Kanokporn
- ORCID
- Venue
- Open Forum Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-12-01
- Volume
- 6
- Issue
- 12
- Pages
- ofz518-ofz518
- ISSN
- 2328-8957 (ISSN-L)
- PMC
- PMC6934156
- OpenAlex
- W2996797921
- Cited by
- 17
- References
- 35
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 9 · 2020: 2
- FWCI
- 2.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Open Forum Infectious Diseases (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Wellcome-Trust (106698/Z/14/Z)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- hepatitis B immunoglobulin, birth dose hepatitis B vaccine, infant immunization, vaccination documentation, migrant children, Myanmar migrants, northern Thailand, Expanded Programme on Immunization, missed vaccination opportunities, data linkage, vaccination coverage
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