Peer-reviewed article
Immunization Status and Effectiveness Analysis of Hepatitis B Vaccine Among Preterm Infants in Fujian Province, 2022-2023.
Hairong Zhang, Jie Zhang, Zhikun Cai, Lifang Huang ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined hepatitis B vaccine uptake and effectiveness in preterm infants across Fujian Province, China, from 2022 to 2023. Among 779 preterm infants, 78% received the first vaccine dose on time, but only 64% completed the full vaccination schedule. The vaccine worked well immunologically, with over 90% developing protective antibodies. However, the study found important delays in vaccination among infants born very early, with low birth weight, via cesarean section, or whose mothers tested negative for hepatitis B.
Key points
- Timely first-dose hepatitis B vaccination rate was 78.18% among preterm infants, with only 63.80% completing the full vaccination schedule
- Among 363 infants tested for immunity, 90.91% were hepatitis B surface antibody positive, indicating robust immune protection from the vaccine
- 8.82% of infants were double-negative for both hepatitis B surface antigen and antibody, making them susceptible to infection
- Preterm infants born before 34 weeks gestation or weighing less than 2500g were significantly more likely to receive delayed vaccination
- Infants delivered at county-level or lower-tier facilities and those born via cesarean section had higher rates of vaccination delays
Limitations
This study only reports findings from one province in China and may not be generalizable to other regions or countries with different healthcare systems. The cross-sectional design with serological follow-up cannot definitively establish causation for the identified risk factors.
Abstract
Objective: This study evaluated hepatitis B vaccine (HepB) uptake, associated influencing factors, and post-vaccination immune responses among preterm infants residing in Fujian Province. The findings can support targeted improvements in hepatitis B prevention and control strategies tailored for this high-risk neonatal population. Methods: We conducted a multicenter cross-sectional study combined with short-term prospective serological follow-up across five counties, cities and districts of Fujian Province between 2022 and 2023. A total of 779 eligible preterm infants were enrolled in this study. We collected demographic information of participating mothers and infants, as well as complete HepB vaccination records throughout the study period. For 363 enrolled infants, we performed serological tests to detect hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) at 1-2 months after they completed the full HepB vaccination series. To explore factors linked to timely administration of the first HepB dose (HepB1), completion of the full vaccination course and HBsAb serostatus, we adopted a set of statistical approaches including descriptive statistics, the chi-square test (Fisher's exact test was used for groups with small sample sizes) and binary logistic regression. Results: The timely HepB1 vaccination rate among all preterm infants was 78.18%, while 63.80% completed the full vaccination schedule as required. In the serology cohort, the HBsAb positive rate was 90.91%, and 8.82% of infants showed double-negative HBsAg and HBsAb results, indicating susceptibility to HBV infection. Multivariate analysis identified multiple risk factors for delayed vaccination. Preterm infants were more likely to receive vaccinations late if their mothers tested HBsAg-negative (HepB1: OR = 25.231, 95%CI: 4.997-127.406; full-course HepB: OR = 2.440, 95%CI: 1.395-4.269), were delivered in county-level or lower-tier medical facilities (HepB1: OR = 3.724, 95%CI: 2.107-6.580), or were born via cesarean section (HepB1: OR = 3.460, 95%CI: 2.169-5.520; full-course HepB: OR = 1.954, 95%CI: 1.411-2.704). Additional risk factors included a gestational age below 34 weeks (HepB1: OR = 4.369, 95%CI: 1.894-10.081; full-course HepB: OR = 2.237, 95%CI: 1.148-4.359) and a birth weight less than 2500 g (HepB1: OR = 2.251, 95%CI: 1.397-3.629; full-course HepB: OR = 1.513, 95%CI: 1.065-2.150). Conclusions: Preterm infants enrolled from five regions in Fujian Province achieved robust immune protection following standard HepB vaccination. However, timely first-dose coverage and on-schedule full-course vaccination remain suboptimal in this cohort. Observed gaps in routine vaccination management at primary care settings highlight a key area for improvement in local hepatitis B prevention. Targeted standardized training for maternity care staff at county-level facilities, paired with a full-cycle follow-up system for preterm infant vaccination, may further strengthen hepatitis B mother-to-child transmission (MTCT) interruption in the study regions.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Standard hepatitis B vaccination schedule for preterm infants with tracking of timely first-dose administration and full-course completion
- Population
- 779 preterm infants across five counties, cities and districts in Fujian Province, China; 363 of these had serological testing for immune response
Key finding
90.91% of vaccinated preterm infants who were tested developed hepatitis B surface antibodies, indicating successful immune protection
Zhang et al. · PubMed (US National Library of Medicine) · 28 Jun 2026