pp 1-7 | Cite as

Decreasing Vaccination Coverage Against Hepatitis B and Tuberculosis in Newborns

  • Aneta Nitsch-OsuchEmail author
  • Beata Pawlus
  • Maria Pawlak
  • Ernest Kuchar
Part of the Advances in Experimental Medicine and Biology book series


The number of parents who refuse to vaccinate their children or present the so-called hesitant behavior, i.e., delay the moment of vaccination beyond the mandatory time, has increased in many developed countries. The purpose of this retrospective study was to evaluate the completeness and timeliness of vaccinations against hepatitis B (HBV) and tuberculosis (TB) in neonates in a single maternity hospital in Warsaw, Poland. We reviewed medical files of 14,785 children born in the hospital in 2015–2017 and calculated the proportion of newborns not vaccinated on time according to the Polish Immunization schedule that includes vaccination against HBV and TB in the first day of life. Newborns remained unvaccinated because of parental refusal (refusers) or decision for a delay (hesitants), or medical contraindications. The percentage of unvaccinated newborns in the 3 years was as follows: 7.3% in 2015, 6.7% in 2016, and 10.1% in 2017. Parental decisions rather than medical contraindications caused nonvaccination (4.4% vs. 2.9% in 2015, 4.7% vs. 2.0% in 2016, and 7.5% vs. 2.6% in 2017). The majority of refusals concerned both vaccinations (67.3% in 2015, 74.8% in 2016, and 68% in 2017). Among parents who refused only one vaccination, TB vaccination was refused more often than HBV (9.2% vs. 7.1% in 2015, 8.3% vs. 5.7% in 2016, and 5.9% vs. 2.7% in 2017). Similar trends were observed among the hesitants. In conclusion, it seems essential to implement effective educational and informative activities targeted to parents to reinforce positive attitudes toward vaccinations.


Hepatitis B Immunization Newborns Tuberculosis Vaccination coverage Vaccine 


Conflicts of Interest

The authors declare no conflict of interests in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Warsaw Medical University in Poland.

Informed Consent

The requirement to obtain individual patient consent was waived as the study is of retrospective nature consisting of the anonymous review of patient hospital files.


  1. Braczkowska B, Kowalska M, Barański K, Gajda M, Kurowski T, Zejda JE (2018) Parental opinions and attitudes about children’s vaccination safety in Silesian Voivodeship, Poland. Int J Environ Res Public Health 15:224–228Google Scholar
  2. CDC (2013) Centers for Disease Control and Prevention. National, state, and local area vaccination coverage among children aged 19–35 months – United States, 2012. MMWR Morb Mortal Wkly Rep 62(36):733–740Google Scholar
  3. Chiabi A, Nguefack FD, Njapndounke F, Kobela M, Kenfack K, Nguefack S, Mah E, Nguefack-Tsague G, Angwafo F (2017) Vaccination of infants aged 0 to 11 months at the Yaounde Gynaeco-obstetric and pediatric hospital in Cameroon: how complete and how timely? BMC Pediatr 17:206Google Scholar
  4. ECDC (2018) European Center for Diseases Control and Prevention. Vaccine scheduler. Accessed on 2 May 2018
  5. Giambi C, Fabiani M, D'Ancona F, Ferrara L, Fiacchini D, Gallo T, Martinelli D, Pascucci MG, Prato R, Filia A, Bella A, Del Manso M, Rizzo C, Rota MC (2018) Parental vaccine hesitancy in Italy – results from a national survey. Vaccine 36:779–787Google Scholar
  6. Harmsen IA, Lambooij MS, Ruiter RA, Mollema L, Veldwijk J, van Weert YJ, Kok G, Paulussen TG, de Wit GA, de Melker HE (2012) Psychosocial determinants of parents’ intention to vaccinate their newborn child against hepatitis B. Vaccine 30:4771–4777Google Scholar
  7. Hontelez JA, Hahné SJ, Oomen P, de Melker H (2010) Parental attitude towards childhood HBV vaccination in the Netherlands. Vaccine 28:1015–1020Google Scholar
  8. Korzeniewska-Koseła M (2017) Tuberculosis in Poland in 2015. Przegl Epidemiol 71:391–403Google Scholar
  9. Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G (2012) Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr 12:154Google Scholar
  10. Magdzik W, Czarkowski MP (2006) Epidemiological situation of hepatitis B in Poland in the years 1979–2004. Przegl Epidemiol 60:471–480Google Scholar
  11. Mrożek-Budzyn D (2001) The reasons of low performance and delaying in the compulsory vaccinations in children. Przegl Epidemiol 55:343–353Google Scholar
  12. NIPH-NIH (2015) National Institute of Public Health – National Institute of Hygiene Vaccinations in Poland in 2015. Accessed on 14 Mar 2018
  13. NIPH-NIH (2016) National Institute of Public Health - National Institute of Hygiene Vaccinations in Poland in 2016. Accessed on 14 Mar 2018
  14. NIPH-NIH (2017) National Institute of Public Health – National Institute of Hygiene Vaccinations in Poland in 2017. Accessed on 22 Oct 2018
  15. Parache C, Carcopino X, Gossot S, Retornaz K, Uters M, Mancini J, Garnier JM, Minodier P (2010) Bacillus Calmette-Guérin (BCG) vaccine coverage in newborns and infants at risk before and after a change in BCG policy. Arch Pediatr 17:359–365Google Scholar
  16. Petrelli F, Contratti CM, Tanzi E, Grappasonni I (2018) Vaccine hesitancy, a public health problem. Ann Ig 30:86–103Google Scholar
  17. PNIP (2017) Polish national immunization program. Accessed on 14 Mar 2018
  18. Stępień M, Piwowarow K, Czarkowski MP (2015) Hepatitis B in Poland in 2015. Przegl Epidemiol 71:351–362Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Aneta Nitsch-Osuch
    • 1
    • 2
    Email author
  • Beata Pawlus
    • 2
  • Maria Pawlak
    • 1
    • 3
  • Ernest Kuchar
    • 4
  1. 1.Department of Social Medicine and Public HealthWarsaw Medical UniversityWarsawPoland
  2. 2.Saint Family HospitalWarsawPoland
  3. 3.Voivodeship Sanitary Inspection StationWarsawPoland
  4. 4.Department of Pediatrics and Clinical Assessment UnitWarsaw Medical UniversityWarsawPoland

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