(520) Maternal vaccination behavior as predictor of neonatal vaccine acceptance

The COVID-19 pandemic represented a disruption event in vaccination uptake, with shifting public sentiment on vaccination. We sought to examine the association between maternal Tdap refusal and neonatal hepatitis B vaccine refusal while assessing rural-urban geographic disparities in vaccination.

Study Design:

We performed a retrospective analysis of 103,549 mother-infant pairs from 2016 to 2024 undergoing prenatal and delivery care at a large regional health system in the American South. Multivariable logistic regression was used to assess maternal Tdap refusal as a predictor of neonatal hepatitis B refusal, controlling for insurance, age, delivery year, and COVID-19 period. Rural-Urban Commuting Area (RUCA) codes were used to stratify populations into urban, large rural, small rural, and isolated rural categories. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were generated.

Results:

The mean patient age was 28.4 years (SD 5.8), 60.3% public insurance, and 41.1% Black. RUCA categorization from urban to most rural was 88.4%, 7.6%, 3.3%, and 0.7%, respectively. Overall maternal Tdap, neonatal hepatitis B, and concordant vaccination rates were 56.4%, 85.9%, and 61.9%, respectively. Maternal Tdap refusal strongly predicted neonatal hepatitis B refusal (aOR 3.13, 95% CI 3.02, 3.25). Substantial rural-urban vaccination rate disparities were found, with urban areas achieving the highest concordant maternal-neonatal vaccination rates at 53.7%, while rural areas demonstrated significantly lower rates: large rural 33.9%, small rural 38.7%, and isolated rural 35.6%. Maternal Tdap vaccination rates showed the largest geographic disparities, ranging from 58.8% in urban areas to 37.3% in large rural areas. Neonatal hepatitis B vaccination rates were more geographically consistent, but still showed urban advantages.

Conclusion:
Maternal vaccination strongly predicts neonatal vaccine acceptance, with pronounced rural-urban disparities in vaccination coordination. These findings highlight the need for targeted interventions in rural areas to improve both maternal and neonatal vaccination rates.