# Adherence to hepatitis B vaccination recommendations for children and adolescents aged 3 to 17 years in Germany, 2014–2017: results from a cross-sectional national population-based study

## TL;DR

This study examines how well German children and adolescents followed hepatitis B vaccination guidelines from 2014 to 2017, finding significant gaps in adherence.

## Contribution

The study provides the first population-based analysis of adherence to hepatitis B vaccination schedules in Germany using nationally representative data.

## Key findings

- Only 48% of children received their first hepatitis B vaccine dose on time.
- 79.1% of children received a recommended series of at least three doses.
- Children born after 2001 had better adherence to vaccination schedules than those born between 1994 and 2001.

## Abstract

Although universal childhood vaccination of hepatitis B has been recommended in Germany since 1995, evidence on adherence to the recommended hepatitis B vaccination schedule is lacking. Using data from the second wave of the population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (2014–2017), we aimed to assess the adherence to the recommended hepatitis B vaccination schedule by describing the timeliness of the first dose, the timeliness of the recommended vaccination series, the vaccination series by number of doses, and the adherence to six months period between the last two doses given.

Reflecting recommendations in Germany, we defined a timely first dose as given at two months of age or as a birth-dose given prior to two days of age. A catch-up vaccination series was defined as first dose given after 14 months of age. We defined a recommended hepatitis B vaccination series as at least three doses, with six months between the two last doses, as in accordance with national recommendations. We defined a hepatitis B vaccination series as being timely if the last dose was given prior to 15 months of age. We calculated weighted proportions and their 95% confidence intervals (CI) overall, according to socio-demographic and health utilization characteristics.

Of the 3,165 included participants, 93.4% [95%CI: 91.9%-94.5%] received at least one hepatitis B vaccination dose; 48% [95%CI: 45%-51%] received a timely first dose and 4.62% [95%CI 3.59%–5.92%] received a catch-up vaccination series. Of all participants, 79.1% [95%CI: 76.8%-81.2%] received a recommended series, and 30.9% [95%CI: 28.3%-33.6%] had a timely recommended series. We found a higher proportion of children in birth-cohorts after 2001 with a timely first dose and a recommended series than children born in 1994–2001. The proportion of children with a timely first dose was higher for children living in eastern Germany (66.3%; 95%CI: 61.1%–71.2%) compared with western Germany (46.2%; 95%CI: 42.9%–49.6%).

Our analyses reveal gaps in adherence to vaccination recommendations against hepatitis B in Germany. However, we identified great potential for catch-up vaccinations with close to 95% of children and adolescents receiving at least one hepatitis B vaccination dose.

The online version contains supplementary material available at 10.1186/s12879-026-12519-z.