Since 2018, the American Academy of Pediatrics and the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) have recommended universal hepatitis B vaccination of medically stable newborns weighing at least 2,000 grams within 24 hours of birth. After the unprecedented wholesale dismissal and replacement of the ACIP membership in June 2025, the American Academy of Pediatrics posted a fact sheet on its website emphasizing the significance of the hepatitis B vaccine birth dose and infant series in preventing acquisition of chronic infection. Although the U.S. Preventive Services Task Force recommends screening for hepatitis B virus at the first prenatal visit, a recent study found that more than 1 in 7 pregnant patients are never tested; some women do not receive any prenatal care or become infected later in pregnancy.
Perinatal hepatitis B infection has lifelong health consequences; 90% of infected infants develop chronic hepatitis B, and 15% to 25% of those die from cirrhosis or liver cancer in adulthood. In addition to being vertically transmitted from infected mothers, hepatitis B virus can also be passed on to infants through incidental contact with blood or body fluids of infected household members. The birth dose thus functions as a safety net for thousands of children who, before 1990, were being overlooked by risk factor–based vaccination strategies. Since its implementation in the United States, the birth dose has not only been associated with higher completion rates for the full hepatitis B vaccine series but also higher odds of receiving all recommended vaccines by age 19 months. A study of birth dose use in Washington, DC, found that vaccine refusals declined from 12.1% in 2017 to 4.1% in 2020 and remained below 4% in 2021 and 2022.
Nonetheless, when the reconstituted ACIP met in September 2025, it came close to voting to delay the first dose of hepatitis B vaccine to 1 month of age in infants born to hepatitis B surface antigen-negative mothers. This occurred despite the presentation of a systematic review by CDC staff that found no increased risk of any serious safety outcome when the vaccine was administered within 24 hours of birth. As highlighted in an in-depth analysis of the meeting by former ACIP members, the new committee repeatedly ignored its established processes for evaluating evidence and deliberating recommendations. Family physicians and former ACIP workgroup members Doug Campos-Outcalt and Jonathan Temte observed in a JAMA Viewpoint: “The evidence-based processes used by the ACIP were adopted to prevent exactly what happened at the first 2 meetings this year: presentation of anecdotes, selective quoting of single studies, and a lack of in-depth evaluation of some of the evidence presented.”
Ultimately, the ACIP deferred its vote on hepatitis B vaccine, preserving access to the birth dose for now. But in October, nearly all of the CDC staff that provided logistical support and subject-matter expertise to the ACIP was laid off, imperiling production of the 2026 vaccine schedules and making future departures from evidence-based recommendations more likely.
**
This post first appeared on the AFP Community Blog. On December 2, the Vaccine Integrity Project posted an independent review of data on the efficacy, safety, and public health impact of hepatitis B vaccine at birth. In a decision analysis posted as a preprint, authors affiliated with the Hepatitis B Foundation projected that “delaying Hep B vaccination to 12 years for infants of both HBsAg-negative and HBsAg-unknown parents resulted in an additional 2,351 acute infections, 744 deaths, and $368 million in excess costs.”
