For decades, U.S. public health policy has treated hepatitis B vaccination at birth as non-negotiable: every newborn, regardless of maternal risk factors, receives a first dose within 24 hours of life.
The approach aligns with global guidance from the World Health Organization and has been credited with significantly reducing pediatric hepatitis B infections and the risk of future liver cancer.
But new recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP) have reopened the debate. On December 5, the ACIP issued revised guidelines, recommending that only infants born to mothers who are hepatitis B (Hep-B) positive should be immunized at birth. Hep-B negative mothers can now choose to vaccinate or not, according to new ACIP recommendations, which also cancelled out the mandatory three-dose series. The Centers for Disease Control and Prevention approved the updated guidelines Dec. 15.
Newborns, infants, and young children are particularly susceptible to hepatitis B and more likely than teens and adults to develop chronic infection that leads to life-threatening complications, including cirrhosis and liver cancer. And of those who develop chronic hepatitis B infection, 15–25 percent will die from the disease.
“From a public health perspective, universal hepatitis B vaccination at birth has been extremely effective in reducing infections and is the best strategy to minimize the risk of transmission to all infants,” says William Moss, MD, MPH, a professor in Epidemiology and executive director of the International Vaccine Access Center.
The West Coast Health Alliance — composed of the states of California, Hawaii, Oregon, and Washington also released a statement recommending that the hepatitis B vaccine series should be given to all newborns.
Dr. Samuel So — founder and executive director of the Asian Liver Center at Stanford University — called the new ACIP recommendations “short-sighted and not evidence-based.” In an interview with American Community Media, Dr. So stated that birth dose is not simply an infection-prevention tool, but a cancer-prevention strategy for infants.
“If an adult contracts hepatitis B, only about 5 percent will go on to develop a chronic infection that could result in liver cancer or cirrhosis. However, if a newborn or young child becomes infected, the risk significantly increases. Between 50 percent to 90 percent of these infants will develop a chronic infection that can lead to serious liver disease and cancer.”
African Americans — many of whom trace ancestry to African countries with high prevalence — are two to three times more likely to die from hepatitis B complications.
Although hepatitis B mortality rates have been decreasing in California over the last few decades, the mortality rate (0.8 per 100,000) in 2021 was 1.7 times higher than the overall rate in the U.S. More than two-thirds of hepatitis B deaths in Californians occurred in persons younger than 75 years of age, indicating that hepatitis B is associated with premature death compared to other causes.
Adults over 40 years of age, males and patients identifying as Black or African American are disproportionately affected by acute hepatitis B. In 2023, 10,928 newly reported chronic hepatitis B (CHB) cases were reported in California.