Newborn hepatitis B vaccination rates decline amid policy shifts

Investigators have found significant declines in hepatitis B virus (HBV) vaccination among newborns between 2023 and 2025, publishing their findings in JAMA.¹

The HBV vaccine has been linked to significantly reduced morbidity and mortality. Additionally, HBV infection in the first year of life has been linked to a 90% risk of chronic infection incidence, often leading to chronic liver disease and liver cancer. This has led to a significant increase in HBV vaccination rates from 21% in 2002 to 66% to 75% in 2019.

“However, recent HBV vaccination rates remain unknown, representing a critical gap given increasing concerns about vaccine hesitancy,” wrote investigators.

Assessing vaccine trends

The study was conducted to evaluate recent trends in newborn HBV vaccination based on data from large-scale electronic health records. Participants included infants born to US hospitals with more than 10 annual births between January 1, 2017, and August 31, 2025.

Vaccine trends from July 2023 onward were assessed, with monthly rates measured as doses administered within 30 days of birth divided by the number of live births in the same month. July 2023 was chosen as a reference point because it was a time when public discourse and media coverage about childhood vaccination were significant.

There were 12,404,779 newborns included in the final analysis. Between January 2017 and February 2023, an increase in HBV vaccination rates was observed in this population, from 67.5% to 83.5%. However, a decline was reported after February 2023, to a rate of 73.2% by August 2025. This highlighted a significant reduction compared to forecasted rates.

Investigators noted this decline correlates with increased discourse in the United States surrounding childhood vaccination. However, no single explanation for the reduction in HBV vaccination was identified. The study was also limited by not having a complete national census and the evolution of site composition over time.

Updated policy may influence vaccine uptake

Notably, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to eliminate universal recommendations to vaccinate newborns for HBV at birth. Additionally, HBV vaccination was moved to shared clinical decision-making alongside several other vaccines in the January 2026 CDC update to the childhood immunization schedule.

“These changes may further influence clinician recommendations and parent decisions toward continued declines in newborn HBV vaccination rates,” wrote investigators.

The ACIP recommendation changes did not include changes to vaccine recommendations in infants born to women who tested positive for hepatitis B surface antigen (HBsAg) or had an unknown HBsAg status.² However, the committee now recommends individual-based decision-making for infants born to women who tested negative for HBsAg.

The second vote passed by the ACIP was that parents should consult with health care providers when deciding whether a postvaccination anti-HBs serology testing should be offered. A protective anti-HBs titer threshold of 10 mIU/mL or greater was indicated. According to the ACIP, this testing should be covered by insurance.

Expert concerns

During the week of the voting, multiple experts called for a lack of relevant evidence by the ACIP supporting these updates from a universal vaccine recommendation within 24 hours of birth. These frustrations were highlighted by James Campbell, MD, MS, FAAP, vice chair of the American Academy of Pediatrics Committee on Infectious Diseases.

“We have overwhelming evidence suggesting that the birth dose helps to keep children safe from infection,” said Campbell. “But still, as I said, they voted to remove that recommendation for the birth dose for infants born to surface antigen–negative mothers, and I think we should all just make no mistake: As some of the members stated, this is a very dangerous decision."

References

1. Rothman JM, Kwan B, Longhurst CA, Jena AB. US newborn hepatitis B virus vaccination rates. JAMA. Published online February 23, 2026. doi:10.1001/jama.2026.0866
2. Fitch J. ACIP votes to update hepatitis B vaccine recommendation for infants. Contemporary Pediatrics. December 5, 2025. Accessed February 25, 2026. https://www.contemporarypediatrics.com/view/acip-votes-to-update-hepatitis-b-vaccine-recommendation-for-infants