The CDC's Advisory Committee on Immunization Practices recently voted to end its long-standing recommendation for a universal hepatitis B vaccine birth dose, instead leaving the decision to clinicians and parents for infants born to mothers who test negative for the virus. The change breaks with more than three decades of U.S. policy.
A modeling study published in the Annals of Internal Medicine projects that this shift could have significant consequences. Using a single-year U.S. birth cohort of 3.6 million infants, the researchers estimated that delaying the first dose until age 2 months would increase chronic hepatitis B infections by 19%, while a shared decision-making approach would raise them by 83% compared with a universal birth-dose policy. The absolute numbers remain modest in the base case—467 chronic infections versus 255—but the authors warn that if vaccination coverage falls, the impact would be larger.
The study also looked at susceptibility in adulthood. Under shared decision-making, up to 1.8 million people could enter adulthood without immunity, compared with 232,000 under the universal policy. The authors note that lower uptake rates could push chronic infections even higher, and they call on policymakers to consider reinstating the universal birth dose. Limitations include the lack of simulations for liver disease outcomes or death, and the model did not predict immunity for children receiving only one or two doses of the three-dose series.