New Uncertainty: US Newborn Hepatitis B Vaccination Rates Plummet Following CDC Policy Shift

February 24, 2026

WASHINGTON D.C. — A landmark study published in JAMA reveals a sharp decline in newborn hepatitis B vaccination rates across the United States, dropping from 83.5% in early 2023 to 73.2% by August 2025. This downward trend, identified by researchers at the University of California, San Diego, preceded a controversial December 2025 decision by the Centers for Disease Control and Prevention (CDC) to scrap its 34-year-old recommendation for a universal “birth dose” of the vaccine. Public health experts now warn that the combination of rising vaccine hesitancy and weakened federal guidance could dismantle decades of progress against a virus that remains a leading cause of liver cancer and cirrhosis.

A Decade of Progress Under Threat

For over thirty years, the “birth dose”—the first of a three-shot series administered within 24 hours of delivery—has served as the primary defense against the hepatitis B virus (HBV). Since the universal recommendation was established in 1991, acute HBV infections among children under 19 have plummeted by 99%.

However, new data suggests this “safety net” is fraying. Analyzing over 12 million infant records from Epic Systems Corp, the JAMA study found that after reaching a peak in February 2023, vaccination rates began a steady retreat. The decline notably accelerated following July 2023, a period marked by high-profile media discussions that questioned established pediatric vaccine schedules.

“If vaccination rates decline too sharply, we may witness a resurgence of hepatitis B infections in infants and children,” warned Dr. Joshua Bryant, lead author of the study and a pediatrician at UC San Diego. “We are seeing a shift in behavior before the policy even changed, suggesting that public trust is currently at a tipping point.”

The Transmission Risk: Why the First 24 Hours Matter

Hepatitis B is a highly contagious virus transmitted through blood and bodily fluids. While adults often clear the infection, the stakes for infants are much higher. Approximately 90% of infants infected at birth develop a chronic, lifelong infection, compared to only 5% to 10% of adults.

The birth dose is designed to address three critical gaps:

1. Undetected Maternal Infection: Despite routine screening, roughly 14-16% of pregnant women may not be tested, or errors in lab reporting can occur.

2. Household Exposure: Infants can be exposed to the virus through non-sexual contact with infected family members or caregivers.

3. Follow-up Failures: Administering the first dose in the hospital ensures the series begins even if the family lacks immediate access to a primary care pediatrician.

A Drastic Shift in CDC Policy

In December 2025, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted 8-3 to move away from the universal birth dose for infants born to HBV-negative mothers. The new guidance favors “shared decision-making,” allowing parents and providers to delay the first dose until the infant is two months old.

The committee, operating under Health Secretary Robert F. Kennedy Jr., argued that the universal mandate was “overly broad” for families with no known risk factors. Supporters of the change, such as Dr. Retsef Levi, emphasized the importance of empowering parents to weigh risks and benefits individually, noting that perinatal transmission in the US is currently low.

However, the dissenting voices were sharp. Dr. Cody Meissner, a pediatrician at Dartmouth and one of the three “no” votes, expressed grave concern during the proceedings. “We’ve heard ‘do no harm’ as a moral imperative,” Meissner stated. “We are doing harm by changing this wording.”

Medical Community Reacts: “Irresponsible” Guidance

The departure from a universal strategy has created a rift between federal regulators and major medical associations. The American Academy of Pediatrics (AAP) and the Infectious Diseases Society of America (IDSA) have both maintained their stance that every newborn should receive the vaccine at birth.

“This guidance is irresponsible and purposely misleading,” said AAP President Dr. Susan J. Kressly. She emphasized that there have been no new safety concerns regarding the vaccine, which has been administered to hundreds of millions of children worldwide with an exemplary safety record.

Senator Bill Cassidy, a physician himself, also weighed in, calling the policy shift “a mistake.” He pointed to the historical context: before 1991, the US saw upwards of 20,000 newborn infections annually. “We are inviting a return to those numbers,” Cassidy warned.

What This Means for Parents and Families

For expectant parents, the policy shift places the burden of choice back on the individual. While the vaccine remains available through the Vaccines for Children (VFC) program and is covered by insurance, the ambiguity in federal recommendations may lead to confusion at the hospital bedside.

Medical experts suggest the following for families navigating these changes:

• Confirm Maternal Status: Ensure your HBV screening results are clearly documented in your delivery records.

• Discuss the “Safety Net”: Even if a mother tests negative, the birth dose protects against accidental exposure from other sources.

• Maintain the Schedule: If the birth dose is skipped, it is vital to begin the series at the two-month checkup to ensure full immunity by 18 months.

Balancing the Narrative: The Counterargument

Those in favor of the CDC’s move argue that a “risk-based” approach is common in many other developed nations. They contend that for a low-risk infant with a confirmed HBV-negative mother, delaying the vaccine by eight weeks poses a statistically negligible risk. They frame the policy change not as “anti-vaccine,” but as “pro-clinical judgment,” allowing doctors to tailor care to the specific needs of the family.

Critics, however, argue that risk-based models failed in the 1980s, which is precisely why the US moved to a universal model in the first first place. “The history of HBV in the US shows that when we only vaccinate ‘at-risk’ groups, we miss the majority of infections,” said Dr. Demetre Daskalakis, former CDC immunization chief.

Medical Disclaimer

This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

References

• Reuters. (2026, Feb 23). Birth doses of hepatitis B vaccine on decline in US before CDC scrapped recommendation.