Before the United States began vaccinating all infants at birth with the hepatitis B vaccine in 1991, around 18,000 children every year contracted the virus before their 10th birthday – about half of them at birth. About 90% of that subset developed a chronic infection.
In the U.S., 1 in 4 children chronically infected with hepatitis B will die prematurely from cirrhosis or liver cancer.
Today, fewer than 1,000 U.S. children or adolescents contract the virus every year – a 95% drop. Fewer than 20 babies are reported infected at birth.
I am a pediatrician and preventive medicine specialist who studies vaccine delivery and policy. Vaccinating babies for hepatitis B at birth remains one of the clearest, most evidence-based ways to keep American children free of this lifelong, deadly infection.
On Sept. 18, 2025, the Advisory Committee on Immunization Practices, an independent panel of experts that advises the Centers for Disease Control and Prevention, debated changing the recommendation. According to the proposed language of the vote, infants whose mothers test positive for hepatitis B would still receive the vaccine at birth. Infants whose mothers do not test positive for hepatitis B would get the vaccine at 1 month of age, though parents would have the choice for them to receive it earlier. On Sept. 19, however, the committee tabled the vote, delaying it to the next committee meeting, scheduled for Oct. 22-23.
Although such a proposed change sounds small, it is not based on any new evidence. It would undo more than three decades of a prevention strategy that has nearly eliminated early childhood hepatitis B in the U.S.
While the committee regularly reviews vaccine guidance, nothing is business as usual about this meeting. In June 2025, Secretary of Health and Human Services Robert F. Kennedy Jr. disbanded the entire committee and handpicked new members. The committee has long-standing procedures to evaluate the evidence supporting the risks and benefits of a given vaccine, as well as other parameters of its use. But in this case, these procedures are not being followed.
Hepatitis B is a virus that infects liver cells, causing inflammation and damage. In adults, it is spread through blood and bodily fluids, which can happen through unprotected sex, contaminated needles or contact with open cuts or sores of someone who is carrying it.
The hepatitis B vaccine has been available since the early 1980s. Before 1991, public health guidance recommended giving newborns and young children the hepatitis B vaccine only if they were at high risk of being infected – for example, if they were born to a mother infected with hepatitis B or living in a household with someone known to have hepatitis B.
That targeted plan failed. Tens of thousands of children were still infected each year.
Some newborns were exposed when their mothers weren’t properly screened or if their mothers got infected late in pregnancy. Children also became infected through household contacts or in child care settings by exposures as ordinary as shared toothbrushes or a bite that breaks the skin. Because hepatitis B can survive for a week on household surfaces, and many carriers are unaware they are infected, even babies and toddlers of uninfected mothers remained at risk.
Recognizing these gaps, in 1991 the CDC recommended hepatitis B vaccination for every child starting at birth, regardless of maternal risk.
The greatest danger for infants contracting hepatitis B is at birth, when contact with a mother’s blood can transmit the virus. Without preventive treatment or vaccination, 70% to 90% of infants born to infected mothers will become infected themselves, and 90% of those infections will become chronic. The infection in these children silently damages their liver, potentially leading to liver cancer and death.
About 80% of parents choose to follow the CDC’s guidance and vaccinate their babies at birth. If the CDC’s recommendations change to delaying the first dose to 1 month old, it would leave babies unprotected during this most vulnerable window, when infection is most likely to lead to chronic infection and silently damage the liver.
The hepatitis B vaccines used in the U.S. have an outstanding safety record. The only confirmed risk is an allergic reaction called anaphylaxis that occurs in roughly 1 in 600,000 doses, and no child has died from such a reaction. Extensive studies show no link to other serious conditions.
The current recommendations are designed to protect every child, including those who slip through gaps in maternal screening or encounter the virus in everyday life. A reversion to the ineffective risk-based approach threatens to erode this critical safety net.
This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: David Higgins, University of Colorado Anschutz Medical Campus
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David Higgins is a member of the American Academy of Pediatrics and volunteer board member for Immunize Colorado.
