Why We Vaccinate Newborns Against Hepatitis B

by Gertrud U. Rey

On December 16, 2025, the Centers for Disease Control and Prevention (CDC) adopted new recommendations from the Advisory Committee on Immunization Practices (ACIP) that end universal hepatitis B vaccination at birth. Under this policy, parents may defer vaccination if the mother tests negative for hepatitis B virus (HBV). This decision disregards strong scientific evidence supporting the birth-dose strategy and is likely to result in serious consequences for unvaccinated children and more widely, for public health.

HBV is the leading cause of liver cancer, a major contributor to cancer-related mortality worldwide. The virus spreads through contact with infected blood, semen, or other bodily fluids. Although adults are often infected through unprotected sex or injection drug use, the predominant global route of transmission is perinatal – from an infected mother to her baby during childbirth. Infants can also become infected after birth during close contact with infected caregivers or household members, via minor skin injuries, shared personal items like nail clippers, or trace amounts of dried blood on surfaces. HBV is highly stable in the environment and remains infectious on inanimate objects for extended periods. Transmission dynamics are further complicated by the fact that most individuals with HBV are asymptomatic, unaware of their infection, and unknowingly contribute to its spread.

Children are far less likely than adults to clear HBV infection and face a much higher risk of developing chronic disease, which can lead to cirrhosis and liver cancer. As many as 90% of infants infected at birth or during their first year progress to chronic hepatitis, compared to only 5-10% of older children and adults. There is currently no cure for chronic HBV infection.

A single birth dose of the HBV vaccine reduces mother-to-child transmission by approximately 70%, and protection increases to roughly 98% when two additional doses are given before 18 months to complete the previously recommended three-dose series. The HBV vaccine itself is safe: it is non-infectious because it is a recombinant subunit vaccine, containing only purified HBV surface antigen produced in yeast cells, rather than the whole virus. Aluminum salts are included as an adjuvant to enhance the immune response to the antigen. Persistent concerns regarding the safety of aluminum adjuvants in pediatric vaccines have been repeatedly disproven. Extensive evidence shows no link between aluminum in early childhood vaccines and autoimmune diseases, neurodevelopmental disorders, or other serious adverse events. These conclusions are supported by a recent nationwide Danish cohort study, which tracked 1.2 million children over 24 years and found no association between aluminum-containing vaccines and 50 chronic health conditions, including autism, asthma, and autoimmunity.      

Globally, an estimated 300 million people live with chronic HBV infection, and up to 1 million die annually from hepatitis B – despite the fact that it is preventable and treatable. Before universal birth-dose vaccination, approximately 20,000 U.S. children were infected with HBV each year. Since the CDC and the American Academy of Pediatrics recommended newborn vaccination in 1991, HBV infections among children have declined by 99%.

Successful vaccination programs are often described as “victims of their own success,”  because they render diseases rare and foster complacency, denial, and reliance on individual experiences over collective history. This erosion of awareness increases vulnerability to disease resurgence, as seen with the recent re-emergence of measles. We must prevent further deterioration of public health infrastructure to avoid backslides in global health and the return of previously controlled diseases.