Washington, D.C. (December 2, 2025) — A public comment filed by 73 public health deans and scholars, along with the American Public Health Association - representing more than 23,000 individual members and numerous organizational members, concludes that the evidence overwhelmingly supports maintaining the current schedule for immunizing children against the hepatitis B virus (HBV). The CDC adopted this schedule in 1991 in response to a landmark recommendation by the Advisory Committee on Immunization Practices (ACIP) to begin HBV vaccination at birth.
The 35-year-old ACIP recommendation remains a landmark in the U.S. child health policy. The schedule has virtually eliminated chronic HBV infections in children. In the intervening period, no evidence raising efficacy or safety concerns in connection with universal newborn immunization has emerged. By contrast, eliminating a universal newborn immunization policy and delaying the initial HBV dose until later in infancy raises significant health risks.
In 1991, ACIP abandoned its initial approach to HBV immunization in children, which utilized a high-risk approach to identifying infants requiring newborn vaccination. It concluded that risk-based screening missed a significant proportion of hepatitis B-positive cases, a highly significant problem, given that infants and young children under age five living with HBV-infection are typically asymptomatic. Infants infected during the perinatal period have a 90 percent risk of developing chronic hepatitis B, which substantially increases the risk of cirrhosis and liver cancer; within this group, twenty-five percent will die of chronic liver disease as adults.
The 1991 policy has had a profound impact in both immunization rates and health outcomes. Between 1993 and 2000, the proportion of very young children immunized against HBV rose from 16 percent to 90 percent. Since the 1991 recommendation took effect, the universal HBV birth dose has prevented over 500,000 childhood infections and prevented an estimated 90,100 childhood deaths. Between 1991 and 2019, HBV infection among children and adolescents dropped 99%, preventing tens of thousands of cases of cirrhosis, liver cancer, and death. The evidence shows that now the annual rate of infection is extremely low: fewer than 1,000 US children and adolescents become infected and fewer than 20 infants are infected at birth.
"The universal hepatitis B birth dose is one of the most significant public-health achievements in U.S. child health over the past several decades,” said Kelly Gebo, Dean of the George Washington University Milken Institute School of Public Health. “It has all but eliminated chronic HBV in children, prevented tens of thousands of deaths, and remains a safe, effective, and essential measure. Delaying or eliminating this vaccine would expose infants, especially those most vulnerable, to unnecessary and preventable risk."
APHA Executive Director Georges C. Benjamin noted – absolutely no evidence suggesting that the highly successful policy needs to be revisited. He adds, “Taking preventative measures, like vaccination, greatly reduces the risk of infection for babies. The science is clear.”
Commenters note that substantial evidence shows the ease with which the health system can miss infections during pregnancy, since risk screening happens in early pregnancy and yet infection can happen at any time throughout pregnancy. Furthermore, delaying the first dose until a mother and infant return home unnecessarily exposes the infant to the risk of infection at home or in the community, from people whose condition remains undetected. Additionally, of the 3.5 million births that occur annually, over 50,000 take place in emergency departments whose personnel likely will lack complete information on maternal health risks, including their infection status. Finally, eliminating the HBV birth dose poses an especially high risk for the poorest infants and families who depend on Medicaid and the Vaccines for Children Program (VFC).
These families likely face the greatest risk because of the significantly reduced accessibility and comprehensiveness of prenatal care in thousands of medically underserved communities.
-GW-