Experts Advocate for Universal Hepatitis B Vaccination at Birth

Leading health experts are calling for the continued administration of the hepatitis B vaccine to all newborns in the United States within 24 hours of birth. A recent commentary published in the journal Gastroenterology highlights the critical role of this universal “birth dose” in preventing chronic hepatitis B infections, which can lead to severe health complications, including liver cancer and cirrhosis.

The recommendation for hepatitis B vaccination was first established by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) in 1991. Initially, the vaccine was advised for infants born to mothers who tested positive for hepatitis B. However, the guidelines have evolved. In 2005, the CDC recommended that the first dose be administered within 12 hours of birth for those at higher risk. By 2018, this recommendation expanded to include all infants, directing that the initial dose occur within 24 hours, regardless of maternal hepatitis B status.

This universal approach has proven effective, resulting in a remarkable 95% decline in infant hepatitis B infections. According to estimates, these vaccination policies have prevented approximately 1 million hospitalizations and 90,000 deaths over the years.

In an interview, first author Anna S. Lok, M.D., the Alice Lohrman Andrews Research Professor of Hepatology at Michigan Medicine, elaborated on the necessity of this vaccine for all newborns. She emphasized that many mothers might not have their hepatitis B status known at the time of delivery. The U.S. healthcare system does not always provide timely testing, particularly for those without insurance or those who arrive at hospitals late in labor.

Vaccinating every newborn eliminates concerns regarding unknown maternal status. Additionally, Dr. Lok pointed out that hepatitis B can be transmitted beyond maternal contact. Family members, caregivers, or children at daycare may also pose infection risks. Infants who contract the virus have a staggering 90% chance of developing chronic infections, which can lead to life-threatening conditions.

The challenge of vaccinating older children and adults is significant due to the lack of robust healthcare infrastructure. Dr. Lok noted that administering the vaccine to infants at birth ensures a higher vaccination rate, thereby enhancing public health outcomes.

Regarding safety, the hepatitis B vaccine has been established as safe and effective since its approval in 1981. Over 1 billion doses have been administered globally, making it one of the few vaccines approved for use in newborns and pregnant women. This safety record is especially critical, as newborns represent a vulnerable population.

Dr. Lok’s message to parents and policymakers is clear: By ensuring that every newborn receives the hepatitis B vaccine at birth, we can prevent the onset of chronic infections and the related complications. She stated, “We have safe and effective vaccines that have been around for 45 years. If we use the vaccine appropriately, we can prevent infections and avoid the long-term consequences of hepatitis B.”

Vaccination remains the most cost-effective strategy for preventing hepatitis B, significantly more so than managing the disease after infection. While effective treatments exist, they do not eliminate the virus, underscoring the importance of prevention through vaccination.

For further insights, the commentary titled “Hepatitis B Vaccination: A remarkable success story that must continue” is available in Gastroenterology, DOI: 10.1053/j.gastro.2025.10.295.