In a significant policy reversal, a key US vaccine advisory panel has voted to end the long-standing universal recommendation for administering the hepatitis B vaccine to all infants at birth. This decision, seen as a major win for Health Secretary Robert F. Kennedy Jr., has raised alarms among disease experts who fear it could undermine decades of progress in controlling the virus.
Understanding Hepatitis B and the New Vaccine Guidelines
The hepatitis B virus (HBV) is a serious infection that attacks the liver and is the world's leading cause of liver cancer. A major challenge is that many infected individuals show no symptoms, unknowingly spreading the virus. While most adults clear the infection, it becomes chronic in over 90% of infected infants and up to 50% of young children. Chronic infection can lead to liver failure decades later, often requiring a transplant, with no permanent cure available.
The new recommendation, voted on by the Advisory Committee on Immunization Practices (ACIP) on Friday, December 5, reserves the birth dose only for infants whose mothers test positive for HBV or whose status is unknown. For babies born to mothers who test negative, the panel now advises that parents, in consultation with a healthcare provider, should decide when or if to start the vaccine series. The panel also backed testing children for hepatitis B antibodies before deciding on subsequent shots.
Why Universal Vaccination Was Crucial
The original 1991 universal recommendation was a cornerstone of public health strategy. Before widespread vaccination, mother-to-child transmission during childbirth was the most common infection route. In the US, about 85% of newborns became infected when mothers had active infections. The vaccine dramatically changed this landscape, reducing US infection rates by nearly 90%, from about 9.6 per 100,000 people to roughly one per 100,000 by 2018.
Universal dosing protected infants in several key scenarios:
- When a parent's hepatitis B status was unknown or not tested during prenatal care.
- When maternal testing missed recent infections.
- From potential exposure through infected caregivers or close contacts, even if the mother was not infected.
Currently, only 0.7% to 1.1% of infants born to infected mothers develop the infection after receiving the birth dose vaccine, according to the US Centers for Disease Control and Prevention (CDC). This practice has been adopted by 190 of 194 WHO member countries as of 2022.
Global Context and Safety Profile
Globally, the World Health Organization estimates 254 million people were living with chronic hepatitis B in 2022, with 1.2 million new infections
The hepatitis B vaccine is widely regarded as safe. The World Health Organization states that side effects are typically mild, such as soreness or a low-grade fever. Serious allergic reactions like anaphylaxis are extremely rare.
If accepted by the CDC, this policy shift marks the end of a three-decade-old universal shield that protected generations of American children. Public health advocates are now closely watching the potential impact of this decision on future infection rates.
