The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has voted to recommend that parents use individual-based decision-making when considering the hepatitis B vaccine, including the birth dose, for infants born to women who test negative for the virus. The committee voted 8 to 3 in favor of this approach, which is also known as shared clinical decision-making.
Under this recommendation, parents and health care providers are encouraged to weigh the benefits and risks of vaccination as well as potential infection risks. They should consult together to decide when or if a child will begin the hepatitis B vaccine series. The committee highlighted that families should consider specific risk factors such as having a household member with hepatitis B or frequent contact with people from regions where hepatitis B is common.
For infants who do not receive the birth dose, ACIP advised that the first dose should be given no earlier than two months of age. Additionally, ACIP recommended that parents work with health care providers to determine whether testing antibody levels could help assess protection against hepatitis B before giving subsequent doses.
These recommendations ensure consistency across various payment programs, including entitlement programs like Vaccines for Children Program, Children’s Health Insurance Program, Medicaid, Medicare, and insurance plans through the federal Health Insurance Marketplace. In September 2025, ACIP had already recommended universal testing for hepatitis B among pregnant women—a test covered by all insurance programs.
The committee’s votes followed presentations on topics such as disease burden trends since 1985, vaccine safety data, international immunization policies, and input from vaccine manufacturers. Cynthia Nevison, Ph.D., presented findings indicating that while acute cases of hepatitis B have declined sharply since 1985—mainly due to improved blood screening and needle exchange initiatives—the contribution of universal birth dosing appears small. She noted that most U.S. births at risk involve mothers from countries with high rates of hepatitis B; about 0.5% of pregnancies in the United States are affected by maternal infection.
Vicky Pebsworth, Ph.D., RN, chairing ACIP’s Childhood/Adolescent Schedule Workgroup, explained that compared to other developed nations with low prevalence rates of hepatitis B, the United States’ policy recommending a universal birth dose stands out as unusual.
“The American people have benefited from the committee’s well-informed, rigorous discussion about the appropriateness of a vaccination in the first few hours of life,” said Deputy Secretary of Health and Human Services and CDC Acting Director Jim O’Neill.
A recommendation from ACIP becomes part of CDC’s official immunization schedule once adopted by the CDC director.
