Daijiworld Media Network - New Delhi

New Delhi, Dec 17: After prolonged deliberations, the CDC’s vaccine advisory body has voted to discontinue the long-standing policy of automatically giving the hepatitis B vaccine to all newborns at birth. Instead, the new guidance narrows routine birth-dose vaccination to infants considered at higher risk—specifically those born to mothers who test positive for hepatitis B or whose infection status is unknown at delivery.

The birth dose will remain strongly recommended in these high-risk situations. However, for babies born to mothers who have tested negative for hepatitis B, vaccination decisions will now be made on an individual basis in consultation with a healthcare provider.

What Has Changed in Practice

For more than three decades, U.S. health policy called for every newborn to receive a hepatitis B vaccine within 24 hours of birth, regardless of maternal infection status. This universal strategy was credited with a roughly 99% reduction in hepatitis B infections among children and adolescents.

In December 2025, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted 8–3 to move away from that approach. Under the revised guidance, infants born to hepatitis B–negative mothers are no longer automatically recommended to receive the vaccine at birth. Instead, parents and clinicians are encouraged to decide together when—or whether—to begin the vaccine series, with any delayed first dose administered no earlier than two months of age.

Who Still Needs the Birth Dose

The updated recommendation does not alter guidance for newborns at increased risk. A hepatitis B vaccine at birth remains essential for:
• Infants born to mothers who are hepatitis B–positive
• Infants whose mothers’ hepatitis B status is unknown at the time of delivery

In these cases, the birth dose—often paired with hepatitis B immune globulin—is critical to preventing lifelong infection and serious liver disease. Hospitals are expected to continue treating these measures as standard perinatal care.

What “Individual-Based” or “Shared” Decision-Making Means

The CDC describes the new framework as both “individual-based” and “shared clinical decision-making.” This model requires parents and clinicians to weigh several factors together, including:

• The benefits of early protection against hepatitis B
• The very low but perceived risks associated with the vaccine
• The infant’s potential exposure risk, such as living with someone who has hepatitis B or contact with individuals from regions where the virus is more common

Parents may still choose to give the vaccine at birth, delay the first dose until the baby is at least two months old, or—only in exceptional cases—decline vaccination.

Some experts have cautioned that the terminology around “shared decision-making” may confuse parents and lead to unintended delays in infant immunisation.

Why the Advisory Panel Supported the Shift

During ACIP discussions, presenters argued that routine birth-dose vaccination for all infants now offers limited additional benefit. They cited low hepatitis B rates in the U.S., improved blood screening, safer medical practices, and expanded harm-reduction programs.

The committee also reviewed analyses suggesting that factors other than the birth dose were largely responsible for the sharp decline in hepatitis B cases since the 1980s. Members noted that the U.S. had become an outlier among high-income countries, many of which do not vaccinate newborns at birth if the mother tests negative. Aligning U.S. policy with international norms and focusing resources on high-risk infants were key reasons cited for the change.

Why Many Doctors Are Concerned

The decision has drawn criticism from paediatricians and infectious-disease specialists, who warn that:

• The universal birth-dose policy has been instrumental in nearly eliminating hepatitis B in young children
• Real-world healthcare systems are imperfect, with risks such as lost test results, mislabelled records, or unrecognised maternal risk factors
Paediatric leaders fear the new guidance could create vaccination gaps and lead to a resurgence of childhood infections. Some medical practices have already stated they will continue offering the hepatitis B vaccine to all newborns at birth despite the updated recommendations.

What This Means for Parents

Under the new policy, whether a newborn receives the hepatitis B vaccine at birth will depend largely on the mother’s test results and discussions with the child’s doctor. Parents should expect:

• A conversation with their healthcare provider about the advantages and timing of the birth dose
• If vaccination is delayed, the first dose should be given at or after two months of age
• Full protection requires completion of the entire three-dose series; partial vaccination or relying on antibody testing alone is not considered sufficient

Insurance coverage is expected to remain unchanged, with hepatitis B vaccination continuing to be covered under both public and private health plans.