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's vote was 8 to 3 in favor of this approach.
Under this recommendation, parents and health care providers are advised to weigh the benefits and risks of vaccination as well as infection risks before deciding when or if a child should begin the hepatitis B vaccine series. The ACIP noted that families should consider factors such as whether a household member has hepatitis B or if there is frequent contact with people from regions where hepatitis B is common.
For infants who do not receive the birth dose, ACIP recommends that the first dose be given no earlier than two months of age. Additionally, when determining whether a child needs further doses of the vaccine, parents are encouraged to consult with their health care provider about testing antibody levels to assess protection against hepatitis B.
These recommendations ensure consistent coverage across all payment systems, including 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 also recommended universal testing for hepatitis B in all pregnant women; this test is covered by all insurance programs.
The votes followed presentations on topics such as disease burden, vaccine safety, and international immunization policies. Cynthia Nevison, Ph.D., presented data showing that while acute cases of hepatitis B have declined since 1985—largely due to improved blood screening and other practices—the universal birth dose may have contributed only modestly to this decline. A cited study found that more than half of births at risk were among non–US-born women from countries with high rates of hepatitis B. In the U.S., 0.5% of pregnancies involve mothers who test positive for the virus surface antigen.
Vicky Pebsworth, Ph.D., RN, chairing the ACIP Childhood/Adolescent Schedule Workgroup, highlighted that recommending a universal birth dose sets the United States apart from other developed countries with low prevalence rates.
"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 immunization schedule once adopted by its director.
