The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has voted 8 to 3 in favor of individual-based decision-making regarding the hepatitis B vaccine for infants born to women who test negative for the virus. This approach, referred to as shared clinical decision-making on CDC immunization schedules, encourages parents and health care providers to weigh the benefits and risks of vaccination as well as infection risks before deciding when or if an infant should begin the hepatitis B vaccine series.
Parents are advised to consider specific risk factors such as whether anyone in the household has hepatitis B or if there is frequent contact with individuals from regions where hepatitis B is more common. For infants not receiving the birth dose, ACIP recommended that the first dose be given no earlier than two months of age.
Additionally, ACIP recommended that decisions about subsequent doses of the hepatitis B vaccine should involve consultation between parents and health care providers. They also suggested considering antibody testing to assess whether a child has adequate protection against hepatitis B.
These new recommendations ensure continued coverage across all payment mechanisms, including programs like Vaccines for Children Program, Children’s Health Insurance Program, Medicaid, Medicare, and insurance plans available through the federal Health Insurance Marketplace. In September 2025, ACIP had already voted that all pregnant women should be tested for hepatitis B—a test covered by all major insurance programs.
During meetings preceding this vote, experts presented data on disease burden and vaccine safety. Cynthia Nevison, Ph.D., discussed research showing that while acute cases of hepatitis B have declined since 1985—largely due to improved blood screening and safer medical practices—the universal birth dose may have contributed little to this decline. A 2019 study highlighted that most births at risk are among non–US-born women from high-endemicity countries; only 0.5% of pregnancies in the U.S. involve mothers who test positive for hepatitis B surface antigen.
Vicky Pebsworth, Ph.D., RN, chair of ACIP’s Childhood/Adolescent Schedule Workgroup, noted that recommending a universal birth dose sets the United States apart from other developed nations with low rates of hepatitis B prevalence.
Deputy Secretary of Health and Human Services and CDC Acting Director Jim O’Neill commented on the process: “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.”
ACIP recommendations become part of official CDC immunization schedules once adopted by the CDC director.
