The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has voted to recommend that parents use individual-based decision-making when considering the hepatitis B vaccine for infants born to women who test negative for the virus. The committee voted 8 to 3 in favor of this approach, which allows parents and health care providers to consider 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.
For infants not receiving the birth dose, ACIP recommends that the first dose be given no earlier than two months of age. The committee also advised that parents consult with health care providers about whether to test antibody levels in children to assess protection against hepatitis B.
These recommendations ensure consistency in vaccine coverage across all payment mechanisms, including federal programs such as 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 recommended universal testing for hepatitis B among pregnant women, a test covered by all insurance programs.
Presentations made to ACIP included data on hepatitis B disease burden and vaccine safety. Cynthia Nevison, Ph.D., presented findings showing that while acute cases of hepatitis B have declined since 1985 due mainly to improved blood screening and needle exchange programs, the universal birth dose’s contribution to this decline is likely small. A 2019 study cited in her presentation found that more than half of births to women positive for hepatitis B surface antigen were among non–US-born women from high-endemicity countries. In the U.S., about 0.5% of pregnancies are among women who test positive for this antigen.
Vicky Pebsworth, Ph.D., RN, chair of ACIP’s Childhood/Adolescent Schedule Workgroup, noted that the United States’ universal recommendation for a birth dose is unusual compared with other developed countries with low prevalence of hepatitis B.
“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 the CDC director.
