U.S. Newborn Hepatitis B Vaccination Has Fallen by More Than 10 Points in Two Years

The hepatitis B birth dose is one of the most time-sensitive vaccines in the pediatric immunization schedule. Administered within 24 hours of birth, it provides critical protection against perinatal transmission -- the passage of hepatitis B virus from an infected mother to her newborn during delivery. Without that protection, infants born to mothers with active hepatitis B infection have a 70 to 90% chance of becoming chronically infected. Chronic hepatitis B acquired in early life carries a substantially higher risk of progressing to cirrhosis and liver cancer than infection acquired as an adult.

For these reasons, vaccination at birth -- not at the first well-child visit, not at two months, but in the hospital before discharge -- has been the standard recommendation of the Advisory Committee on Immunization Practices for decades. A study published in JAMA now documents a troubling reversal in how consistently that recommendation is being followed.

The Scale of the Decline

The JAMA study analyzed national data on newborn hepatitis B vaccination rates, finding that birth-dose coverage fell by more than 10 percentage points over the two-year period between 2022 and 2024. That decline followed six years of growth in birth-dose coverage. The reversal wipes out a substantial portion of the progress made during that earlier period.

A 10 percentage point decline in vaccination coverage among a birth cohort of approximately 3.7 million infants per year represents hundreds of thousands of children born without birth-dose protection each year. For most of those children, the practical risk may be low if their mothers do not have hepatitis B infection. But for children born to infected mothers -- and hepatitis B prevalence in the United States is not trivial, particularly in certain immigrant communities and among people with a history of injection drug use -- the absence of birth-dose vaccination substantially increases transmission risk.

What Might Be Driving the Decline

The timing of the decline -- beginning around 2022 -- places it in the aftermath of the COVID-19 pandemic, a period in which vaccine hesitancy increased broadly across the U.S. population. Surveys conducted during this period found rising skepticism about childhood vaccines more generally. The sources of that skepticism are multiple, including misinformation spread on social media, eroded trust in public health institutions, and the influence of anti-vaccine advocacy that has gained political salience.

The hepatitis B vaccine has been a specific target of false claims for decades, with allegations about associations with multiple sclerosis and autism that have been thoroughly refuted in the scientific literature but persist in online communities. Renewed attention to vaccine safety concerns in the pandemic period may have amplified hesitancy around the birth dose specifically.

Structural factors may also play a role. Hospital systems that experienced staffing shortages, administrative disruptions, or changes in birthing protocols during and after the pandemic may have had reduced consistency in implementing birth-dose vaccination. The birth dose requires identification of newborns' hepatitis B status at delivery and a coordinated nursing workflow -- disruptions to that workflow can reduce coverage rates even without any change in parental attitudes.

Why the Birth Dose Specifically Matters

The hepatitis B vaccine is eventually administered to virtually all U.S. children as part of the routine immunization schedule. An infant who misses the birth dose will typically receive the vaccine at two months and again at four and six months. The question is not whether children will be vaccinated, but when.

The clinical significance of the birth dose lies in the specific window it covers. Perinatal transmission from an infected mother can occur during delivery, before any scheduled vaccine appointment. An infant exposed at birth and not vaccinated until two months of age has had eight weeks of potential viral replication without immune protection. That window is when infection, if it occurs, establishes itself -- and infections established in this period are far more likely to become chronic than those acquired later in life.

Universal birth-dose vaccination also provides a safety net for cases where maternal hepatitis B status is unknown or where screening results are not available at the time of delivery. Even infants born to uninfected mothers contribute to herd immunity; the strategy eliminates the need for a perfectly accurate maternal screening system to protect every infant.

What the Data Cannot Determine

The JAMA study documents the decline but does not fully characterize its causes. Whether the decline is driven primarily by parental refusal, hospital system failures, documentation problems, or some combination has not been established. Understanding the relative contribution of each would require data on the reasons for vaccination non-receipt, which national surveillance systems do not routinely capture. The geographic and demographic distribution of the decline also matters -- if declines are concentrated in specific states or demographic groups, interventions can be more precisely directed.