Support to maintain the the recommendation of hepatitis B universal birth dose vaccination

Comments for the December 2025 Meeting of the Advisory Committee on Immunization Practices (Docket No. CDC-2025-0783)
Recommendation of Hepatitis B Universal Birth Dose Vaccination

To the Advisory Committee on Immunization Practices:

The HIV+Hepatitis Policy Institute strongly urges the Advisory Committee on Immunization Practices (ACIP) to maintain the recommendation of a universal hepatitis B birth dose in the United States. Maintaining this requirement will not only help prevent people from becoming ill but result in ending hepatitis B in our country, which is still a highly infectious disease.

Since 1990, universal infant and childhood vaccination for hepatitis B has resulted in a 99% decrease in reported cases of acute hepatitis B among children, adolescents, and young adults.[1] Before the universal childhood vaccination for hepatitis B was recommended, an estimated 18,000 children were infected with hepatitis B each year before age ten. Nearly half of these infections were transmitted from mother to child at birth. Approximately 90% of infants who are exposed to hepatitis B will develop a chronic infection, placing them at a significantly increased risk of cirrhosis and liver cancer later in life. While there still is no cure for hepatitis B, there is an effective birth-dose vaccine for infants, and it is well-documented that the hepatitis B vaccine is extremely safe for newborns.

A negative test result during pregnancy does not guarantee a baby will not be infected with hepatitis B virus.  A test result could be a false negative, or hepatitis B virus could be acquired after testing. Further, testing, treatment and monitoring may not be consistent for every pregnancy. An adult with an infection may not be aware they carry the virus, which is highly contagious; and according to the American Academy of Pediatrics, the hepatitis B virus can be transmitted from any household member with a known or unknown infection who is in close contact while caring for an infant after birth. More than half of people with hepatitis B and 50-70% of people with acute hepatitis B are asymptomatic.[2]

Removing the universal birth dose recommendation will create confusion among parents about what guidelines to follow and can lead to delayed administration of the vaccines. Further, ACIP guidelines will impact insurance coverage for vaccinations.  Eliminating the universal recommendation would ultimately create unnecessary barriers and confusion and will limit access to the vaccine.

Therefore, the HIV+Hepatitis Policy Institute strongly urges the Advisory Committee on Immunization Practices to maintain the recommendation of a universal hepatitis B birth dose in the United States.

Sincerely,

Carl Schmid II
Executive Director

[1] Bixler et. al. Progress and Unfinished Business: Hepatitis B in the United States, 1980-2019, Public Health Reports, June 6, 2023.

[2] CDC, Clinical Testing and Diagnosis for Hepatitis B, January 31, 2025, https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/.