CDC ACIP Recommends Individual Decision-Making for Hepatitis B Birth Dose in Low-Risk Infants

The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) voted 8 to 3 to recommend individual-based decision-making for the administration of the hepatitis B vaccine birth dose in infants born to women who test negative for hepatitis B virus. This approach encourages parents and healthcare providers to weigh the benefits and risks of vaccination and assess infection risk factors before deciding when or whether to initiate the hepatitis B vaccination series. For infants not receiving the birth dose, ACIP recommends the initial vaccine dose be administered no earlier than two months of age. ACIP also advised that parents consult healthcare providers to determine the need for subsequent hepatitis B vaccine doses and consider testing antibody levels via hepatitis surface antigen serology to confirm adequate immunity. These recommendations align with coverage policies across payment programs, including the Vaccines for Children Program, Medicaid, Medicare, and plans under the federal Health Insurance Marketplace. Earlier, ACIP recommended universal hepatitis B testing for pregnant women, a measure also covered by all insurance programs. Presentations to the committee highlighted the significant decline in hepatitis B incidence since 1985, attributing reductions primarily to improved blood screening, dialysis safety, and needle exchange programs rather than universal neonatal vaccination in low-risk populations. Data indicates that approximately 0.5% of U.S. pregnancies involve women positive for hepatitis B surface antigen, mainly among non-U.S.-born women from regions with higher endemicity, representing the primary risk for neonatal infection. The United States’ universal recommendation for the hepatitis B vaccine birth dose contrasts with immunization policies in other developed countries with lower hepatitis B prevalence. This shift toward shared clinical decision-making reflects a nuanced approach, balancing public health considerations with individual risk assessment, and once adopted by the CDC director, will be incorporated into the CDC immunization schedule. These changes could impact insurers, healthcare providers, and policyholders by influencing vaccine coverage, clinical protocols, and preventive care practices related to hepatitis B infection.