ACIP Recommends Delaying Birth Dose of Hepatitis B Vaccine for Most Infants

The Advisory Committee on Immunization Practices (ACIP) voted 8-3 to recommend delaying the hepatitis B vaccination for most infants until at least two months of age, overturning a policy in place since 1991 that mandated a birth dose for all newborns. This new guideline applies only to infants born to mothers who tested negative for hepatitis B during pregnancy, with continued birth vaccination recommended for babies born to HBV-positive or unknown-status mothers. The decision requires final approval from the acting CDC director or the health secretary before adoption by the CDC vaccination schedule. The vote sparked opposition from medical professionals and organizations, including the American Academy of Pediatrics (AAP), which continues to endorse the birth dose due to its proven effectiveness in reducing infant HBV infection rates since inception. Data show a significant decline in hepatitis B cases in infants following the 1991 policy. Critics of the recommendation highlight the risks of delayed vaccination, including modeling studies estimating that postponing vaccination could result in increased chronic infections, liver cancer, and hepatitis B-related deaths among children. The debate was notable for the absence of prominent vaccine experts invited but declining to participate. The shift in policy reflects broader challenges in US vaccine guideline formulation amid evolving expert and public opinion. The vote also introduced a recommendation for post-first dose serology testing to determine the necessity of subsequent doses, despite insufficient data supporting single-dose protection. Insurance coverage for hepatitis B vaccination remains unaffected, including Medicaid, CHIP, and the Vaccines for Children program. The ACIP is concurrently reviewing the entire childhood vaccine schedule, with potential further recommendations pending. The policy change highlights tensions in balancing infection prevention with vaccine policy evolution, regulatory processes, and healthcare professional consensus.