The CDC has changed its approach to hepatitis B vaccination at birth for babies born to hepatitis B-negative mothers, adopting shared decision-making in response to declining vaccination rates and ongoing safety evidence, with potential implications for infection prevention.
For more than 30 years, hepatitis B vaccination at birth was treated as the default for newborns in American hospitals. That has now changed. The Centres for Disease Control and Prevention adopted a shared decision-making approach in December 2025 for babies born to mothers who test negative, meaning parents and clinicians now decide together whether to give the first dose straight after delivery. The policy does not apply to babies whose mothers test positive for hepatitis B or whose status is unknown; in those cases, vaccination plus immune globulin within 12 hours remains the recommendation.
The timing of the change matters because uptake was already weakening before the federal recommendation shifted. A JAMA study of more than 12.4 million newborns found birth-dose coverage climbed from 67.5% in early 2017 to 83.5% in February 2023, then dropped to 73.2% by August 2025. The same research found the steepest decline began after July 2023, raising questions about the role of hesitancy and changing clinical practice.
That falloff is especially significant because the birth dose does more than protect on day one. National research published in JAMA Network Open found that babies who received the birth dose were far more likely to complete the full three-dose series by 18 months. Among children who missed it, completion rates fell sharply over time, suggesting that skipping the first shot often means the rest of the schedule slips as well.
Independent reviews have not found evidence that delaying the vaccine makes babies safer. A review in Pediatrics by researchers linked to the University of Minnesota’s Vaccine Integrity Project examined more than 400 studies and reports spanning four decades. It found no serious short-term or long-term adverse events or deaths tied to newborn hepatitis B vaccination, no proof that postponing the first dose improves safety, and no basis for routine antibody testing to decide whether the series should be finished later.
The public health argument for early protection remains strong. Hepatitis B infection acquired around birth becomes chronic in roughly 90% of cases, and the birth dose has long served as a safeguard against missed prenatal screening, paperwork failures and infections acquired after testing. Since universal newborn vaccination was introduced in 1991, paediatric hepatitis B infections in the United States have fallen by more than 95%, and infant infections have become rare. The American Academy of Pediatrics continues to advise giving the dose within 24 hours of birth, and several state health departments, including New York’s, still recommend it for every newborn.
For families trying to decide ahead of delivery, the most practical questions are simple: whether the mother’s hepatitis B test result is on file at the delivery hospital, what the hospital now does by default, and when the first dose would be given if it is deferred. The CDC says that if parents choose to wait, the vaccine should not be started before two months of age. It also says coverage remains available through the Vaccines for Children Programme, Medicaid, the Children’s Health Insurance Programme, Medicare and federal marketplace plans.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
