A federal advisory panel is calling for a major change to the long-standing guidance on hepatitis B vaccination for newborns. In a vote taken this week, the Advisory Committee on Immunization Practices (ACIP) recommended that most parents wait until their baby is 2 months old before receiving the first dose.
The 8–3 vote from the Advisory Committee marks the first significant shift to this policy in more than three decades.
The recommendation applies only to babies born to mothers who test negative for hepatitis B during pregnancy. For those born to mothers who are infected or whose status is unknown, the current requirement, a dose within 12 to 24 hours of birth, remains unchanged.
The new guidance encourages parents to speak with their doctors about whether to give the vaccine at birth or “at all,” and suggests delaying the start of the vaccine series for most infants. A second vote, passed 6–4 with one abstention, advises parents who choose to vaccinate to consider testing their child after the first dose to determine whether additional doses are necessary.
Before the change can take effect, it must be approved by acting CDC director Jim O’Neill or Health Secretary Robert F. Kennedy Jr. Should the Health Secretary support the move, it would mark one of his most consequential actions on vaccine policy since his taking office. The Health Secretary is the founder of the anti-vaccine organization Children’s Health Defense. He previously dismissed all ACIP members and reappointed the panel with several vaccine skeptics.
Medical experts who spoke at the meeting opposed altering the decades-old recommendation. Former ACIP chair José Romero criticized the shift, calling it “… an historic departure from the role ACIP has played in shaping vaccine policy in the United States, when we could expect science to inform decisions, experts to debate evidence, and consensus to drive shared, clear recommendations.”
“Rather than advance sound vaccine policy, this ACIP sowed doubt in the vaccines themselves,” he said.
Public health officials warn that postponing the birth dose could have long-term consequences. A new modeling analysis suggests that delaying vaccination until 2 months could result in more than 1,400 newborns becoming chronically infected within the first year, potentially leading to hundreds of future cases of liver cancer and hepatitis B–related deaths.
The current birth-dose policy, introduced in 1991, led to infections in infants dropping from hundreds annually to fewer than two dozen. Panel experts note that the revision was driven by parental concerns, comparisons to European vaccine schedules, and the amount of time since the last evaluation.
An ACIP working group is now reassessing the entire childhood vaccine schedule.
