A modeling study suggests that replacing universal hepatitis B vaccination at birth with delayed vaccination or a shared decision-making approach, as recommended by the U.S. federal government this year, could lead to substantially more chronic hepatitis B infections among U.S. children.
Compared with the current universal birth-dose strategy, a shared decision-making approach was projected to increase chronic infections by 83% and more than 50% of children entering adulthood vulnerable to hepatitis B infection. The findings are published in Annals of Internal Medicine.
Researchers from Massachusetts General Hospital and Harvard Medical School developed a Markov state transition model to project the long-term impact of proposed childhood hepatitis B vaccination policy changes in a single year birth cohort of 3.6 million infants.
The model compared the current practice of vaccinating all newborns against two alternative strategies: deferred (2-month) vaccination of infants born to women without HBV infection, consistent with the Advisory Committee on Immunization Practices (ACIP) recommendations of December 2025; and shared decision making for 2-month vaccination of infants born to women without HBV infection, consistent with the proposed Centers for Disease Control and Prevention (CDC) policy of January 2026.
The analysis found that deferring vaccination to age 2 months would increase chronic HBV infections acquired by age 20 years by 19%, and a shared decision-making vaccination policy would increase chronic HBV infections acquired by age 20 years by 83%. The authors conclude that universal hepatitis B vaccination at birth remains the most effective strategy for preventing childhood infections and reducing future vulnerability to the virus.
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