ATLANTA, GA — A key federal advisory panel voted Friday to endorse a more flexible, parent-driven approach to infant hepatitis B vaccination, marking a significant departure from longstanding U.S. policy and setting the stage for renewed national debate over how early in life immunizations should begin.
In an 8–3 vote, the CDC’s Advisory Committee on Immunization Practices recommended that parents of infants born to mothers who test negative for hepatitis B rely on individual, or “shared clinical,” decision-making when determining whether to administer the vaccine’s traditional birth dose. For families choosing to delay, ACIP advised that the first dose be given no earlier than two months of age.
The decision places greater weight on conversations between families and their health care providers, who are urged to consider both medical risk and household context — such as whether an infant will live with someone who has hepatitis B or have frequent contact with people from regions where the virus is more prevalent.
ACIP also recommended that parents consult clinicians when evaluating whether a subsequent dose is needed, including whether antibody testing is appropriate to assess protection.
The shift does not affect insurance coverage. Officials said the recommendations remain fully compatible with all major payment mechanisms, including Medicaid, Medicare, the Vaccines for Children Program, and ACA-marketplace plans. In September, ACIP voted to require hepatitis B testing for all pregnant women, a service now covered across insurers.
Friday’s vote followed a series of detailed scientific presentations, including new analyses of hepatitis B disease trends. Research presented by Cynthia Nevison, Ph.D., found that reductions in acute hepatitis B since the 1980s appear largely driven by improved blood screening, safer dialysis practices, and needle-exchange programs — not the universal infant birth dose. The data also highlighted that only 0.5% of U.S. pregnancies involve women who test positive for hepatitis B surface antigen, with more than half of those cases involving mothers born in countries with high prevalence.
Workgroup Chair Vicky Pebsworth, Ph.D., RN, told the committee that the U.S. remains an outlier among low-prevalence nations for recommending the vaccine at birth, noting that other developed countries typically begin hepatitis B vaccination later in infancy.
Deputy Health and Human Services Secretary and Acting CDC Director Jim O’Neill said the panel’s deliberations reflected the kind of evidence-based decision-making the public expects on early-life medical interventions. “The American people have benefited from the committee’s well-informed, rigorous discussion about the appropriateness of a vaccination in the first few hours of life,” O’Neill said.
ACIP recommendations become official CDC policy once adopted by the agency’s director, a step that could influence state-level immunization guidelines and pediatric practice across the country.
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