In the U.S., hepatitis B vaccination became routinely recommended for all infants in 1991; later guidance specified that the first dose should happen within 24 hours of birth. However, in Dec. 2025, the U.S. Centers for Disease Control and Prevention (CDC) under the Trump Administration moved to cease recommending this practice for babies born to mothers who test negative, instead advising a shared decision-making model where parents and clinicians decide together what is medically appropriate: a dose shortly after birth, or a first dose "no earlier than 2 months of age." (For babies born to mothers who test positive or whose status is unknown, the CDC continues to recommend a dose shortly after birth.)
When should kids get the first dose of hepatitis B vaccine?
The American Association of Pediatrics continues to recommend vaccination at birth against hepatitis B for all infants, and 15 states have sued the Trump Administration over vaccination schedule changes.
The simulation modeled how many of 3.6 million children, born the same year in the U.S., would develop hepatitis B under a number of scenarios, including if the former CDC recommendations continued to be followed, if the initial dose (also called a “birth dose”) was delayed, and if a shared decision-making scenario was employed.
This study modeled only at a single year of births, notes Mahoreb. “Imagine that happening year after year after year after year. That could quickly become thousands and thousands of new infections, and even a small number of new infections could result in lifelong chronic infection that could be detrimental to families, lead to more cases of cancer, and [become] costly to the health care system,” Mohareb says.
“All three of these studies complement each other, in a good way, and provide some modicum of evidence so that we don't need to risk doing a clinical trial or testing this on people,” Mahoreb says. “We have done those experiments.” Decades ago, he continues, clinical trials already proved the efficacy of the existing approach, “so that we would have the benefit now of advancing medical progress and not needing to reopen that question.”
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