Previously, the Centers for Disease Control and Prevention (CDC) recommended that all newborns be vaccinated against HBV within hours of birth — a strategy known as "universal birth-dose vaccination." But in December 2025, the Advisory Committee on Immunization Practices (ACIP) advised ending this recommendation, and the CDC accepted that advice.
Health experts widely criticized the proposed change when it was announced, and for the moment, its implementation has been put on pause by legal action. The modeling study, published Oct. 19 in the journal Annals of Internal Medicine, predicts what would happen if it came to pass.
When caught in infancy or early childhood, over 90% of HBV infections become chronic. About 15% to 25% of people with chronic HBV go on to develop liver scarring (cirrhosis), a form of liver cancer called hepatocellular carcinoma, or another chronic liver disease. So, an uptick in chronic HBV infections would translate to an uptick in these harmful liver conditions.
Mohareb and his colleagues built a simulation model using published data, including the current prevalence of HBV and the screening rate among pregnant people. The team also factored in the HBV test's sensitivity, the share of children who are fully vaccinated by age 2, and the risk of developing chronic HBV infection in different age groups. They made estimates of how often children are exposed to the virus through contact with infected household or community members.
Infants and young children have a greater risk of their HBV infections becoming chronic than people infected in adulthood. (Image credit: THOM LEACH / SCIENCE PHOTO LIBRARY via Getty Images)
With this data, the researchers tested what would happen if vaccination were postponed to 2 months of age for babies whose mothers tested negative. Among babies born in 2026, 19% more would have chronic HBV infections by age 20, compared with universal birth-dose vaccination, they found.
The researchers ran a stimulation to compare these two scenarios: one where kids get their first shot two months late and one intended to capture this looser "shared clinical decision-making" scenario.
The researchers assumed that about 87% of kids would complete the vaccine series by age 2 under the deferred strategy, while only 50% would under the shared decision-making strategy. That 50% coverage, in turn, would increase chronic HBV infections acquired by age 20 by 83%, and about 50% and 70% of those born under that guidance would be susceptible to HBV infection at age 20.
A "missed opportunity to protect against infection"
To test the robustness of the findings, Mohareb's team varied the most uncertain inputs across wide ranges and ran the model 1,000 times. In every simulation, the birth-dose strategy led to fewer chronic infections than either alternative.
The new study does not specifically show how many additional cases of liver disease or cancer would result from the uptick in HBV infections. But Terrault said that the risks of liver failure, cirrhosis and liver cancer "would be anticipated to increase due to the missed opportunity to protect against infection."
Related storiesMohareb stressed that he is in no way opposed to the principle of shared decision-making between doctors and patients. "They should always make the decision together," he said. "But we rely on our public health agencies not to tell us that we should be making decisions with the patient, but rather to tell us what policy would make us healthier as a country."
"Certainly without following a universal dose vaccination recommendation there would be a lot more hep B infections early in life," Dr. Brian McMahon, a hepatologist and the director of the Liver Disease and Hepatitis Program at the Alaska Native Medical Center, told Live Science in an email.
This article is for informational purposes only and is not meant to offer medical advice.
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