Declining Hepatitis B Birth Dose Rates and the Risk to Long-Term Liver Health, With Joshua Rothman, MD, MS

For decades, universal newborn vaccination against hepatitis B has been a cornerstone of pediatric preventive care in the United States, widely regarded not only as protection against viral infection, but as a powerful tool in preventing chronic liver disease and liver cancer later in life.

New data published in JAMA suggest that uptake of the birth dose may be slipping at a pivotal moment. Against a backdrop of evolving vaccine policy and shifting public discourse around immunization, these findings raise urgent questions about whether progress toward hepatitis B elimination could be at risk.

In discussing the findings from his research, Joshua Rothman, MD, MS, a clinical assistant professor in the department of pediatrics and Medical Director of Informatics Academic Pediatrics at the University of California San Diego, emphasized the critical importance of hepatitis B vaccination in infancy.

“Infants who are infected with hepatitis B in the first year of their life have up to a 90% risk of developing chronic hepatitis B, and that's associated with liver disease and cancer,” he explained. “Iif you think about it, the hepatitis B vaccine, especially in the early stages of life, is really like an anti-cancer vaccine.”

He goes on to explain how the rationale for administering the hepatitis B vaccine at birth is rooted in prevention of unexpected exposures. While maternal screening during pregnancy is standard, Rothman noted that false-negative maternal tests can occur. In addition, infants may be exposed through household members, caregivers, or delayed follow-up care. As such, the birth dose functions as a critical safety net, offering protection during a vulnerable period when the risk of progression to chronic infection is highest.

The study found that rates of the newborn hepatitis B vaccine declined by more than 10% over the past 2 years in the United States. Of note, this decline occurred before updated recommendations from the Advisory Committee on Immunization Practices (ACIP) in December 2025 and subsequent updated guidance from the Centers for Disease Control and Prevention (CDC) in January 2026. Rothman underscored that because the data predate these policy changes, vaccination rates may decline even further following the new guidance.

When considering possible drivers of the decrease, Rothman pointed to broader shifts in public discourse surrounding vaccines.

“I would say that coming out of the COVID-19 pandemic, there was a concern about messaging around the COVID vaccine, and then that conversation seemed to shift into childhood vaccinations in general,” he said.

While chronic hepatitis B rates in the United States have been declining for years, in large part due to vaccination efforts, Rothman cautioned that sustained declines in vaccination coverage could halt this progress or even reverse it. He says a reduction in early-life immunization may lead to an increase in pediatric infections, with long-term consequences that include chronic liver disease and liver cancer decades later.

Despite growing safety concerns among some parents, Rothman stressed that the hepatitis B vaccine has decades of evidence supporting its safety and efficacy. For pediatricians and healthcare providers, he said, the goal remains clear: eliminate hepatitis B, both nationally and globally. Until that goal is achieved, he emphasized the need for continued vigilance in counseling families about the importance of early, evidence-based protection.

Editors’ Note: Rothman reports no relevant disclosures.

References

1. Rothman JM, Kwan B, Longhurst CA, Jena AB. US Newborn Hepatitis B Virus Vaccination Rates. JAMA. Published online February 23, 2026. doi:10.1001/jama.2026.0866

2. Brooks A. CDC Changes Infant Hepatitis B Vaccine Recommendation. HCPLive. December 5, 2025. Accessed February 25, 2026. https://www.hcplive.com/view/cdc-changes-infant-hepatitis-b-vaccine-recommendation