An analysis involving more than 12.4 million US newborns shows that after six years of growth, receipt of the hepatitis B virus (HBV) vaccine birth dose fell more than 10 percentage points in the past two years.
Researchers from the University of California San Diego led the study, which was published yesterday in JAMA.
The team used more than 300 million Epic Cosmos electronic health records from more than 1,800 hospitals and 41,500 clinics up to September 2025 to assess monthly newborn HBV vaccination rates. Hospitals with at least 11 births per year from 50 states and Washington, DC, contributed data, and all infants born from January 2017 to August 2025 were included.
The authors noted that HBV vaccination at birth has substantially cut HBV-related disease and death. “Infants infected with HBV in the first year of life have a 90% risk of developing chronic infection, which is associated with chronic liver disease and liver cancer,” they wrote.
Data from the World Health Organization (WHO) show that US birth-dose HBV vaccination rates rose from roughly 21% in 2002 to 66% to 75% in 2019, findings that align with those from the Centers for Disease Control and Prevention’s (CDC’s) National Immunization Survey.
The researchers chose to estimate birth-dose HBV vaccination trends starting in July 2023 because this period co-occurred with increased public discussion and press coverage of childhood vaccination. “This period included a widely circulated podcast episode in which current US Department of Health and Human Services Secretary Robert F. Kennedy Jr discussed HBV vaccination,” they wrote.
Changed vaccine guidance may further lower birth-dose uptake
Among the more than 12.4 million newborns included in the analysis, birth-dose HBV vaccination rates climbed from 67.5% in January 2017 to a peak of 83.5% in February 2023 before dropping to 73.2% by August 2025. After July 2023, HBV vaccination rates fell significantly below forecasted rates.
These estimates correspond with those from the WHO and CDC through 2022 and provide interim surveillance data for 2023-25, a period not yet reflected in national or global reports.
“While no single explanation can be identified, the decline coincides with a period of heightened public discourse in the US regarding childhood vaccination following the COVID-19 pandemic, including high-visibility media coverage and policy discussions that may have influenced perceptions of vaccine safety, clinician recommendations, and parent decisions,” the investigators wrote.
While no single explanation can be identified, the decline coincides with a period of heightened public discourse in the US regarding childhood vaccination following the COVID-19 pandemic.
The researchers indicated that while Epic Cosmos contains a large and geographically diverse segment of US births, it isn’t complete, and site compositions have changed over time.
“As a result, observed trends may partially reflect changes in data coverage rather than population-wide shifts in vaccination behavior,” they wrote. “Vaccination rates were estimates from deidentified, aggregated data, limiting inference about true coverage, delay vs nonreceipt, and individual-level factors such as geography, race, ethnicity, and socioeconomic status.”
In December 2025, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to eliminate universal recommendations for the HBV vaccine birth dose, and in January 2026, the CDC updated its childhood vaccine schedule, shifting the HPV series and several other vaccines from universal recommendation to shared clinical decision-making.
“These changes may further influence clinician recommendations and parent decisions toward continued declines in newborn HBV vaccination rates,” the authors concluded. “Further investigation is warranted to determine whether declining newborn vaccination rates are associated with increased HBV infection risk among infants and young children.”
Since the CDC updated its guidance, many health care providers, medical societies, city and state health departments, and regional health alliances have said they reject the CDC’s childhood vaccine guidance and will continue to vaccinate all newborns against HBV.
