Hepatitis B vaccination protocols for infants and young children were established in 1991 and have been touted as among the most successful policies in medicine. The series of three vaccinations begin with the first within 24 hours of a child’s birth (the “birth dose”), and two additional vaccinations between the ages of 1 and 18 months.
99 % drop in Hep B infections
The vaccine has one of the most well-established safety records of any vaccine, said Jon Dvorak, MD, Director of Medical Operations, Pediatrics, with ProMedica Physician Group. Annual Hepatitis B infections among infants and children have dropped 99 percent (from 16,000 per year to less than 20 per year) since the protocol was recommended by the Advisory Committee on Immunization Practices (ACIP).
“Most adults with chronic Hepatitis B have no symptoms and are unaware they are infected. Unvaccinated infants can be infected through household or community exposures, such as nail clippers or toothbrushes,” Dvorak said.
Recent federal revisions to established policy
But recent federal revisions to Hepatitis B vaccination policy have thrown a wrench into pediatrics practices. In the revisions, announced last December by the Centers for Disease Control and Prevention (CDC), vaccine advisers have instead recommended that the vaccine be given at the time of birth only to those children born to women who test positive for the virus. The panel also voted to revise the remainder of the policy, recommending that physicians check a child’s antibody levels after each shot to determine whether additional shots are needed.
The American Academy of Pediatrics (AAP), however, continues to recommend giving newborns a dose of hepatitis B vaccine within 24 hours of birth, with additional doses at 1-2 months and 6-18 months. In Toledo, many pediatricians are following the AAP guidelines for these immunizations. “We strongly believe the schedule of the AAP is best,” said Dr. R. W. Mills, Chief Medical Officer with Nationwide Children’s Hospital Toledo. “We have not changed our recommendations.”
Stemming the confusion tide
What has changed, however, is the discussion. “Our single biggest concern is confusion,” Mills continued. Whenever you make changes to a standardized policy, he said, “you’re implying that there’s something wrong with the previous schedule. There has not been any new evidence or concerns about the vaccine or the schedule.”
Children are at their highest medical risk when they are infants, when the immune system is not at its peak. Vaccines are critical at this time of life, Mills said. Stopping the protocol at fewer than three shots assumes efficacy that may not be supported by existing data.
Dvorak explained that the “Vaccine Integrity Project” published in December 2025, found that delaying the birth dose of the Hepatitis B vaccine would lead to increased infections with no benefit to the vaccine’s safety or effectiveness. “Because the changes to the vaccine’s recommendation were made in early December 2025, and reiterated on January 5, we have not seen much, if any, change in our Hepatitis B vaccinations,” he said.
CDC Recommendations
The CDC has revised the number of vaccines they recommend for children, based on three criteria:
- Immunizations recommended for all children – including measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Hib and pneumococcal disease vaccines
- Immunizations recommended for certain high-risk groups or populations – based on underlying comorbidities, unusual exposure to the disease or the risk of disease transmission to others
- Immunizations based on shared clinical decision-making – based on discussions between physicians and the patient or parent/ guardian
The Hepatitis B vaccination has been moved to both the high risk and clinical decision-making recommendations.
Beginning last fall, the CDC also shifted the number of vaccines routinely recommended for children from 17 to 11, and the number of routine vaccines from 13 to 7. Vaccines no longer recommended for routine use by all children in the U.S. include Rotavirus, COVID-19, Influenza, Hepatitis A, Hepatitis B and Meningococcal.
Call your doctor
Maternal screening throughout pregnancy (and for other family members too, if needed) is recommended. “All of our decisions are based on conversations between families and their physicians,” said Mills.
“Important issues have come up in our conversations with families,” said Mills. “We look at the ‘community’ of their broader families, and who might not be able to be protected when the new baby comes (young and older).”
“A good relationship between families and providers is critical today,” Mills said. “It’s key to trust your family provider and, for providers, it’s all about communication with families. We want to be available to answer any questions families have.”
