Delaying the Birth Dose of Hepatitis B Vaccine Could Lead to More Infections, Greater Costs

New data analysis shows the health and economic consequences of delaying the infant hepatitis B (HBV) birth dose vaccine in the United States. The findings—based on a model of 2024 US births—show that even short delays in vaccination lead to substantially more infections, severe long-term health complications, and sharply increased health care spending.¹

The research comes from a partnership with HepVu, the Hepatitis B Foundation, and the National Viral Hepatitis Roundtable, and according to the analysis, the findings show:

• By delaying the birth dose to 2 months among infants whose mothers are not known to be living with hepatitis B, there could be at least 1,400 preventable hepatitis B infections among children, 300 excess cases of liver cancer, 480 preventable deaths and over $222 million in excess healthcare costs, for each year the revised recommendation is in place.
• If the birth dose was delayed to 12 years, this would balloon to at least 2,700 preventable hepatitis B infections and $313 million in excess healthcare costs for each year the revised recommendation is in place.¹

“These data provide a powerful, evidence-based foundation for decision-makers, health departments, and advocates who are working to strengthen infant immunization policies,” Michaela Jackson, Program Director, Prevention Policy, Hepatitis B Foundation, said in a statement. “By quantifying the real-world consequences of delaying the hepatitis B birth dose, including thousands of preventable infections and hundreds of millions in avoidable healthcare costs, this analysis offers a clear, data-driven tool to inform policy discussions and ensure that all infants receive the timely protection they need.”¹

The work was led by researchers and public health practitioners from Oregon Health & Science University, the Los Angeles County Department of Public Health, Emory University, and Cornell University. The model and results were released as a pre-print in medRxiv titled, Economic evaluation of delaying the infant hepatitis B vaccination schedule. This new analysis quantifies the impact of delaying the first HepB vaccination by months or years among infants whose mothers are not known to be living with hepatitis B.¹

The authors have previously developed models on hepatitis B vaccination policies, within the framework outlined by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) Guidance for Health Economics Studies, which have informed prior ACIP decisions.¹

In addition to infections, more serious illness such as liver cancer or increased mortality is predicted.

Infants whose mothers test negative for hepatitis B experience substantial increases in severe outcomes. For each year a delayed birth dose policy is in place, modeling projects:

• Delaying the birth dose to 2 months results in at least 62 preventable deaths and 39 cases of liver cancer.
• Delaying to 12 years results in at least 163 preventable deaths and 107 cases of liver cancer.¹
  

Health Care Costs

By delaying vaccines, health care spending due to new infections and lifelong management of chronic hepatitis B infection and liver disease increases. For each year the delayed birth dose policy is in place for infants whose mothers test negative for hepatitis B:

• Delaying the birth dose to 2 months results in at least +$21.6 million in healthcare costs
• Delaying to 7 months results in at least +$24.5 million
• Delaying to 4 years results in at least +$24.6 million
• Delaying to 12 years results in at least +$27.5 million¹

Hepatitis B Vaccines: A Microcosm of Government Public Health Today

The existing vaccine guidance is for babies to receive their first hepatitis B vaccine dose within 24 hours of their birth; a second dose is given at 1–2 months of age; and the third dose is given at 6–18 months of age. Back in September, the ACIP voted to table their vote on whether to recommend a change to the HBV immunization schedule for neonates and move it back to 30 days after birth. With their decision to table the vote, the ongoing recommendation stayed in place.²

However, this could all change by week's end.

This Thursday and Friday, the ACIP will meet for its 2-day meeting. On Thursday, the meeting is solely dedicated to the hepatitis B vaccines with a vote at the end of the day. However there is limited information on who is presenting, and it not certain on what the vote will be on specifically.

Check out our coverage at the conclusion of the vote on Thursday to learn the latest on the committee’s recommendations.

References
1.New Analysis Shows Delaying the Hepatitis B Birth Dose May Lead to Thousands of Preventable Infections and Hundreds of Millions in Avoidable Healthcare Costs. HepVu. December 1, 2025, Accessed December 2, 2025.
https://hepvu.org/news-updates/new-analysis-shows-delaying-the-hepatitis-b-birth-dose-may-lead-to-thousands-of-preventable-infections-and-hundreds-of-millions-in-avoidable-healthcare-costs/

2.Parkinson J. CDC Vaccine Advisors Table Hepatitis B Vaccine Vote, Keeps Current Policy in Place. Contagion. September 19, 2025. Accessed December 2, 2025.
https://www.contagionlive.com/view/cdc-vaccine-advisors-table-hepatitis-b-vaccine-vote-keeps-current-policy-in-place