The hepatitis B virus (HBV) vaccination rate in US-born infants has declined by more than 10% in the past 2 years, reversing a trend of increasing coverage, from 21% in 2002 to approximately 83% in 2023, according to findings from a study1 conducted by investigators at the University of California and at Harvard University in the absence of recent reporting by the Centers of Disease Control and Prevention (CDC).
"Recent HBV vaccination rates remain unknown, representing a critical gap given increasing concerns about vaccine hesitancy," Joshua Rothman, MD, MS, from the Department of Pediatrics at the University of California San Diego School of Medicine, and colleagues remark.
The concern about the unavailability of recent data is compounded, the investigators indicate, by the period coinciding with a widely circulated podcast conveying commentary by US Department of Health and Human Services Secretary Robert F. Kennedy Jr, who is critical of HBV vaccination of infants.
They also point out that in December 2025, the CDC's Advisory Committee on Immunization Practices, with members recently replaced by Kennedy, voted to eliminate the universal recommendation for HBV vaccination at birth. This was followed by the CDC updating the childhood immunization schedule, with the HBV series, along with several other vaccines, moved from universal recommendation to "shared clinical decision-making."
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Coverage for hepatitis B vaccination within 30 days of birth increased from 67.5% in 2017 to a peak of 83.5% in February 2023 but then fell to 73.2% by August 2025, representing a drop of more than 10 percentage points in roughly 2 years.
Investigators note the decrease occurred during a period of intensified public discourse about vaccines following the COVID-19 pandemic, including high-profile criticism of infant HBV vaccination and policy shifts such as the removal of the universal birth-dose recommendation in favor of “shared clinical decision-making.”
Although infection trends have not yet been linked to declining vaccination rates, infants infected with hepatitis B in their first year of life have approximately 90% risk of developing chronic infection, which can lead to chronic liver disease and liver cancer later in life.
Although HBV vaccination has substantially reduced HBV-related morbidity and mortality in the past, Rothman and colleagues emphasize that unprotected infants infected in the first year of life have a 90% risk of developing chronic infection, which is associated with chronic liver disease and liver cancer.
To ascertain the recent rate of HBV vaccination of infants, the investigators accessed a large electronic health records database (Epic Cosmos), comprising over 1800 hospitals and 41,000 clinics across the US, to evaluate anonymized records of over 12 million newborns born in the period between January 1, 2017, and August 31, 2025. Monthly HBV vaccination rates were calculated as doses administered within 30 days of birth divided by live births in the same month.
The investigators determined that vaccination rates rose from 67.5% in January 2017 to a peak of 83.5% in February 2023 and then declined to 73.2% by August 2025. They report that HBV vaccination rates had fallen significantly below forecasted rates by July 2023.
"While no single explanation can be identified, the decline coincides with a period of heightened public discourse in the US regarding childhood vaccinations following the COVID-19 pandemic," Rothman and colleagues observe. This discourse includes "high visibility media coverage and policy discussions that may have influenced perceptions of vaccine safety, clinician recommendations, and parent decisions."
The investigators point out several limitations of the study, including that although the Epic Cosmos database captures a large and diverse segment of US births, it does not represent a complete national census. In particular, they note, the database may underrepresent underserved regions, which could limit the generalizability of their findings.
"As a result, observed trends may partially reflect changes in data coverage rather than population-wide shifts in vaccination behavior," they acknowledge.
The investigators also note that although the effectiveness of HBV vaccination is well established, there have not yet been correlations of infection rates with the declining vaccinations.
Reference
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
