NEONATAL infections could increase if the United States moves away from universal hepatitis B virus (HBV) birth-dose vaccination, according to a new modelling study.
Researchers found that replacing the current universal birth-dose recommendation with a targeted approach—where vaccination is prioritised only for infants born to mothers who test positive or have unknown hepatitis B status—would likely result in more newborn infections under current screening and vaccination conditions.
Modelling Suggested Higher Infection Burden Under Targeted Strategy
A US birth cohort of more than 3.6 million infants was simulated, and outcomes were compared under two policy scenarios: universal birth-dose vaccination and a targeted strategy linked to maternal screening results.
Under current maternal screening coverage of 86%, the universal vaccination strategy was associated with a median of 1,292 neonatal infections. By contrast, the targeted approach resulted in hundreds of additional infections when vaccination coverage among infants of unscreened mothers was assumed to fall to levels seen historically after similar policy changes.
Even when higher vaccination coverage was assumed, the targeted strategy still resulted in additional cases in some scenarios, or at best minimal difference compared with universal vaccination.
Screening Gaps and Wider Public Health Impact
Findings suggested that preventing the additional infections associated with a targeted strategy would require substantial increases in maternal screening—more than 100,000 additional pregnant individuals would need to be tested under higher vaccination coverage scenarios. Where vaccination uptake among infants of unscreened mothers was lower, this figure rose significantly, highlighting the sensitivity of outcomes to small declines in coverage.
Authors noted that removal of universal recommendations has historically been associated with declines in vaccination uptake, particularly among infants whose mothers are not screened.
Given this pattern, the researchers suggested that the real-world impact of shifting away from universal birth-dose vaccination could be larger than modelled estimates, increasing the risk of preventable neonatal HBV infections and subsequent chronic disease.
Implications for Vaccination Policy
Authors concluded that a targeted birth-dose strategy is likely to increase neonatal hepatitis B infections unless maternal screening coverage rises substantially or vaccination rates in unscreened populations remain consistently high.
The authors emphasised that universal screening and universal birth-dose vaccination function as complementary safeguards in preventing mother-to-child transmission of hepatitis B, particularly in the immediate newborn period when infection risk is highest.
Reference
Lind ML et al. Impact of removing the universal hepatitis B birth-dose vaccination in the US. JAMA Pediatr. 2026;DOI:10.1001/jamapediatrics.2026.1226
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