What Do the CDC's New Recommendations Mean for Hepatitis B Vaccine Coverage?

On Dec. 4, the U.S. Centers for Disease Control and Prevention (CDC) vaccine advisors voted 8-3 to change their recommendations on vaccinating infants for hepatitis B.

The old guidance, which had stood for more than three decades, was to universally vaccinate all newborns against the disease. However, the new recommendation, pending approval, will be to only vaccinate those infants whose mothers test positive for hepatitis B. Those with a negative test, the recommendation continues, should discuss the matter with their doctors.

What does the hepatitis B vaccine rollback mean for parents — and kids?

Under the CDC's current guidance (which remains in place until acting director Jim O'Neil approves the new decision), "all infants" should receive the vaccine, one of only two that are recommended to be given right at birth. The standard immunization schedule involves three doses of the vaccine, with the final dose being given between six and 18 months of age — this holds even if the child's mother tests negative for hepatitis B.

Before this recommendation, an estimated 18,000 children in the United States were infected with hepatitis B before they turned 10. About half of those got the disease from their birth parents, whereas the other half contracted it from others in early childhood. In 2022, after the universal birth dose recommendation had been in place for more than 30 years, there were only 13 reported cases of perinatal hepatitis B cases — a drop from 17 in 2021.

Hepatitis B is a viral infection that causes liver inflammation. Some acute (short-term) cases can go away after a brief period of illness and without treatment, but some people can develop chronic cases that can lead to liver failure and cirrhosis.

There's no cure for the disease, though antiviral medications can reduce the risk of spreading it to others. Aside from perinatal transmission, the disease is also transmitted through body fluids including blood, saliva and semen.

For those infected during infancy, 80% to 90% will develop chronic hepatitis B, according to the CDC. Further, around 25% of those chronically infected during childhood will die prematurely from cirrhosis or liver cancer.

Many health experts, including former CDC director Dr. Tom Frieden, believe this move is "a big mistake," as he puts it. President of the American Association of Pediatrics (AAP) Susan J. Kressly — also an M.D. — calls the new guidance "irresponsible and purposely misleading." The AAP continues to champion the old recommendation: Newborns should be given a dose of the vaccine within 24 hours of birth, with additional doses at one to two months and six to 18 months, regardless of the results of the prenatal hepatitis B screening.

Will the hepatitis B vaccine be covered by insurance if the new recommendation holds?

Hepatitis B vaccines are generally covered by health insurance, whether they're given at birth or later in life. According to the CDC, "all Health Insurance Marketplace plans and most other private insurance plans must cover certain vaccines without charging a copayment or coinsurance when provided by an in-network provider." Of those "certain vaccines," both hepatitis A and hepatitis B make the cut — plus, Medicare Part B covers hepatitis B vaccines, too.

Fortunately, industry experts don't expect the updated guidelines to impact the insurance coverage of the vaccine. And even if the recommendation is approved, according to CDC Immunization Services Division director Dr. Georgina Peacock, hepatitis B inoculation would still be covered under the Vaccinations for Children (VFC) program.