Sunita Sohrabji
American Community Media
For decades, U.S. public health policy has treated hepatitis B vaccination at birth as non-negotiable: every newborn, regardless of maternal risk factors, receives a first dose within 24 hours of life.
The approach mirrors global guidance from the World Health Organization and has been credited with sharply reducing pediatric hepatitis B infections and future liver cancer risk.
But new recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP) have reopened the debate. On Dec. 5, ACIP issued revised guidelines, recommending that only infants born to Hep-B positive mothers should be immunized at birth. Hep-B negative mothers can now choose to vaccinate or not, according to new ACIP recommendations, which also cancelled out the mandatory three dose series. The Centers for Disease Control and Prevention approved the updated guidances Dec. 15.
Pushback
In a Dec. 5 memo, the American Association of Immunologists said it was disappointed by ACIP’s recommendations. AAI noted that since implementation of vaccination at birth, chronic hepatitis B cases in children and adolescents have fallen by 99%.
The West Coast Health Alliance — comprised of the states of California, Hawaii, Oregon, and Washington also released a statement Dec. 5, recommending that the hepatitis B vaccine series should be given to all newborns.
ACIP Recommendations Not Evidence-Based
Dr. Samuel So — founder and executive director of the Asian Liver Center at Stanford University — called the new ACIP recommendations “short-sighted and not evidence-based.” In an interview with American Community Media, So stated that birth dose is not simply an infection-prevention tool, but a cancer-prevention strategy for infants.
“If an adult contracts hepatitis B, only about 5% will go on to develop a chronic infection that could result in liver cancer or cirrhosis. However, if a newborn or young child becomes infected, the risk significantly increases. Between 50% to 90% of these infants will develop a chronic infection that can lead to serious liver disease and cancer.”
”This heightened risk is why organizations like the World Health Organization and the CDC have referred to the hepatitis B vaccine as the first anti-cancer vaccine,” said So. “Rolling back immunizations at birth puts us on a path toward more liver cancer, more cirrhosis, and more preventable deaths.”
The stakes are highest for East Asian, South Asian, and African immigrant communities, where chronic hepatitis B remains endemic and is often acquired at birth or in early childhood.
Below are excerpts of the interview with Dr. So.
Dr. So, why are certain communities disproportionately impacted by hepatitis B?
People born in East Asia, South Asia, and Africa have much higher rates of chronic hepatitis B because many were infected at birth or in early childhood — before vaccines were widely available. In those regions, between 4% and 12% of adults may be chronically infected. When those individuals immigrate to the U.S., they carry a much higher risk of liver cancer and cirrhosis.
In the U.S., Asians are about nine times more likely to die from hepatitis B–related liver disease. African Americans — many of whom trace ancestry to African countries with high prevalence — are two to three times more likely to die from hepatitis B complications.
ACIP emphasizes maternal testing. Why isn’t testing alone sufficient?
Testing pregnant women has been recommended for over 20 years — this is not new. But it’s not foolproof. Even among women with private insurance, about 15% are not tested during pregnancy. The numbers are likely much worse for women without stable prenatal care.
More importantly, hepatitis B is extraordinarily infectious — 50 to 100 times more infectious than HIV. A drop of blood can remain infectious on a surface for up to five days. Babies can be exposed through household contact, caregivers, or daycare environments. Testing alone does not address those risks.
Can you explain environmental or “horizontal” transmission?
Babies and young children can be infected through minor skin breaks — scratches, abrasions — from contact with infected household members or other children. This used to be a major problem before universal vaccination.
With universal birth-dose vaccination, children can safely interact without fear. Without it, we return to an era of testing, exclusion, and stigma — something many Asian countries experienced before vaccination programs were in place.
Some policymakers argue hepatitis B is mainly spread through sex or drug use. How do you respond?
That completely misses the point. The primary goal of hepatitis B vaccination is not to prevent adult behavior — it’s to prevent lifelong infection acquired in infancy that leads to cancer decades later.
Saying we should vaccinate teenagers once they’re sexually active is nonsensical. By then, the cancer risk is far lower. We learned this lesson with HPV: framing vaccines around behavior reduces uptake. Framing them around cancer prevention saves lives.
What impact could ACIP’s recommendation have long-term?
It will lead to more babies becoming infected — especially those born to mothers who weren’t tested, tested late, or lacked prenatal care. Those infections won’t show symptoms in childhood, but decades later we’ll see more liver cancer and cirrhosis.
This decision does nothing to improve public health. It dismantles one of the most successful childhood vaccination strategies we’ve ever had.
What do global examples tell us?
China is the best example. Before universal newborn vaccination, 10% of children developed chronic hepatitis B by age one. Today, that number is under 0.3%. That success is recognized worldwide as a major public-health achievement.
I’ve spent 20 years helping low-income countries improve birth-dose coverage. Now the U.S. risks sending the message that universal vaccination is optional — which could undermine global progress, especially in Africa, where most countries still struggle to implement birth-dose programs.
Q: What is your advice to pregnant parents right now?
Follow the gold-standard recommendation: every newborn should receive the hepatitis B vaccine within 24 hours of birth and complete the full series. Three shots within six months protect for life — against infection, liver cancer, and stigma.
This is one of the safest, most effective vaccines we have. As a surgeon who treats liver cancer, I can tell you: prevention is everything.
