Study Has Warning About Missed Hepatitis B Shots at Birth

U.S. data from the past decade warned that a growing number of babies who miss their hepatitis B vaccine at birth may never get fully vaccinated.

Among 210,000 children who missed their birth dose, 73.2% of those born in 2014 still ended up getting fully vaccinated by age 18 months, but that percentage plunged to 55.3% for those born in 2023, reported researchers led by Joshua Williams, MD, of Denver Health and Hospital Authority in Colorado.

Of the babies born in 2014 who missed the birth dose, 18.4% never received a single hepatitis B shot over the next 18 months, a percentage that grew to 35.1% for the 2023-born babies, the findings in JAMA Network Open showed.

The study was based on data from nine Vaccine Safety Datalink sites and told a far different story for the nearly 910,000 kids who did receive their birth dose. In these kids, nearly all (97.6%) went on to receive the next two shots in the hepatitis B vaccine series by age 18 months.

“If you get that first birth dose, almost all children are going to be up to date on that three-dose hepatitis B vaccine series by 18 months, and that coverage is going to be equitable,” Williams told MedPage Today. “That’s a public health win.”

More research is needed to understand why that first dose is being missed. “We need to work with pregnant moms to help them understand hepatitis B and the vaccine, and to work together to avert hepatitis B in our communities,” he said.

Spread through contact with infected blood and other body fluids, the hepatitis B virus can pass from mother to baby during childbirth. About 90% of infants infected at birth and about 30% of children infected at ages 1 to 5 years will go on to develop chronic hepatitis B, which increases the risk of cirrhosis and liver cancer in adulthood.

The American Academy of Pediatrics recommends a universal hepatitis B birth dose and two subsequent doses by age 18 months, noting that pediatric hepatitis B cases have dropped 99% since the vaccine’s adoption in 1991.

In December, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to reverse more than three decades of U.S. vaccine policy and stop recommending a universal dose of the hepatitis B vaccine at birth. Critics said the move would leave children vulnerable to a preventable disease. A federal judge in March temporarily blocked ACIP’s new recommendations, and other changes to the childhood vaccination schedule, but HHS has started making moves that could reinstate the controversial guidance.

Vaccination at birth isn’t just a tool for preventing maternal transmission, Williams noted. Given the number of adults with hepatitis B who don’t know they have it, many infections in children come from family contacts, not necessarily infected mothers. Birth-dose vaccination “is an important way to begin childhood protection early against hepatitis B,” he said.

The study included 1,119,709 children born from January 2014 to April 2023 included in nine Vaccine Safety Datalink sites, of which 210,333 (18.8%) did not receive a birth dose. Participants were followed for 18 months and had to have at least 1 year of continuous enrollment at their health system. The study’s primary outcome was the number of hepatitis B vaccine doses the children received through age 18 months.

Overall, 81.2% of the kids got a hepatitis B birth dose and 87.1% were fully vaccinated at 18 months. More than half of the children were male (51%), 15.7% were Asian, 10.6% were Black, 31.9% were Hispanic, and 38% were white.

There was little difference in the rates of children receiving a birth dose and completing the three-dose vaccine series by race, ethnicity, or household spoken language.

Among those who missed their birth dose, children who were white were most likely to not complete the hepatitis B vaccine series by age 18 months, as only 66.3% of those infants received all three doses. In contrast, 84.2% of Asian children and 77.5% of Middle Eastern or North African children who didn’t get a birth dose went on to complete the series by age 18 months.

Nearly nine of 10 children who missed their birth dose and lived in a household where Chinese or Vietnamese was spoken received all hepatitis B shots by age 18 months, at 89.6% and 88.8%, respectively. That compared with 69.1% of those living in households where English was the preferred spoken language.

Study limitations included use of data primarily from privately insured healthcare systems, as well as local differences in the coding of demographic information.