By Jennifer Calfas

Vaccine advisers to the Centers for Disease Control and Prevention voted Friday to no longer recommend all newborns receive a hepatitis B vaccine at birth, ending the panel’s decadeslong guidance that has helped lower the number of infections nationwide.

This vote is one of several times in the past year that CDC’s Advisory Committee on Immunization Practices has strayed from aligning its recommendations with those from leading medical societies and doctors.

What does the change in the hepatitis B vaccine schedule mean?

ACIP—a panel handpicked by vaccine skeptic Health Secretary Robert F. Kennedy Jr.—voted eight to three to no longer recommend doctors administer the first dose of the hepatitis B vaccine at birth to infants born to mothers who have tested negative for the virus.

They advised parents to consult with their doctors about whether their newborns should receive the first dose if the mother isn’t infected. They also suggested that infants who don’t get the early dose shouldn’t receive their first hepatitis B shot until they are at least two months old.

The panel’s vote kept in place longstanding recommendations for newborns of mothers who have tested positive for hepatitis B to receive the vaccine at birth.

Acting CDC Director Jim O’Neill will need to approve ACIP’s new guidance for it to take effect.

Supporters of the changed recommendation have argued that most babies aren’t likely to contract hepatitis B and there isn’t enough known about the potential risks of vaccinations. Opponents have said the change isn’t backed by science and the safety of the birth dose is evidenced by decades of use.

The panel also voted to recommend parents consider antibody testing for their children to determine whether they need more doses in the three-dose series.

What has the scientific community said about the new CDC guidance?

Infectious disease and subject-matter experts have said delaying the first dose in the three-shot series would increase preventable hepatitis B infections and cause unnecessary confusion for families. Medical societies and a coalition of states recommend newborns receive their first dose at birth.

The Vaccine Integrity Project, a group of public-health veterans and researchers formed this year to make recommendations for inoculations, said in a recent report they didn’t find any benefits related to vaccine safety when delaying the first dose—and instead found newborns could be more at risk of infection if they aren’t inoculated shortly after birth.

The hepatitis B vaccine has been administered within 24 hours of birth in the U.S. for more than three decades. The second vaccine has typically been given at one to two months of age and the third between six to 18 months old, according to the CDC. The number of children diagnosed with hepatitis B in the U.S. has fallen dramatically since recommending the vaccine for all births in 1991. Parents have been able to choose whether to delay or decline to have their infants inoculated, according to the Vaccine Integrity Project.

The push to recommend a universal birth dose for the vaccine came in part due to challenges with screening all expecting mothers for hepatitis B, with some never getting tested or others receiving false negatives. Even if mothers test negative from hepatitis B, newborns may still be susceptible to the virus if other members of the household are infected.

What is hepatitis B and how is it transmitted?

Hepatitis B is a serious liver infection, acute or chronic, resulting from a virus by the same name. Chronic cases could result in liver cancer, liver failure, liver scarring, known as cirrhosis, and death. About 90% of infants with hepatitis B will develop a chronic infection, according to the CDC.

The hepatitis B virus is highly transmissible and many people may not know they have it. The virus can spread through blood or other bodily fluids, and it can live for up to seven days on surfaces. Newborns can be exposed to hepatitis B during labor and delivery if their mothers are infected, according to the American Academy of Pediatrics.

Can parents still have their children inoculated at birth?

Under these recommendations, parents who wish to have their infants vaccinated at birth, if the mother isn’t infected with hepatitis B, will be able to do so after discussing it with their doctor. Doctors might face additional hurdles in administering the vaccine at birth for some families, including additional time spent counseling.

Insurers will likely still cover the shots if administered earlier than recommended. AHIP, a group representing insurers, said its members will cover vaccines recommended by ACIP through Sept. 1 until the end of 2026. Insurers typically handle coverage decisions yearly.

Are hepatitis B vaccines safe?

Hepatitis B vaccines are safe and effective, doctors say, and are the best way to prevent infection. The vaccines protect about 98% of healthy infants from hepatitis B, according to the CDC.

Dr. Susan Kressly, president of the American Academy of Pediatrics, wrote in a recent letter to federal vaccine advisers that the shot “has one of the most well-established safety records of any vaccine.” She wrote universal birth doses have prevented tens of thousands of new infections.