This week the Advisory Committee on Immunization Practices (ACIP) will consider delaying the infant hepatitis B (HepB) birth dose vaccine schedule. However, new research from Portland State University shows that even a short delay can lead to substantially more infections, severe long-term health complications and sharply increased healthcare spending.
OHSU-PSU School of Public Health Assistant Professor of Epidemiology Eric Hall, in partnership with the Los Angeles County Department of Public Health, Emory University and Cornell University, evaluated the health and economic consequences of delaying the HepB vaccine in the United States using a model of 2024 U.S. births.
By delaying the birth dose to 2 months among infants whose mothers are not known to be living with hepatitis B, there could be at least 1,400 preventable hepatitis B infections among children, 300 excess cases of liver cancer, 480 preventable deaths and more $222 million in excess healthcare costs, for each year the revised recommendation is in place.
If the birth dose was delayed to 12 years, this would balloon to at least 2,700 preventable hepatitis B infections and $313 million in excess healthcare costs for each year the revised recommendation is in place.
“Our analysis makes clear that the hepatitis B birth dose is a critical tool for preventing infections that can last a lifetime,” Hall said. “When vaccination is delayed, whether by months or by years, we see predictable and preventable increases in new infections, chronic disease, liver cancer, and related deaths; these findings show how important timely protection at birth is for safeguarding children’s long-term health.”
The model and results were released as a pre-print in medRxiv titled, Economic evaluation of delaying the infant hepatitis B vaccination schedule. This new analysis quantifies the impact of delaying the first HepB vaccination by months or years among infants whose mothers are not known to be living with hepatitis B. The authors have previously developed models on hepatitis B vaccination policies, within the framework outlined by the Advisory Committee on Immunization Practices (ACIP) Guidance for Health Economics Studies, which have informed prior ACIP decisions.
Historically, ACIP uses their published Evidence to Recommendations framework which includes evaluating data across many domains, to make recommendations. After the September 2025 ACIP meeting, Hall and his team recognized that the committee did not have the necessary evidence to evaluate a delay to the HepB vaccine schedule.
“Our team worked quickly to modify and build upon our previous work to fill that need and provide these results and data for consideration in their discussion this week,” Hall said. “Universal infant vaccination has been the cornerstone of hepatitis B elimination efforts for decades.”
Since universal infant HepB vaccination started in 1991, pediatric HBV infections have dropped 90% and an estimated six million infections have been prevented.
“We have made great progress toward eliminating this preventable disease, and it is very important we continue this work and do not undo the important public health achievements of the past 45 years,” Hall added.