The CDC’s guidance on the hepatitis B (HepB) vaccine schedule has undergone some of the most significant tweaks in decades—especially for newborns and adults—and it’s flying under the radar outside medical circles.
Here’s what’s new, what stayed the same, and why some experts are alarmed.
The Big Picture: Who Should Get the Hepatitis B Vaccine Now?
According to the latest CDC and ACIP (Advisory Committee on Immunization Practices) guidance,
hepatitis B vaccination is now broadly recommended across the lifespan:
-
All infants-
All unvaccinated children and adolescents under 19 years-
All adults 19–59 years-
Adults 60+ with risk factors for hepatitis B (such as diabetes, chronic liver disease, HIV, multiple sex partners, injection drug use, or occupational exposure)
- *
Adults 60+ without known risk factors may
also be vaccinated based on shared decision-making with their clinician
The CDC reiterates that the HepB vaccine is safe, effective, and provides long-term protection against acute and chronic hepatitis B infection.
Newborns: A Major Shift Away from Universal Birth-Dose
For decades, US policy was clear: every newborn should get a hepatitis B shot within 24 hours of birth, regardless of maternal status. That has now changed at the advisory level.
What ACIP Just Recommended
In September 2025, ACIP voted to move away from a strict “universal birth-dose” recommendation for infants born to women who test negative for hepatitis B virus (HBV).
- ACIP now recommends “individual-based decision-making” for the HepB birth dose in infants born to women who test negative for HBV.
- The panel also voted that all pregnant women should be tested for hepatitis B, with testing covered under insurance and federal programs.
Infants born to mothers who are infected with HBV or whose status is unknown remain in a high-priority group and should continue to receive immediate birth-dose vaccination plus additional prophylaxis as indicated.
Why This Is Controversial
A news analysis from CIDRAP (University of Minnesota) reported that CDC advisers effectively “dropped” the decades-old universal birth-dose recommendation for infants of HBV-negative mothers.
Key concerns raised by public health experts:
- Missed infections: Lab errors or undocumented infections in pregnant women could leave infants unprotected if the birth dose isn’t given universally.
- System failures: Real-world gaps in testing, documentation, and follow-up could undermine a more “targeted” approach.
- Historical success: A 2024 CDC study estimated that the existing HepB vaccination program (including the birth dose) had prevented more than 6 million hepatitis B infections and nearly 1 million deaths in the U.S.
Supporters of the shift argue that:
- Universal maternal testing plus risk-based vaccination is a more tailored public health approach.
- It opens more space for parent–clinician discussion for low-risk infants when the mother is confirmed HBV-negative.
CDC has not yet fully updated its public-facing infant schedule pages to reflect every nuance of this advisory vote, but ACIP decisions are the blueprint for coming schedule updates.
Adults: Broad Expansion and More Flexible Schedules
While the infant policy has become more nuanced, the adult hepatitis B vaccination strategy has become more aggressive and inclusive.
Who Should Get Vaccinated as an Adult?
Per CDC’s current HepB vaccination page and provider guidance:
- All adults aged 19–59 years should receive hepatitis B vaccination, regardless of traditional risk factors.
- Adults 60+ with risk factors: vaccination is recommended.
- Adults 60+ without known risk factors: vaccination is optional but allowed—CDC says they may
receive it based on shared clinical decision-making.
CDC also urges unvaccinated adults of any age to be screened (using a triple panel: HBsAg, anti-HBs, total anti-HBc) and then vaccinated if susceptible.
The Current CDC Hepatitis B Vaccine Schedules
The latest official immunization schedules from CDC (updated through August 7, 2025 addenda for children and adults) preserve the core timing but offer multiple product-based options.
Infant, Child, and Adolescent Schedule (CDC baseline)
For most children, the classic 3-dose childhood schedule remains the backbone:
- Dose 1: Birth (still strongly supported for infants with unknown or positive maternal HBV status; now individualized for infants of HBV-negative mothers)
- Dose 2: 1–2 months
- Dose 3: 6–18 months
Unvaccinated children and adolescents under 19 should complete a catch-up series, typically 3 doses spread over at least 6 months.
Adult Schedules: 2-, 3-, or 4-Dose Options
The 2024–25 CDC Adult Immunization Schedule spells out multiple HepB vaccine options based on product and patient context.
Common regimens include:
- 2-dose series (Heplisav-B)
- Doses: 2
- Timing: 0 and 1 month (at least 4 weeks apart)
- For adults 18 years and older.
- 3-dose series (Engerix-B, Recombivax HB, PreHevbrio\)
- Doses:
3
- Standard timing:
0, 1, and 6 months
- Minimum intervals:*
- Dose 1 → Dose 2: 4 weeks
- Dose 2 → Dose 3: 8 weeks
- Dose 1 → Dose 3: 16 weeks
- \PreHevbrio is
not recommended in pregnancy due to limited safety data.
-
Combination HepA–HepB (Twinrix)-
Standard 3-dose series: 0, 1, and 6 months
-
Accelerated 4-dose series: 0, 7, and 21–30 days, with a
booster at 12 months.
- Used when simultaneous protection against both hepatitis A and B is desired.
In special cases, such as
hemodialysis patients or the
immunocompromised, higher-dose or additional-dose formulations (e.g., Recombivax dialysis formulation) and tailored schedules are recommended, as detailed in CDC provider resources and package inserts.
Why This Is Happening Now
Multiple trends pushed ACIP and CDC to revisit the HepB strategy:
-
Residual adult burden: Many adults, especially those born before universal childhood vaccination,
remain unvaccinated and at risk.
-
Evidence of impact: A CDC analysis showed that vaccination has already prevented
millions of infections and
hundreds of thousands of deaths, supporting expanded adult coverage.
-
Equity and missed risk: Relying solely on “traditional” risk categories has left vulnerable populations unprotected—hence the move to
universal adult vaccination for 19–59.
-
Testing plus targeting in pregnancy: ACIP’s new emphasis on
universal maternal testing is intended to make perinatal prevention more precise, while some members argue the system is robust enough to safely individualize the newborn birth dose for HBV-negative mothers.
What This Means If You’re a Parent or Patient
For expectant parents:- You can expect
HBV testing during pregnancy as part of standard care.
- If you test
positive or your status is unknown, your baby is still
strongly recommended to get the
HepB birth dose right after delivery, often with additional medications.
- If you test
negative, the decision about the
birth-dose vaccine may now involve more discussion with your clinician, depending on how quickly CDC translates ACIP’s vote into public-facing guidance and how hospitals implement it.
For adults:- If you’re
19–59 and never received HepB vaccine, CDC says you
should be vaccinated, even if you don’t think you’re “high risk.”
- If you’re
60+, ask your clinician:
- You
should be vaccinated if you have risk factors.
- You
may be vaccinated even without risk factors—this is now a recognized option.
Sources
1. [PDF] Recommended Adult Immunization Schedule | CDC
2. Hepatitis B Vaccine Administration - CDC
3. Hepatitis B Vaccine - CDC
4. ACIP Recommends Individual-Based Decision-Making for Hepatitis ...
5. CDC advisers drop decades-old universal hepatitis B birth dose ...
