Study Warns Of More Chronic Hepatitis B In The Years Ahead

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A U.S. modeling study projects more chronic hepatitis B infections if the universal newborn vaccine dose is replaced by delayed vaccination or shared decision-making. For a birth cohort of 3.6 million, the model estimates an 83% increase under shared decision-making in its main scenario; these are projections, not observed outcomes.

A modeling study projects that replacing the universal hepatitis B vaccine birth dose with shared clinical decision-making could increase chronic hepatitis B infections in a U.S. birth cohort by 83%. The estimate is based on a modeled cohort of 3.6 million infants and describes a possible effect of a policy change, not infections already recorded.

Researchers led by Amir Mohareb of Massachusetts General Hospital modeled outcomes under a universal birth-dose policy, a plan to delay the first dose until age 2 months, and a shared decision-making approach. Their report, published in Annals of Internal Medicine, estimated 467 chronic infections under shared decision-making, compared with 255 under the delayed-vaccination scenario and 255 under the birth-dose baseline. The study reported the delayed schedule as a 19% increase and the shared-decision approach as an 83% increase over the universal-dose policy.

The projections also examined how many people could remain susceptible to infection as they reached adulthood. At year 20, the model estimated 1.806 million susceptible people under shared decision-making, compared with 232,000 under a universal birth-dose policy. These figures depend on the model’s assumptions about vaccination and do not represent a count of people currently susceptible.

The authors also tested scenarios with lower vaccine uptake. With 75% uptake in the delayed-vaccination scenario, the model projected 357 chronic infections; with 26% uptake under shared decision-making, it projected 575. In a separate scenario combining lower birth-dose coverage among infants whose mothers tested positive or had unknown hepatitis B status with greater population-wide prevalence, projections rose to 1,700 childhood chronic infections for delayed vaccination and 2,192 for shared decision-making.

How Lower Coverage Could Raise Risk

The findings matter because hepatitis B acquired early in life is much more likely to become chronic than infection acquired in adulthood. The report states that 90% of newborns exposed around birth develop chronic infection. It also notes that one in four people with untreated chronic hepatitis B develops complications such as cirrhosis or liver cancer. Those risks give prevention in infancy lasting consequences, even though the model’s estimated near-term increase in cases is modest in absolute numbers.

The study authors cautioned that the public-health effect could grow if a policy shift reduces vaccination overall. They wrote that a fall in coverage could make the number of infections greater than their base-case estimates. The modeled susceptibility figures likewise point to a larger group potentially vulnerable to infection later in life, though they are not predictions of how many people will become infected.

The Birth-Dose Policy Shift

The study follows a change in U.S. vaccine guidance. According to the report, the CDC’s Advisory Committee on Immunization Practices voted to stop recommending a universal hepatitis B birth dose, ending a policy in place for more than three decades. For infants whose mothers test negative for hepatitis B surface antigen, the committee instead recommended shared clinical decision-making between parents and clinicians about whether and when to vaccinate. For families who defer the dose, the panel suggested starting at 2 months.

The researchers said their results align with two earlier modeling studies that also raised concerns about dropping the universal birth dose. Their analysis adds estimates for chronic infections and susceptibility under different uptake assumptions. It does not establish what will happen in practice: actual outcomes would depend on vaccination coverage and the implementation of the guidance.

“These estimates suggest that the relative increase in HBV infections would be substantial, although the absolute increase would remain modest, at least in the early years after a policy change.”

— Amir Mohareb and colleagues, in the study

Limits of the Projections

The study presents model estimates, not observed changes in infection rates after the policy shift. The source report does not provide enough detail here to independently assess all assumptions behind the model or how closely future vaccine uptake will match its scenarios. The projected outcomes vary substantially with the assumed coverage levels.

The authors also identified limits in what they simulated: the models did not project liver disease development or deaths, and they did not estimate immunity among children who received only one or two doses of the three-dose vaccine series. It remains unclear how the guidance will affect real-world uptake and whether the projected differences will emerge in practice.

Monitoring Uptake and Outcomes

The next key evidence will be actual vaccination coverage after the revised guidance is implemented, alongside surveillance for hepatitis B infections in children and adults. Those data can show whether families commonly defer or decline the birth dose and whether patterns differ across risk groups. The study does not report a timeline for new outcome data.

Policymakers and clinicians will also have to weigh the model’s projections against the committee’s revised approach as further evidence becomes available. Until real-world coverage and infection trends are measured, the study’s estimates describe possible consequences, not a confirmed rise in chronic hepatitis B.

Key Questions

What did the study project?

For a modeled U.S. birth cohort of 3.6 million infants, researchers estimated that shared decision-making could produce 467 chronic infections, an 83% increase over the universal birth-dose baseline used in the study.

Did chronic hepatitis B infections already increase by 83%?

No. The 83% figure is a model projection comparing vaccination policies. It is not a measured increase in current infections.

What does shared clinical decision-making mean here?

For infants whose mothers test negative for hepatitis B surface antigen, parents and clinicians would discuss whether and when to give the vaccine. The committee suggested a first dose at 2 months for families who do not choose the birth dose.

What were the study’s main limitations?

The models did not predict liver disease, deaths, or immunity in children who received only one or two doses of the three-dose series. The estimates also depend on assumptions about how many families will vaccinate.

Source: rss