Dec. 10, 2025 — A controversial vote by advisers to the Centers for Disease Control and Prevention (CDC) has thrown maternity wards, pediatric practices and public health departments into uncertainty, as clinicians try to interpret a major reversal to long-standing hepatitis B vaccination guidance for newborns.
For decades, all infants in the U.S. have routinely received their first hepatitis B vaccine dose within 24 hours of birth. But during a meeting last week, the CDC’s vaccine advisory panel recommended limiting that immediate birth dose only to infants born to mothers who test positive for hepatitis B — a dramatic departure from the universal approach that has been in place since the early 1990s.
“We don’t know how hospitals and individual clinicians are going to handle this yet,” said Dr. Brenna Hughes, interim chair of obstetrics and gynecology at Duke University. “It’s generating fear and distrust at a critical moment for parents.”
Gaps in maternal testing create safety risks
While the new guidance centers on maternal hepatitis B testing, many pregnant women never receive early prenatal care. A November report from March of Dimes found that nearly one in four expectant mothers are not evaluated during the first trimester — when hepatitis B screening typically occurs.
Clinicians say the birth dose serves as a vital safeguard. Dr. Steven Fleishman, president of the American College of Obstetricians and Gynecologists, noted that a woman can contract hepatitis B later in pregnancy, or an initial test may miss a new infection.
“The vaccine ensures the baby is protected during delivery if the mother becomes infected later,” he said.
CDC director has not signed off
As of Tuesday, acting CDC Director Jim O’Neill had not formally approved the panel’s recommendation — a step that is typically procedural but not mandatory. The CDC does not require vaccination; it publishes a recommended schedule that health systems and states generally follow.
Experts, however, say this panel — newly appointed in June by Health Secretary Robert F. Kennedy Jr. — has broken sharply with the CDC’s evidence-based tradition.
“They have not followed the transparent, data-driven process the agency is known for,” said Dr. Jason Goldman, president of the American College of Physicians. “Their decisions cannot be trusted.”
The new recommendation advises parents of hepatitis B–negative mothers to make an individualized decision with their healthcare provider. It also suggests delaying the first hepatitis B dose until at least two months of age if not given at birth — a position public health experts say contradicts decades of safety data.
Implementation of the universal birth dose in the early 1990s led to a 99% reduction in acute hepatitis B infections among children in the U.S.
Frontline doctors report chaos
During a Tuesday briefing, Dr. Aaron Milstone of Johns Hopkins Medicine said the fallout is causing “chaos and confusion” as doctors struggle to explain conflicting guidance to anxious parents.
Physicians worry that time spent clarifying misinformation will detract from other critical newborn care.
“If you spend 20 minutes assuring parents vaccines are safe, that’s time you’re not spending addressing feeding, growth, or safety,” said Dr. Kevin Schulman of Stanford Medicine.
Some clinicians say the new policy places heavy and unnecessary burdens on families.
“We’re creating hurdles at every step,” said Dr. Anna Lok of the University of Michigan Medical School. “It makes something simple far more difficult to accomplish.”
States craft their own guidance
Several states in the Northeast are moving independently of the CDC. Members of the Northeast Public Health Collaborative — including Massachusetts — have reaffirmed support for the universal hepatitis B birth dose.
But national consistency appears unlikely. “Some states will manage this better than others,” said Joe Zamboni, an attorney with American Families for Vaccines.
Public health experts express particular concern about Florida. The state’s surgeon general, Joseph Ladapo, has signaled plans to roll back childhood vaccine requirements. The state health department is scheduled to meet Friday, Dec. 12, to discuss school immunization rules, though officials say the meeting will not be streamed publicly.
Despite the CDC panel’s recommendation, many physicians say their clinical practice will not change until stronger evidence is presented.
“From a medical standpoint, nothing has changed,” said Dr. Rashmi Roa, a high-risk pregnancy specialist at UCLA Health. “Our recommendation for the birth dose remains the same.”
