Murkowski pushes back against CDC’s end of Hepatitis B vaccine mandate for infants

Sen. Lisa Murkowski is pushing back against a recent change to the federal childhood immunization schedule that shifts the hepatitis B birth dose from a universal mandate to a shared decision between parents and doctors, a move supporters say restores informed consent and flexibility but critics warn could undermine past public health gains.

Murkowski, who is a member of the Health, Education, Labor and Pensions Committee, cited Alaska’s experience with hepatitis B as justification for retaining a universal birth-dose recommendation.

“Alaska’s experience shows why the hepatitis B birth dose is essential,” Murkowski said, pointing to high infection rates in parts of Western Alaska prior to vaccination efforts and the success of Alaska Native screening and vaccination programs launched in the early 1980s. She said there have been no new symptomatic hepatitis B cases among Alaska Native children under 20 for more than three decades and warned that delaying the birth dose risks reversing that progress, particularly in rural communities.

Hepatitis B is a viral infection that attacks the liver and can become chronic, leading to serious conditions such as liver cirrhosis, liver failure, or liver cancer. The virus is spread through contact with infected blood or certain bodily fluids, including during childbirth from an infected mother to her baby, through sexual contact, sharing needles or syringes, needle-stick injuries, or exposure to open wounds. It is not spread through casual contact such as hugging, kissing, coughing, sneezing, sharing food or drinks, breastfeeding, or everyday household interaction. Hepatitis B is also not transmitted through air, water, or casual social contact, which is why risk levels vary widely depending on exposure rather than proximity.

The policy change was formally adopted by the Centers for Disease Control and Prevention on Dec. 16, ending a universal requirement in place since 1991 that all newborns receive the hepatitis B vaccine within 24 hours of birth. Under the new guidance, infants born to mothers who test negative for hepatitis B surface antigen will receive the vaccine based on individual or shared clinical decision-making, allowing parents and health care providers to determine whether and when vaccination should occur.

If parents decline the birth dose, the CDC recommends that the first hepatitis B shot be administered no earlier than two months of age. The guidance does not change for high-risk cases: Infants born to mothers who test positive for hepatitis B or whose status is unknown are still advised to receive the vaccine and hepatitis B immune globulin within 12 to 24 hours of birth.

The change follows a Dec. 5 vote by the CDC’s Advisory Committee on Immunization Practices and was approved by acting CDC Director Jim O’Neill. It represents the first significant modification to the US childhood vaccine schedule during the Trump II Administration and under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr.

The change moves federal policy away from a one-size-fits-all model and respects parental rights and medical judgment for low-risk newborns. They note that hepatitis B is primarily transmitted through blood or bodily fluids and that the United States has long maintained stricter newborn vaccination requirements than some other developed nations with similarly low prevalence rates.

Some medical organizations such as the American Medical Association and the American Academy of Pediatrics, say the mandatory birth dose played a key role in reducing pediatric hepatitis B cases by more than 99% since 1990. They warn that loosening the recommendation could lead to missed vaccinations, especially in “underserved” areas.

Some hospitals and state health systems have indicated they will continue offering or recommending the universal birth dose regardless of the federal change.