Delaying hepatitis B vaccination after birth increases neonatal infections and reduces survival rates and quality of life, according to a new study from Cornell University.
The paper, “Economic Evaluation of Delays in Infant Hepatitis B Vaccination Schedules,” is embargoed until April 27, 2026, at 11 a.m. ET. JAMA Pediatrics.
The study found that the longer the delay, the higher the cost in lives and health care, with costs ranging from $16 million to $370 million, depending on the age of first vaccination and compliance with the vaccination schedule.
Chronic hepatitis B is a leading cause of cirrhosis, liver failure, liver cancer, and death, affecting 2.4 million people in the United States. Newborns are at greatest risk. When infected with hepatitis B virus (HBV), 90% of newborns develop chronic infection and 25% die early from cirrhosis or liver cancer.
“Prevention of HBV infection at birth is the cornerstone of hepatitis B eradication efforts,” said study lead author Noele Nelson, professor of practice in the Department of Public and Ecosystem Health.
In December 2025, the Federal Advisory Committee on Immunization Practices (ACIP) voted to postpone the first dose of HBV vaccine for infants whose birth parents test negative for the virus. This reverses the 2018 recommendation that all infants be vaccinated within 24 hours of birth.
In this study, Nelson and her team used a probabilistic model built on published scientific data on hepatitis B vaccine effectiveness, infection rates, and disease progression to estimate the number of infections and health care costs that would occur under different vaccine scenarios.
Dr. Nelson compared models in which vaccination was given at birth or delayed until age 2 months, 7 months, 4 years, or 12 years in children with HBV-negative biological parents, unknown parental infection status, or both. Their model also takes into account if all children received all three recommended doses, or if vaccination was incomplete.
All predictions showed that more people in the unvaccinated group would progress to chronic infections and severe complications such as cirrhosis and liver cancer. This effect was amplified if the child did not receive all three doses as prescribed.
Importantly, our study underestimates the costs and health impacts associated with delays in administering the birth dose of hepatitis B vaccine. Our model assumptions were conservative. For example, it does not take into account the increased risk of acquiring HBV infection from family and community members, which could occur if the number of people infected with HBV increases. ”
Noel Nelson, Professor of Practice, School of Public and Ecological Health
The latest ACIP recommendations are based, in part, on low rates of HBV infection. Professor Nelson argues that the low rates of HBV infection in the United States are a direct result of the success of the vaccination program.
“Studies have shown that the later children receive their first hepatitis B vaccination, the less likely they are to complete their regular vaccination course,” Professor Nelson said. “This policy has the potential to reverse this progress toward eliminating hepatitis B.”
Recent ACIP decisions also address concerns about the safety of the hepatitis B vaccine and speculation that the vaccine may do more harm than good. Dr. Nelson, who reviewed 40 years of research, including a recent comprehensive safety review, found no evidence of serious side effects, including seizures, other neurological problems, infections, or death.
“More than 35 years of data demonstrate that hepatitis B vaccines provide long-term immunogenicity and possibly lifelong protection,” Nelson said. “We find no benefit to delaying the first dose of this vaccine and our findings support maintaining a policy of universal hepatitis B vaccination at birth.”
Additional authors include Eric W. Hall of Oregon Health and Science University; Prabhu Gounder of the Los Angeles County Department of Public Health. and Heather Bradley of Emory University.
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Reference magazines:
Hall, E.W.; others. (2026) Economic impact of delays in infant hepatitis B vaccination schedules. JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2026.1221. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2848162
