Why Every Newborn Needs the Hepatitis B Vaccine at Birth—and the Dangers of Not Vaccinating

Introduction:

Hepatitis B virus (HBV) is the leading cause of chronic viral hepatitis and is a major contributor to acute and chronic liver disease worldwide. It is transmitted through blood exposure, sexual contact, and—critically—through vertical transmission from mother to child.

In 2022, an estimated 304 million people were living with chronic hepatitis B or C globally, with HBV accounting for over 80% of the burden. Despite the availability of effective prevention tools and therapies, viral hepatitis caused 1.3 million deaths—around 3,500 deaths every day. More than 60 countries report hepatitis mortality rates exceeding 20 per 100,000 people, double the 2025 target. The Western Pacific and African regions bear the greatest burden.

Diagnosis and treatment rates remain far below global targets. As of 2022, only 13% of people with hepatitis B and 36% of those with hepatitis C were diagnosed. Treatment rates were even lower—3% for HBV and 20% for HCV—far from the 2025 goals of 60% diagnosed and 50% treated.

Vertical Transmission of HBV: Definition, Timing, and Risk:

Vertical (mother-to-child) transmission of HBV is highly efficient. In the absence of preventive interventions, transmission rates range from:

• 70–90% for HBeAg-positive mothers
• 10–40% for HBeAg-negative mothers

Contributing factors include:

• Mode of delivery
• Amniocentesis and invasive obstetric procedures
• Breastfeeding 

Prevention of Vertical Transmission: Management at Birth:

1. Neonatal Immunoprophylaxis: The Birth Dose

Post-exposure immunoprophylaxis—consisting of immediate HBV vaccination, with or without HBV immunoglobulin (HBIG)—is the most effective strategy to prevent vertical transmission.

• Administering the first HBV vaccine dose within 12 hours of life, followed by at least two additional doses over 6–12 months, is 90–95% effective in preventing infection.
• Delaying vaccination beyond 24–48 hours significantly reduces efficacy.
• WHO recommends providing the birth dose as soon as possible, ideally within 24 hours, even in low-endemicity settings.

2. Combined Vaccine + HBIG Approach

Adding HBIG at birth further decreases transmission—especially in infants born to mothers with high viral loads—to below 5%.
However, HBIG access remains limited in many low- and middle-income countries due to cost, refrigeration needs, and short shelf life.

Elimination of Mother-to-Child Transmission: Global Progress:

Preventing mother-to-child transmission is central to HBV elimination.

• 129 countries have adopted antenatal HBV screening policies.
• 147 countries administer universal or targeted birth-dose vaccination.
• Global birth-dose coverage remains low at 43%, and only 17% in the African region.
• Just over half of WHO Member States have achieved ≥90% coverage for the full infant HBV vaccine series.

Strategic Planning and Service Integration, as of 2025:

• 123 countries have national hepatitis strategic plans.
• 80 countries have integrated hepatitis testing/treatment into primary health care.

Gaps and Priorities Toward 2030:

Major challenges include:

• Persistently high mortality in Africa and the Western Pacific
• Extremely low diagnosis and treatment rates
• Large disparities in access and medicine pricing
• Significant data gaps affecting national planning

Priority actions for 2030 focus on:

• Expanding access to testing, vaccination, and treatment
• Strengthening service integration
• Addressing pricing and intellectual property barriers
• Increasing political and financial commitment
• Improving surveillance and data systems

Conclusions and remarks:

Infant HBV transmission occurs primarily from mother to baby during pregnancy or childbirth.

Adults and infants respond very differently to Hepatitis B infection.

In adults, most infections are silent: symptoms are uncommon, but individuals remain contagious.

In newborns, the consequences are far more severe:
Nine out of ten infected infants develop chronic hepatitis B, which can later lead to:
• cirrhosis
• liver failure
• liver cancer

Many mothers may unknowingly be infected.
In the U.S., an estimated 3–5% of women of reproductive age have Hepatitis B without being aware of it.
This means any newborn is potentially at risk, even when the mother shows no symptoms.

The Hepatitis B birth dose saves lives.
The U.S. has administered the first Hepatitis B vaccine dose within 24 hours of birth since 1994.
As a result: approximately 90,100 infant deaths have been prevented.
The birth dose is the only intervention that protects the baby immediately—even if maternal infection has not yet been detected.

What would happen if we stopped vaccinating at birth?
Projections indicate that 18,000–20,000 infants per year in the U.S. would be born infected.
Most would develop chronic hepatitis B, facing lifelong risks of cirrhosis and liver cancer.

HBV vaccination at birth must be protected, strengthened, and expanded worldwide—never discontinued.

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