Public Health Reaffirms Continued Adherence to the California Department of Public Health’s Hepatitis B Vaccination Guidance for Children

In light of today’s Advisory Committee on Immunization Practices (ACIP) vote on universal hepatitis B birth-dose recommendations, the Los Angeles County Department of Public Health affirms that Los Angeles County is following existing California Department of Public Health (CDPH) hepatitis B vaccination guidelines recommending that all children receive hepatitis B vaccine as early as possible, including a hepatitis B vaccine at birth. There are no modifications to immunization schedules or vaccine availability for Los Angeles County residents, at this time.

For more than three decades, universal hepatitis B birth dose vaccination has been a cornerstone of perinatal hepatitis B prevention in the United States. As with all other immunizations, medical providers work with each family to ensure families are informed of the recommendations and reasoning for the vaccine before any medical services are provided to infants. Because of the implementation of the universal birth dose vaccine strategy, the US has been on the path of eventual elimination of hepatitis b as a major public health threat.

The Advisory Committee on Immunization Practices’ recommendation to return to selective, risk-based newborn vaccination is not based on new evidence suggesting that hepatitis B vaccine birth dose is unsafe or ineffective. All existing data suggest that the universal birth dose of hepatitis B vaccine is consistently safe and results in life-long protection after the vaccine series is completed.

In Los Angeles County, due to the implementation of the universal birth dose and the partnership between Public Health, providers and parents, perinatal hepatitis B infection is extremely rare, with only one case recorded in the past five years. In contrast, a risk-based strategy was shown to be inadequate more than 35 years ago and can reintroduce preventable risks, particularly in communities such as Los Angeles County where hepatitis B prevalence and risks are higher.

The evidence of the effectiveness of the vaccine includes the following:

1. Perinatally transmitted hepatitis B remains a serious public health concern, and screening alone cannot prevent it.

Infants infected at birth face a high risk of lifelong consequences. Up to 90% develop chronic hepatitis B infection, compared with 5–10% of adults, and at least 25% die prematurely from cirrhosis or hepatocellular cancer—conditions that are largely preventable when early immunization is reliably delivered.

2. Universal hepatitis B vaccination at birth uniquely protects infants.

Universal hepatitis B vaccination at birth serves as a critical safety net, protecting all newborns, including those who may fall through known gaps in prenatal screening, identification, or treatment. This policy remains the only reliable way to ensure early protection for every infant, and it has helped Los Angeles County and the United States make significant progress toward eliminating perinatal hepatitis B transmission.

The vaccine carries minimal risks while preventing lifelong consequences such as chronic liver disease and liver cancer. Adverse events following hepatitis B vaccine administration are mild and include pain, redness or swelling at the site of injection and mild systemic reactions which are signs of a normal immune response. Decades of U.S. experience show dramatic declines in perinatal and early childhood infections following adoption of the universal birth dose.

3. Eliminating or modifying the universal hepatitis B birth dose vaccination recommendation will have predictable, harmful consequences.

A shift away from universal vaccination at birth will:

Increase perinatal hepatitis B transmission and more infants with chronic lifelong infection, even with small drops in vaccination coverage at birth.

Limit parents’ ability to ensure early and effective protection for their newborns against perinatal hepatitis B.

Widen preventable health disparities, disproportionately affecting infants born into communities facing insurance, transportation, or access barriers.

Create programmatic confusion and implementation challenges for hospitals, providers, insurers, and families. Universal recommendations are simple, clear, and workable.

Increase long-term healthcare costs, including those associated with chronic hepatitis B infection, liver cancer treatment, and transplantation.

Undermine public and clinical confidence in the importance of preventing perinatal hepatitis B infection and in the effectiveness of early and effective hepatitis B vaccination.

Public Health remains committed to ensuring that all people who live in Los Angeles County have continued access to affordable, safe, and effective vaccines and will continue to advocate for vaccine recommendations that are grounded in credible, transparent, and science-based evidence. Individuals with questions about the hepatitis B vaccine should contact their health care provider.

For more information and updates, visit our website at ph.lacounty.gov/perinatalhepb and follow us on our social media channels.

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