Impacts of Declining Hepatitis B Vaccine Birth Dose on Future Immunization Uptake

Childhood vaccination remains one of the most effective public health interventions, yet recent national declines in coverage and rising vaccine hesitancy threaten these achievements. Hepatitis B (HepB) birth dose administration is an early predictor of parental adherence to future immunization schedules. We examined recent trends in Rhode Island (RI) HepB birth dose coverage and their relationship to subsequent vaccine completion and school-entry compliance.

We identified the immunization records of RI resident infants born in RI hospitals from 2019 through mid-2025 in the Rhode Island Child and Adult Immunization Registry (RICAIR), and categorized them by timing of initial HepB vaccination: birth dose prior to discharge; early well visit dose; or no dose by 3 months of age in order to compare combined 7-series completion by 24 months and kindergarten immunization. Recent trends were then used to model projected future coverage.

HepB birth dose coverage declined abruptly to 84.2% by Q2 2025. Infants who received a HepB birth dose were more likely to meet kindergarten immunization requirements (91.1%) compared with those vaccinated later (81.8%) or not by 3 months (10.1%). Projections suggest statewide kindergarten compliance could decline from 88.8% to 85.3% if current trends persist.

The accelerating decline in HepB birth dose administration in RI is an early warning sign of eroding vaccine confidence and adherence. Coordinated, cross-sector interventions linking public health, prenatal, and pediatric care are urgently needed to reverse this trend and sustain high early childhood immunization coverage.