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Economic Impact of Delaying the Infant Hepatitis B Vaccination Schedule

Eric W Hall1, Prabhu Gounder2, Heather Bradley3

  • 1OHSU-PSU School of Public Health, Oregon Health & Science University, Portland.

JAMA Pediatrics
|April 27, 2026
PubMed

Insights

Delaying the hepatitis B (HepB) vaccine at birth increases hepatitis B virus (HBV) infections, adverse health outcomes, and healthcare costs. Even short delays lead to significant negative consequences for infants and public health.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Health Economics

Background:

  • Universal hepatitis B (HepB) vaccine administration at birth is crucial for hepatitis B virus (HBV) elimination in the US.
  • Recent recommendations suggested delaying HepB vaccination for infants born to HBsAg-negative parents.

Purpose of the Study:

  • To evaluate the health and economic impact of delaying HepB vaccination in US infants.
  • To quantify the consequences of altered HepB vaccination schedules.

Main Methods:

  • A Markov model simulated HBV infections in a cohort of infants up to age 18.
  • The model incorporated HBsAg prevalence, testing, transmission routes, and sequelae.
  • Eight delay scenarios were compared to birth vaccination, considering perfect and imperfect adherence.

Main Results:

  • All delayed HepB vaccination scenarios resulted in increased infections, worse health outcomes, and higher costs compared to birth vaccination.
  • A 2-month delay for infants of HBsAg-negative parents led to 90 additional acute infections, 76 chronic infections, 29 deaths, and $16.4 million in costs.
  • Delays for infants of parents with unknown HBsAg status or imperfect adherence amplified negative outcomes.

Conclusions:

  • Delaying HepB vaccine initiation, even briefly, significantly increases HBV infections, adverse health outcomes, and healthcare costs.
  • The findings underscore the importance of timely HepB vaccination for public health and economic reasons.
  • Current recommendations for universal HepB vaccination at birth should be maintained to prevent disease burden.
Abstract

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