Why should we not delay the Hepatitis B vaccine until the child is 12 years old?
Here are several reasons, backed by evidence, why giving the HepB vaccine at birth (or very early) is beneficial and essential:
1. Preventing mother-to-child transmission
• If a mother has hepatitis B (HBV), she can pass the virus to her baby during delivery. Even in cases where the mother tests negative, testing isn’t perfect, and infections could be missed. The birth dose helps catch those cases early.
• Without early vaccination, infants born to infected mothers are at high risk of chronic infection, which later can lead to severe liver disease, cirrhosis, or liver cancer.
2. High risk of chronic disease when infection occurs early
• Infants or young children who become infected with HBV are much more likely to develop chronic hepatitis B compared to adults. ACIP’s evidence shows ~90% of persons infected during infancy develop chronic infection, versus a much lower rate in adults.
• Chronic HBV has severe long-term consequences (liver cancer, cirrhosis), hence prevention early in life is highly valuable.
3. Effectiveness & safety of early vaccination
• The vaccine is very safe; adverse events are rare and generally mild. No credible data show that giving the vaccine at birth is unsafe.
• The earlier the vaccine is administered (especially in settings of maternal infection or unknown status), the better the prevention of infection. Delaying weakens that protection.
4. Public health impact
• Since universal newborn vaccination began, rates of hepatitis B in children have dropped drastically. The U.S. saw a nearly 99% decrease in pediatric cases as a result of universal infant vaccination. 
• Delaying the vaccine could lead to an increased risk of infections before vaccination occurs.
The proposal to delay until age 12
• Donald Trump recently stated that he recommends delaying the hepatitis B vaccine until age 12. He is quoted as saying, “There’s no reason to give a baby that’s almost just born hepatitis B … So I would say wait until the baby is 12 years old.”
• The justification he gave is that hepatitis B is sexually transmitted, so in his view, vaccinating infants (who aren’t sexually active) doesn’t make sense.
Why does the evidence not support waiting until age 12
Here are the major counterarguments, based on data and expert opinions:
1. Infants can and do get infected
• Infection can happen during childbirth from mothers who are HBV-positive. Even when mothers test negative, false negatives or late infections can occur. The birth dose provides an added margin of safety.
• There are also non-sexual routes of transmission in early childhood (e.g. sharing items, cuts or scrapes, exposure to infected blood or bodily fluids).
2. Risk of chronic infection is much higher in younger children
• As noted, infants infected are far more likely to develop chronic disease, and that contributes to long-term morbidity and mortality. A delay until 12 means any exposure in the first 12 years isn’t prevented early.
3. Delayed vaccination could result in missed doses / lower uptake
• Administering the first dose at birth helps ensure that babies at least get one dose. If you wait until much later, there’s risk parents/staff might delay, skip, or not complete the series.
4. Established safety and effectiveness
• There is no credible scientific evidence that delaying the first dose until age 12 provides more safety or reduced adverse outcomes. On the contrary, the evidence supports early safety and effectiveness.
Are there any evidence-based reasons for delay?
From what’s available publicly:
• Some debate is underway about whether infants born to mothers known to be negative for HBV could have the first dose delayed slightly (e.g. to one month of age) without much risk. ACIP has postponed a vote about changing the recommendation for that group.
• However, delaying until age 12 is much more severe and is not supported by evidence in expert guidelines or major peer-reviewed studies. The risk of disease and permanent consequences is too great, especially in infants and young children.
What medical experts say about Trump’s position
• Pediatric infectious disease specialists say delaying until age 12 is “extremely dangerous,” “totally irresponsible,” given the risk of serious disease in infants.
• Experts point out that before the universal birth dose policy was adopted, there were ~18,000 children per year in the U.S. infected before age 10.
Summary
• Strong evidence supports giving HepB vaccine at birth: to prevent early infection, especially from mother to child, to reduce chronic infection, and because the vaccine is safe.
• Delaying until age 12 would leave children vulnerable for a long period during which they could acquire infection and suffer serious long-term consequences.
• The idea of waiting until age 12 has no supporting evidence in current medical literature or guidelines; instead, it appears to reflect a misunderstanding of how hepatitis B is transmitted and the risks involved.
We hope this information helps.
Dr.Garofalo and Pediatric Dream Care's team
Mylai Garofalo, MD, FAAP.
Pediatrician/President/Owner
3199 Lake Worth Rd. Ste B-2, Palm Springs, Fl 33461
P: (561)-621-1801 / F: (561)-331-4603 / e-F: (561)-288-4532
E: pediatricdreamcare@gmail.com W: www.pediatricdreamcare.com
