New national research shows a nearly 10% drop in hepatitis B vaccination rates, a downward trend that’s also reflected in data among Texas school children. Physicians emphasize having conversations with patients about the risks, which remain low.
The study, published Feb. 23 in the Journal of the American Medical Association, shows hepatitis B vaccine uptake in the U.S. dropped to 73.2% in August 2025 based on data collected by the World Health Organization. This marks a double-digit percentage drop over two years, after uptake hit its peak at 83.5% in February 2023.
There’s been a downtick the last five years in Texas, too. According to Texas Department of State Health Services data, 97.4% of kindergartners in public schools had the hepatitis B vaccine during the 2019-20 school year. That number was down to 94.8% during the 2024-25 academic cycle.
Authors of the JAMA study note, “While no single explanation can be identified, the decline coincides with a period of heightened public discourse in the U.S. regarding childhood vaccination following the COVID-19 pandemic, including high-visibility media coverage and policy discussions that may have influenced perceptions of vaccine safety, clinician recommendations, and parent decisions.”
The information in JAMA’s report indicates rates declined before the Advisory Committee on Immunization Practices voted to eliminate universal recommendations for hepatitis B vaccination at birth in December 2025.
Then on Jan. 5, 2026, the Centers for Disease Control and Prevention updated the childhood immunization schedule, moving the hepatitis B series from a universal recommendation to shared clinical decision-making. The vaccine is also recommended for certain high-risk groups, including infants born to women who tested positive for hepatitis B or whose status is unknown.
That change may lead to further vaccine reduction rates, according to the JAMA study authors.
Lindy McGee, MD, chair of TMA’s Committee on Child and Adolescent Health, said the stakes are significant. Infants infected with hepatitis B in the first year of life face a 90% risk of developing chronic infection, which dramatically raises the risk of liver disease and liver cancer, according to JAMA’s research.
Making matters more challenging, hepatitis B is more transmissible than many parents realize, Dr. McGee says, with only a tiny amount of blood-to-blood contact needed to transmit the disease.
“Not all bloodborne infections are the same,” the Houston pediatrician said. “One big misconception I hear a lot is, ‘Why are we giving babies a vaccine to treat a sexually transmitted disease?’ But hepatitis B can also be spread through something as simple as sharing a toothbrush, or a toddler bite at daycare if a child has a molar coming in.”
Dr. McGee says maternal screening programs are valuable but not foolproof. False negatives occur, and not all mothers receive complete prenatal care.
She emphasizes physicians shouldn’t direct frustration at vaccine-hesitant parents. “I have a lot of compassion for parents who are confused,” she said.
Dr. McGee’s approach: build trust first, then invite the conversation. She starts by asking parents, “Would you mind if I share my experience with you?” Then, she walks them through the evidence, including the vaccine’s strong safety profile and the real consequences of hepatitis B infection.
The JAMA study’s authors call for further investigation into whether declining vaccination rates are already translating into increased hepatitis B infections among infants and young children. In the meantime, physicians must have complete conversations with parents, some of whom are skeptical but simply want to do the right thing for their child, Dr. McGee says.
“Discussing honestly the risks associated with the vaccine – which are extremely low – and then asking them what they think about the information I’ve shared,” Dr. McGee said. “That’s where the conversation starts.”