May 5, 2026

Faltering hepatitis vaccine uptake ‘seeding next wave of chronic liver disease'


By Octavia Feliciano

Key takeaways:

  • Uneven vaccine uptake may shift clinician workload to screening and treating more liver disease.
  • Clinicians can educate patients about vaccines, offer vaccines in clinic and advocate for evidence-backed policy.

Amid policy shifts and a rise in misinformation fueling vaccine hesitancy, fewer infants in the U.S. are receiving the hepatitis B virus birth dose.

Earlier this year, the CDC changed its universal recommendation for HBV birth dose to include only infants with known risk factors, a move temporarily halted by a federal court order in March 2026. Similar changes were made to the CDC’s hepatitis A vaccine recommendation.

The American Association for the Study of Liver Diseases also opposed the change, supporting the federal court ruling that blocked altering the childhood and adolescent immunization schedule — for now.

Before the policy upheaval, rates of HBV vaccination at birth were already on the decline in the U.S., falling from 83.5% in 2023 to 73.2% in 2025.

“HBV acquired early in life is much more likely to become chronic, and that means decades of monitoring, antiviral therapy and increased risk of cirrhosis and liver cancer,” Anthony Martinez, MD, AAHIVS, FAASLD, associate professor of medicine at University at Buffalo Jacobs School of Medicine and Biomedical Sciences, told Healio. “If younger generations enter adulthood without immunity, we’re essentially seeding the next wave of chronic liver disease.”

Short-term impacts
Pediatricians like Joshua “Yoshi” Rothman, MD, MS, are seeing an uptick in vaccine hesitancy among parents and guardians of young children.

“I think I speak for most pediatricians when I say this is becoming a very prominent conversation in our clinics, and I anticipate this will continue, especially with the changes in the CDC recommendations,” Rothman, assistant professor of pediatrics at UC San Diego Health, said in an interview.

The top concerns among parents who want to vaccinate their children are vaccine schedules and whether they will be covered by insurance, said Rothman, adding that those who are hesitant about vaccination often have questions about refusing or delaying vaccines.

“In the short term, we’re going to see a growing pool of susceptible patients — and that translates directly into more infections,” Martinez said. “For hepatitis A, that means more outbreaks in under-immunized communities. For hepatitis B, the concern is far more consequential; even small gaps in early-life vaccination can lead to lifelong chronic infection.”

Arpan Patel, MD, PhD, assistant professor at David Geffen School of Medicine at UCLA, is concerned that falling rates of the HBV birth dose will leave more patients susceptible to liver injury, cirrhosis and liver cancer.

“While the new HBV vaccine guidance emphasizes shared decision-making for mothers to choose whether they would like their newborn to get the vaccine, inconsistent prenatal care in this country will likely lead to many HBV-infected mothers unknowingly passing off the infection to their newborns, or children being exposed to household contacts with HBV,” Patel said.

Communities at risk
Even with continuing recommendations to test individuals who are pregnant for HBV and vaccinate the children of those who test positive, infants are still at risk for mother-to-child transmission, according to Norah Terrault, MD, MPH, FAASLD.

“We have individuals who are uninsured, underinsured or who present late for perinatal care, and testing can be erroneous or misinterpreted leading to babies not receiving appropriate prophylaxis to prevent infection,” Terrault, professor and chief of gastroenterology and liver diseases at Keck Medicine of USC, said.

Also, by not protecting individuals from birth, risk for HBV infection extends into childhood, adolescence and adulthood. HBV exposure can occur through percutaneous or mucosal contact, such as sharing needles, sexual contact and less commonly from sharing toothbrushes or razors, she added.

When considering other populations at risk for HAV, Terrault noted that foodborne outbreaks are well-known, but person-to-person transmission also can occur during outbreaks, especially in unsanitary conditions among those who are unsheltered or inject drugs. HAV vaccination early in life eliminates any future concern for this infection, both at home and while traveling, Terrault said.

There are some regions in the U.S. where risk for both HBV and HAV is elevated, if current trends continue. According to the CDC, the highest HAV rates were in the southern U.S. and along the East Coast, with Alabama, North Carolina, Delaware, Florida and Virginia reporting the highest HAV rate category of 1.0 to 4.6 cases per 100,000 people in 2024.

“Areas with rising vaccine exemptions and limited access to primary care are particularly concerning,” Martinez said.

This concern is an equity issue as much as a clinical one, according to Martinez.

“Declining vaccination rates don’t affect everyone equally; they disproportionately impact the most vulnerable patients and those already at the highest risk of severe liver disease,” he said.

Terrault emphasized the importance of testing patients for HAV and HBV — even if they come in for another reason — and offering vaccination to those without evidence of immunity.

“Not all practices offer vaccination, but this may need to be expanded so we can be a backstop for missed vaccination opportunities at birth or each stage in life,” she said.

What can clinicians do?
Patel also recommends gastroenterologists and hepatologists offer vaccinations in their clinics, especially if they operate in nonintegrated health care networks.

“Our community needs to be more invested in prevention, outreach and catchup,” he said.

Martinez believes specialty care can integrate vaccinations into practice with electronic health record prompts, standing orders and clinic workflows, and play a role in building public trust in vaccines.

“The most effective approach is still a strong, clear recommendation,” Martinez said. “Patients trust their clinicians. When we say, ‘This vaccine protects your liver and prevents serious disease,’ that carries weight.”

Clinicians can also help educate the public about vaccines by platforming personal experiences.

“If they have patients willing to share their stories, or if they themselves as clinicians can share stories of those who have dealt with the negative consequences of hepatitis and liver disease, that could be a really powerful message,” Rothman said.

When approaching conversations about vaccines with parents who are hesitant, Rothman noted the importance of being respectful and understanding.

“I want to try to be sensitive to the families and the patients who I know want to do what is best for their children, and if we can keep that in mind when we have these conversations, hopefully they can be productive,” he said.

Gastroenterologists and hepatologists also can be advocates for evidence-backed health policy concerning vaccines.

In particular, Patel emphasized the importance of being aware of misinformation online and having familiarity with hospital, payer and state-level vaccine policies.

If vaccination rates continue to decline, the long-term concern is trading prevention for treating chronic disease, Martinez said.

“Clinicians will spend more time managing exposures, chasing down vaccination gaps and treating infections that could have been prevented,” he said. “It’s a step backward for public health and for liver disease prevention.”

Sources:
Healio.com




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