Projected Effect of 2026 Federal Changes to the Childhood Immunization Schedule on Chronic Hepatitis B Virus Infections in the United States

BACKGROUND: The United States recently proposed changes to the recommendations for childhood hepatitis B virus (HBV) vaccination. OBJECTIVE: To project the effect of vaccine policy changes, if fully implemented, on chronic HBV infections. DESIGN: Markov cohort state transition model of perinatal and childhood HBV infection. DATA SOURCES: Published data on maternal HBV prevalence (0.4%) and hepatitis B surface antigen testing (99.5% sensitivity), childhood vaccine completion (universal birth-dose strategy: 91.1%; deferred strategy: 87.1%; shared decision-making strategy: 50.0%), and age-stratified risk for chronic HBV infection. TARGET POPULATION: = 3.6 million). TIME HORIZON: 20 years. INTERVENTION: Universal birth-dose vaccination, deferred (2-month) vaccination, and vaccination through shared decision making. OUTCOME MEASURES: Numbers with chronic HBV infection and susceptibility to HBV, with 95% uncertainty intervals (UIs) derived from probabilistic sensitivity analysis. RESULTS OF BASE-CASE ANALYSIS: Compared with the universal birth-dose strategy (255 childhood infections [95% UI, 130 to 530]), the deferred and shared decision-making strategies would increase chronic HBV infections in the 2026 birth cohort by 19% to 303 (95% UI, 155 to 610) and by 83% to 467 (95% UI, 209 to 1032), respectively. These strategies would also increase the number of HBV-susceptible people at year 20 (474 000 and 1 806 000) compared with the universal birth-dose strategy (232 000). RESULTS OF SENSITIVITY ANALYSIS: In a scenario with lower vaccine coverage (84.5%) and higher HBV prevalence (maternal prevalence of 0.72% and higher risk for horizontal infection), chronic HBV infections would increase to 1700 and 2192, respectively, with the deferred and shared decision-making strategies. LIMITATION: Uncertainty in horizontal HBV infection risk. CONCLUSION: Proposed policy changes for vaccination through shared decision making are projected to result in an 83% increase in childhood HBV infections, and between 50% and 70% of children entering adulthood annually would be susceptible to HBV infection. Policymakers should reimplement recommendations for universal birth-dose vaccination. PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases.