April 24, 2026
As vaccine hesitancy rises and confusion persists around pediatric vaccine schedules, a new national study offers clear evidence supporting the importance of hepatitis B vaccination at birth. Lead author and Denver Health pediatrician Josh Williams, MD, published findings in Journal of the American Medical Association Network Open that show vaccination at birth is strongly associated with equitable and timely completion of the full, three-dose hepatitis B series.
Hepatitis B can cause chronic infection when acquired early in life, increasing the risk of cirrhosis and liver cancer in adulthood. Currently, the American Academy of Pediatrics recommends vaccination within 24 hours of birth for all children. The results of the study reinforce longstanding public health guidance aimed at protecting newborns from a serious, potentially lifelong liver infection.
“In this study, Hepatitis B vaccination at birth set all children up for success in completing the three-dose vaccine series on time, regardless of their race, ethnicity or language,” said Williams. “Ensuring newborns receive the birth dose is one of the most effective ways we can prevent disease and reduce health disparities from day one.”
The study analyzed data from the Vaccine Safety Datalink (VSD), which includes data from 13 geographically diverse sites, including Denver Health, accounting for approximately 4% of the U.S. population. This study included data on 1,119,709 children from nine different sites born between 2014 and 2023. Children were followed through 18 months of age and had at least one year of continuous enrollment in their respective health systems, making this one of the largest U.S. studies to examine early childhood hepatitis B vaccination patterns. The cohort reflected racial, ethnic and language diversity, and it included a new racial category, “Middle Eastern or North African,” previously categorized under “White,” to align with novel federal guidance.
Overall, 81.2% of children received a hepatitis B birth dose, and 87.1% were fully vaccinated by 18 months. Among children who received the birth dose, 97.6% completed the three-dose series by 18 months, with three-dose coverage exceeding 97% across race, ethnicity and preferred language groups.
Of the 18.8% of children who missed a birth dose, three-dose coverage by 18 months fell nearly 20% in the decade-long study (from 73.2% in birth year 2014 to 55.3% in birth year 2023). Among children who missed a birth dose, series completion was highest among children identified as Asian, Middle Eastern or North African, and among families whose preferred languages included Chinese and Vietnamese. Conversely, within the group of children who missed a birth dose, children identified as White and those from English-speaking households had the lowest three-dose coverage through 18 months old.
The study’s findings reinforce the importance of careful attention to race, ethnicity, and preferred language in biomedical research, and identify the hepatitis B vaccine birth dose as a key driver of series completion and health equity nationwide.
