A U.S. model published Oct. 20 projects that delaying the hepatitis B vaccine birth dose or making it a shared decision could increase chronic infections among children by 19% to 83% compared with vaccinating all infants at birth.
Researchers simulated health outcomes for a U.S. birth group of 3.6 million infants through age 20. They compared universal vaccination at birth, vaccination delayed until two months, and a shared-decision approach for infants whose mothers tested negative for hepatitis B. All strategies kept a birth dose for infants whose mothers tested positive or whose hepatitis B status was unknown.
The model estimated 255 chronic infections by age 20 with universal birth-dose vaccination, 303 with delayed vaccination, and 467 with shared decision-making. It also projected that about 1.8 million people could remain susceptible to hepatitis B at age 20 with shared decision-making, compared with 232,000 with universal birth-dose vaccination. These are projections, not observed infections.
The estimates depend in part on modeled vaccine-series completion rates of 91.1% for universal vaccination, 87.1% for delayed vaccination, and 50% for shared decision-making. The authors said the results estimate possible effects if the policy changes are fully implemented. They said actual outcomes could differ if vaccination uptake or other assumptions change.