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: One-year birth cohort of U.S.-born infants (n = 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.