12/09/2025
I am a board certified pediatrician, on faculty at two med schools and five NP/PA programs, practicing for over 25 years, among other "qualifying" accolades to speak on this topic. Paul Offit MD and the AAP are absolutely incorrect. The hep b vaccine should be removed from the childhood immunization schedule for a glaring lack of supporting science. The vaccine should only be administered to high risk children.
Here is the real science: The hep b disease incidence was not tracked in pediatrics in the 1980s. The only individuals tracked in the 1980s were high risk individuals like IV drug users and prostitutes and gay men. The CDC mandated the reporting of acute hep B disease in 1990 for the first time. The only data measured this year were from hospitals and clinics serving high risk hep B patients and communities. Any comparison of pre-vaccine incidence and post-vaccine incidence is a comparison of apples and oranges, or high risk incidence vs normal incidence. This apples and oranges comparison is the only reason a decrease in the incidence of hep B was recognized. This is a false misleading and downright dirty comparison. This means the incidence of hep B in the typical American child was unknown in 1990. The only data we have on Hep B incidence is after the vaccine was added to the childhood immunization schedule.
What about the studies showing a vertical transmission rate from mom to baby in hep B (+) moms were in Taiwanese and Native Alaskan populations. These populations contract a serotype of Hep B that is different than US children. The Taiwanese and Native Alaskans develop serotypes associated with increased risk for chronic hep B status and serious liver disease. The serotype common in the European/White/Latin/Black communities does not lead to chronic hep B or serious liver disease, as noted by several longitudinal studies. Hep B disease in childhood in US children does not progress to chronic disease or serious liver disease and this statement is supported by the very few longitudinal studies done.
The chart summarizes the hard, non-modeled evidence on hepatitis B genotypes in children as of 2025. Only genotypes B and C — almost exclusively found in children of East/Southeast Asian (and Alaskan Native) immigrant families — have ever been prospectively studied from birth: when a mother is HBeAg-positive and no prophylaxis is given, 86–96 % of infants develop lifelong chronic infection; these same genotypes also carry the highest lifetime risk of cirrhosis and liver cancer (20–40 %). In sharp contrast, genotypes A, D, and E — which together make up roughly 50 % of all chronic HBV cases in the United States — have no genotype-specific mother-to-infant cohorts anywhere in the world, so the commonly quoted “∼90 % perinatal chronicity” for them is simply borrowed from Asian B/C data or modeled. In actual U.S. children with chronic HBV, genotypes B and C dominate (75 % of cases, 43 % + 32 %), while the nationally prevalent genotype A is rare (only 5 %), reflecting the fact that nearly all pediatric chronic hepatitis B in America today is imported through perinatal transmission in Asian immigrant families rather than occurring broadly across the U.S. population.
So the conclusions that babies will die unnecessarily is flat out wrong. Debate me publicly Paul Offit MD! Why didn't you or the AAP show up to the ACIP meeting? Because you know that what I write is true. The science does not back universal hep b vaccine health policy. The hep B vaccine should only be used in at-risk newborns and other high risk groups. Period. That is the science.
