Whopper of the Week: RFK Jr. is Dead Wrong Babies Won't Get Hepatitis B

THIS WEEK'S WHOPPER: 

Robert F. Kennedy Jr., Secretary of Health and Human Services, is Dead wrong when he implies babies won't get hepatitis B 

IN SUMMARY:

RFK Jr does not want the Centers for Disease Control to recommend newborns be vaccinated against the hepatitis B virus (HBV). An infection early in life, especially as a baby, puts a person at a high risk of developing a chronic lifelong liver infection, which in a quarter of cases can lead to fatal liver failure or cancer. The hepatitis B vaccine for newborns is safe and effective; and it gives durable lifelong protection against a serious infection that children can encounter during birth, and throughout their lifetime in their families and communities. 

WHY IS THIS A WHOPPER?

Hepatitis B is a virus that is readily transmitted by blood or bodily fluids. It easily passes from mother to child during childbirth. If a mother is infected, without any prophylactic intervention, her newborn has a 90% chance of getting infected. The virus can also be transmitted within a household if family members share toothbrushes, nail clippers, or utensils, or if they are exposed to an infected open wound or a bite, or even from contaminated surfaces or objects (fomites). There have also been documented cases in day care settings of transmission between children, as well as through close contact activities common to older children such as playing sports. In the US, it is estimated between 660,000-1.59 million people have chronic HBV, and only half are aware of their infection. It is ludicrous to imply, as Secretary Kennedy does, that a child’s main risk for HBV infection comes from intravenous drugs or sex given the high prevalence and transmissibility of HBV in the communities that babies and children live in.  

Hepatitis B is far more dangerous for babies and children than for adults. While 90% of adults exposed to HBV will clear the infection, only 10% of infants will clear the virus. This means a whopping 90% of HBV-infected infants will develop chronic liver infection. Older children between 1 and 5 years, according to the American Academy of Pediatrics, “have a 25-50% chance of becoming chronically infected. Twenty-five percent of children who develop a chronic hepatitis B infection will die from the disease.” The earliest possible prevention against HBV infection is obviously critical.

This past September, the Center of Disease Control’s Advisory Committee on Immunization Practices considered delaying the HBV vaccine by one month after birth. The United States already experimented with that idea in the 1990s, but that resulted in kids becoming infected with HBV and developing liver disease. Similarly, removing the recommendation for universal vaccination of newborns and instead screening for hepatitis B infection in the mother and treating only infected newborns (with vaccine and immunoglobulin), will miss 12-16% of pregnant women who do not receive prenatal screening. And delaying vaccination by one month will result in more chronic liver disease cases as many children do not get the recommended medical follow up. 

Slide 13 https://www.cdc.gov/acip/downloads/slides-2025-09-18-19/02-langer-hep-b-508.pdf

Childhood Hepatitis B vaccination programs have been enormously successful. According to Dr. Titanji, in the 1980s, approximately 20,000 American infants were perinatally infected each year, despite vaccine availability. In the 1990s, the Centers for Disease Control recommended every child be vaccinated agains HBV, and in the 2000s that the vaccination occur within 24 hours of birth. The United States has nearly eliminated acute hepatitis B infections among infants. In 2021 there were only 17 reported cases of perinatal hepatitis B and in 2022 there were 13 cases.  

WHY IT MATTERS:

The hepatitis B vaccine reduces the incidence of liver disease and liver cancer, especially in young people. If Secretary Kennedy gets his way, and the US decides to vaccinate babies later, or not at all, our future children will develop chronic HBV infections at much higher rates and about a quarter of those children could die of resultant liver failure or cancer. 

Secretary Kennedy does not have the facts on his side. The American Academy of Pediatrics has said it will continue to recommend that infants receive their first Hepatitis B shot at birth. Even Republican Senator Bill Cassidy, a hepatologist, warned on X that a change to the HBV vaccination schedule would be a cruel mistake: “People objecting to hepatitis B vaccination apparently have never treated patients like this. Their life ending with a terrible liver disease or else requiring a transplantation. This is about preventing illnesses like this. I have the experience of treating patients infected with hepatitis B at birth, who end up terribly ill like this. Why would anyone want someone to end up like this?” 

Despite the clear weight of the evidence,  RFK Jr.’s CDC may still issue a new recommendation soon. Dr. Houry, the former CDC Chief Medical Officer, reports that Secretary Kennedy wanted to move the HBV vaccine to age four, leaving a child unprotected from HBV infections in their family and community for four years. The CDC’s Advisory Committee on Immunization Practices hesitated to go that far this past September. They considered moving HBV vaccination to one month after birth but did not do so, due to lack of clarity about how to word the recommendation and divisions over the risks of infection for children. It is very likely that the public outcry against eliminating vaccines constrained ACIP’s action. The next ACIP meeting is planned for October 22, so the public needs to remain vigilant and vocal!

Contributors to this post are:  Aurora Horstkamp, MD, Miriam Rabkin, MD, MPH, Benedicte Callan, PhD.