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Sticking to the Science: Explaining Birth Vaccine Recommendations

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Released: September 02, 2026

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A scenario that I frequently encounter is parents or caregivers who are open to vaccination but are concerned about mixed messaging and changing guideline recommendations. Read on to learn how a presumptive recommendation can help in this setting.

Mary Koslap-Petraco
Mary Koslap-Petraco, DNP, PPCNP, CPNP, FAANP
Explaining Birth Vaccine Recommendations

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A vaccine counseling scenario that I frequently encounter involves parents or caregivers who are open to vaccination but are confused or concerned about mixed messaging and changing guideline recommendations. For example, more parents and caregivers have recently been questioning the need for the hepatitis B vaccine birth dose.

My Approach
To initiate these discussions, I always begin by mentioning that we are going to be ordering the hepatitis B vaccine birth dose today. Following this presumptive recommendation, I follow up with, "What questions do you have for me?"

If the parent or caregiver says, "I heard that recommendations have changed, and the baby doesn’t need it anymore," I would respond, "I am so proud of you because you are doing your homework. You want the same thing for your baby as I do, which is for them to grow up safe and healthy. Do I have your permission to answer your questions about the hepatitis B vaccine and tell you why I feel it is essential to give the birth dose?"

I have never had anyone say no to me with this approach.

Addressing Safety and Need
Often, parents and caregivers will admit that they are afraid of the vaccine or unsure about its safety. In this situation, I tell them that healthcare professionals have been giving the hepatitis B vaccine as a birth dose for the past 35 years, with an excellent safety profile. I also reassure them that the short-term side effects from the hepatitis B vaccine are very mild, a red, swollen leg at most. I have never observed a baby develop a fever or lethargy following the hepatitis B vaccine.

Then, I take some time to explain the importance of the vaccine. First and foremost, the birth dose is essential because we do not know whether the baby might be exposed to hepatitis B within the first week or so of their life. Even though we test mothers early in pregnancy, they could certainly still be exposed later in the pregnancy.

Hepatitis B is a resilient virus that can live on surfaces for a while, so there are many ways that pregnant mothers or babies could be exposed, even from seemingly normal interactions such as sharing food or drinks. Sometimes, other people forget to wash their hands, or they could have an infection in their mouth or a dental issue causing a break in the skin. They may simply have blood on their lips from bleeding gums after brushing their teeth. A nick from a razor could contaminate someone's face or hands.

The only way to be sure that the baby is protected is to give them the birth dose of the vaccine.

I also make sure to explain that the birth dose is critical because there are strong data showing that babies who get infected in the perinatal period have a 90% chance of going on to develop chronic hepatitis B, greatly increasing their risk for liver cancer. Why take that chance?

Incorporating Storytelling
I share personal stories about the need for vaccination as well. For example, when I was 7 years old, my 4-year-old cousin died from hepatitis. Because of this experience, I made sure that all my grandchildren received the hepatitis B vaccine. I find that most of the time, parents and caregivers want to be reassured that you would do the same for your own family, and storytelling is often more effective than simply listing the facts.

Discussing why the CDC changed the hepatitis B birth dose vaccine recommendation can be challenging, but I tell parents and caregivers that babies could be exposed to blood in many ways that are difficult to predict. Why take a chance? There are strong data demonstrating that early vaccination nearly wiped out hepatitis B in young children. The effects of not vaccinating babies will not be apparent until they are much later, but I predict that as birth vaccine doses decrease, more young adults will be diagnosed with hepatitis B.

As I go along with this discussion, I check in with parents and caregivers to make sure that I am answering their questions and to see whether they have other questions for me. I conclude the conversation by saying, "I want your baby to grow up safe and healthy. I want to be able to give your baby the hepatitis B vaccine at birth." Most of the time, this strategy works.

Your Thoughts
How can you adapt this framework for vaccine discussions in your practice? Leave a comment to join the discussion!

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