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Hepatitis A and B Prevention
Hepatitis A and B Prevention: Vaccines Work if We Use Them 

Released: April 01, 2026

Su Wang
Su Wang, MD, MPH, FACP
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Key Takeaways
  • Universal recommendations for hepatitis A and B vaccination during early childhood led to dramatic reductions in disease incidence and negative long-term outcomes.
  • Declining childhood vaccine rates and conflicting vaccine recommendations threaten to undo decades of progress in the prevention of hepatitis A and B.

In clinical medicine, few interventions demonstrate population-level impact as clearly as vaccines. Yet recent shifts in vaccine policy discussions risk eroding gains that took decades to achieve. As an internist, I am concerned about losing ground in hepatitis A and B prevention. 

The Story of How Hepatitis A and B Vaccines Impacted the United States
Hepatitis A incidence declined dramatically after the vaccine’s introduction in 1995. However, since 2016, the United States has experienced widespread, person-to-person outbreaks across dozens of states. Between 2016 and 2023, more than 44,000 cases were reported, with over 60% requiring hospitalization and more than 400 deaths. Outbreaks disproportionately involved adults with certain risk factors, but many infections via foodborne transmission also occurred in the general population. Nationally, ≥2-dose hepatitis A vaccine coverage among adults remains approximately 12%, allowing large susceptible cohorts to persist.

Hepatitis B (HBV) tells a similar story of progress and unfinished work. Universal childhood vaccination led to a dramatic 89% decline in acute pediatric HBV infection since the early 1990s, with acute cases now concentrated among adults. In 2019, roughly half of reported acute hepatitis B cases occurred among persons 30-49 years of age, and adult vaccination coverage (≥3 doses) has hovered around 30%.

These data underscore a central truth: When we vaccinate consistently, disease declines. When coverage lags, preventable infections persist.

The Risk of Risk-Based vs Universal Recommendations
Recent shifts in vaccine discourse, with a focus on risk-based strategies for infant vaccination promoted by RFK Jr’s ACIP in 2025, threaten to undermine our hard-won gains. Past data proved that risk-based vaccination of infants is ineffective. Lest we forget, before routine pediatric hepatitis B vaccines, an astonishing 24,000 children per year acquired HBV.

For adults, prior HBV recommendations requiring risk stratification contributed to persistently low vaccination rates and missed opportunities for disease prevention. In response, the CDC replaced these risk-based recommendations with a universal HBV vaccination policy in 2022 for adults 19-59 years of age. This change was designed specifically to remove these barriers and increase uptake.

Past experience shows that reverting to complex risk screening would predictably reduce vaccine uptake and widen health disparities.

In a similar vein, hepatitis A control depends on strong childhood vaccination coupled with vaccination of at-risk adults (or anybody who requests it) and outbreak response. However, low adult coverage has allowed large outbreaks to emerge when social conditions permit viral spread. Weakening vaccine implementation and de-prioritization of universal pediatric hepatitis A vaccinations will increase the disease burden on susceptible adolescents and adults, where morbidity is greater.

Vaccination as Stewardship: Protecting Patients and Communities
The American Academy of Pediatrics, which abides by data-driven evidence, recommends:

  • Hepatitis A: Routine vaccination for all children at 12-23 months, catch-up vaccination through 18 years of age, and vaccination of at-risk adults or anyone requesting protection
  • Hepatitis B: Universal birth dose, completion of the pediatric series by 6 months, catch-up for unvaccinated children and adolescents, and universal adult vaccination through 59 years of age or for anybody who requests it

These recommendations are not theoretical. They are grounded in decades of safety, immunogenicity, and real-world effectiveness data for a broad population. At the community level, universal infant HBV vaccination has not only reduced infection rates but also dramatically lowered hepatocellular carcinoma in vaccinated cohorts. Hepatitis A vaccination programs demonstrated herd immunity effects, reducing adult disease when childhood coverage is high.

At the patient level, vaccination prevents acute illness, liver failure, and further spread of hepatitis A and B. For hepatitis B, vaccines also prevent chronic infection, cirrhosis, and cancer. At the population level for both hepatitis A and B, vaccines reduce acute illness, lower hospitalization rates, and decrease the overall population burden of liver disease.

As healthcare professionals, we are stewards of prevention. Maintaining strong vaccination practices is an affirmation of evidence-based medicine and upholds our obligation to protect both individual patients and the communities they live in.

Your Thoughts
What challenges do you experience with declining vaccine uptake in your practice? Do patients and caregivers tend to reject certain vaccines more than others? Leave a comment to join the discussion!