Jan 5, 2026 | Children's Health, Family Medicine, Featured, Infectious Diseases, Pediatrics
For several decades, federal guidelines regarding hepatitis B vaccination for infants in the United States had been unchanged and consisted of a first shot given at birth, a second at 1-2 months, and a third at 6-18 months.
In December 2025, the Centers for Disease Control and Prevention (CDC) announced new recommendations for hepatitis B vaccinations. For infants born to mothers who test negative for hepatitis B, the agency recommended the initial shot only at two months or after, and for infants to undergo antibody testing to determine whether the second and third shots are needed.
“The medical community hasn’t changed its stance on hepatitis B vaccinations, however,” says Daniel Caplivski, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine, and Director of the Icahn School of Medicine Travel Medicine Program.
Daniel Caplivski, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai (left), and Roberto Posada, MD, Professor of Pediatrics (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai (right).
“Hepatitis B is a virus that, for many people, once they get the infection, they have it for the rest of their lives,” says Roberto Posada, MD, Professor of Pediatrics (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai. “It can lead to cirrhosis of the liver and liver cancer, both of which are very preventable through childhood vaccination.”
Why are medical experts recommending that infants receive hepatitis B vaccinations at birth and to receive all shots? Drs. Caplivski and Posada explain the rationale behind the schedule and other facts about the virus.
Why should babies be vaccinated for hepatitis B at birth?
Dr. Posada: This recommendation had been in place since 1991. There are a few reasons why medical experts had pushed for hepatitis B vaccination for infants at birth. Usually, we check pregnant women for hepatitis B. But some people might not have access to full prenatal care, or the check sometimes gets missed. A mother in that situation can unknowingly pass hepatitis B on to the child. Vaccination at birth can prevent that.
Another reason is that the opportunity to protect the child is highest at the moment of childbirth. Once a child and mother are discharged, they might not return for follow-up appointments, or do so at the appropriate times. Thus, giving the hepatitis B vaccination right at childbirth at least provides that initial protection.
What’s the risk of waiting to vaccinate infants for hepatitis B?
Dr. Posada: For infants, other than hepatitis B being passed from the mother, the virus can be transmitted to some degree through household exposure to someone who has hepatitis B. For example, sharing utensils, an infant putting a parent’s toothbrush in the mouth—these are not the main ways of contracting the disease, but they can happen. We want to vaccinate the kids in the event there is someone in the household with hepatitis B.
Other than for infants, the main way hepatitis B is transmitted is through sexual transmission or contact with contaminated blood, such as via needles. That’s another reason to vaccinate children before they become sexually active.
Is the hepatitis B vaccine effective at preventing transmission?
Dr. Caplivski: Ever since we adopted the practice of vaccinating infants at birth, the rate of infants and children contracting hepatitis B has dropped to practically zero.
And the success of vaccinating at childbirth has been replicated around the world. In China, after they adopted a three-dose vaccination schedule from birth, the prevalence of hepatitis B carriers under 5 years old fell from 10 percent to around 0.3 percent in 10 years. That’s a lot of lives saved from chronic complications of the disease.
What could be the consequences of contracting hepatitis B?
Dr. Posada: If a baby gets it at birth, they’re very likely to have it for the rest of their life. And because the infection is lifelong, the more chances for cirrhosis, liver failure, or liver cancer to develop in the lifetime. Someone who contracts it at an older age has a higher chance of clearing the infection from the body.
Dr. Caplivski: The long-term consequences of liver failure and cancer are incredibly difficult for a patient. It is a medically intensive disease, but it also has a huge impact on health care expenditures. All of these could be avoided through vaccinations at childbirth.
According to
statistics from the CDC, about 9 in 10 infants who become infected go on to develop lifelong chronic infection. The risk goes down as a child gets older. About 1 in 3 children who get infected before age 6 will develop chronic hepatitis B. Approximately 15–25 percent of people with chronic infection develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.
Is it safe for infants to be vaccinated at childbirth?
Dr. Posada: The vaccine is a recombinant vaccine—meaning it is not a live virus; it is only protein from the virus synthesized in the lab. It cannot cause infection. Other than discomfort at the time of injection, we have had decades of data showing that hepatitis B vaccination at childbirth is safe.
Would the new recommendation by CDC create any access changes?
Dr. Caplivski: Historically, insurers have used CDC recommendations to base their coverage of vaccinations. While the federal entity is retreating from actively recommending hepatitis B vaccinations at childbirth, don’t forget that state departments of health can have their own recommendations and intervene if needed. In the case of New York State, there has been no change in guidelines, and we are still actively recommending hepatitis B vaccinations at childbirth.
What the new CDC action might have caused is a worsening of vaccine skepticism. Even in that situation, it is worth speaking with your pediatrician and health provider to learn more about what is the right course of action for you and your child.
Dr. Posada: Besides talking to your pediatrician, there are other sources of information that are well trusted, such as the American Academy of Pediatrics. It has very good information about childhood vaccines. At the end of the day, as doctors, we want your children to be healthy too.
Updated on Apr 25, 2025 | COVID-19 Reflections, Featured, Research
Nicole Simons, MA, right, with Katherine Keller, Clinical Research Coordinator
When the first of several waves of COVID-19 cases hit New York City, Nicole Simons, MA, had just landed her first big job out of school as a research coordinator at the Icahn School of Medicine at Mount Sinai. In a matter of days, her dream job was eliminated, along with the jobs of several colleagues.
Then came the call from Human Resources: Could she take on a front-line job that would expose her to this unknown virus and clinics filled with COVID-19 patients? Her answer was a resounding yes.
In a moment of instant serendipity, she was reassigned to work for Alexander Charney, MD, PhD, a noted researcher in the field of schizophrenia, a disease that had first captured her attention in college.
Working closely with clinicians on the front lines during the pandemic would turn out to be a lifechanging experience. She visited hospital wards to collect samples, helped out staff when she could, and even served as a second author of a paper in Nature Medicine that described the team’s work. Now she is the Program Manager of the Jeff and Lisa Blau Adolescent Consultation Center for Resilience and Treatment and is a PhD student in the Clinical Research Program at the Icahn School of Medicine, with plans to continue research into the genetics of schizophrenia. “Working with clinical colleagues on the frontlines really got me thinking about how to narrow the gap between research and clinical care. I plan to use the lessons I’ve learned to keep building research programs that move us closer to becoming a true learning health care system.”
It’s a long way from those early days of the pandemic in 2020. Dr. Charney, Associate Professor, Psychiatry, and Genetics and Genomic Sciences, had been asked by hospital leadership to rapidly build up a COVID-19 Biobank that would collect hundreds of blood samples from patients hospitalized with COIVD-19. It would ultimately serve as a backbone for ongoing research into the virus and the human immune response.
Nicole Simons, MA
Dr. Charney’s team consisted of 100 volunteers who, like Ms. Simons, had seen their research projects paused but were given a chance to come help. The team quickly designed a sample-collection protocol, and once this was in place, the cadre of volunteers organized itself into six teams, with Ms. Simons assigned to the “Running Team.” This team was responsible for transporting collection kits to every location within the hospital, and then bringing those kits back.
What might sound like a simple and straightforward assignment involved a major hurdle. How to gain access to clinics where new hospital rules would not even allow families to enter, even when patients were seriously ill? Ms. Simons would have to find a way in.
“Entering those clinics was like entering a fog of war environment. The strain on the nurses and doctors was palpable; we needed to visit their clinics without creating additional work for them” she says. They had to figure out a way to make easy for them to know if they should allow the researchers on the floor.
“I came up with this idea of making our research team stand apart so we’d be instantly recognizable.” Her solution: hot pink everything. “We wanted to stand out, so we wore hot pink scrubs, gloves, hairnets. Even our labels were pink,” she says. She and her teammates quickly developed a rapport with the nurses managing the floors they’d visit at all hours of the day and night.
“I felt like we were on the outside looking in, that we were somehow protected bystanders while they provided round-the-clock, unconditional care for their patients. To say thank you and support them, we brought them candy and other treats,” she says. They heard that nurses working in the tents constructed in Central Park needed clean, dry socks, so they asked for sock donations, and the response was instantaneous.
Lending help to the clinicians working in the hardest of circumstances also perpetuated for her a sense of shared purpose with staff and faculty at Mount Sinai. Among the volunteers at the Biobank, she found strength.
During the pandemic, Nicole Simons, MA, left, and a team collected hundreds of blood samples from patients hospitalized with COIVD-19, working with MIriam Merad, MD, PhD, center, Dean for Translational Research and Therapeutic Innovation, and Alexander Charney, MD, PhD,
“We all shared this common goal to collect those samples, no matter the hurdles. When the hours were long, and the days were hard, we had this shared humanity that pulled us through,” she says.
When the team reached its goal of 500 samples, they pushed on, ultimately sampling more than 700 participants in 49 days, amounting to more than 10,000 vacutainers portioned into 50,000 smaller samples. A high level of organization was critical to success.
“But strong morale, in the darkest of times, was what really got us through those long days,” she says. “At such a difficult time, it felt like a huge stroke of luck to be working for Dr. Charney, a psychiatrist, leading the Biobank team. His commitment to resilience and mental health was non-stop. He created a safety net for us, with regular weekly check-ins and the option for one-on-one counseling with him any time.”
In July 2020, she served as second author of a paper published in Nature Medicine describing the Biobank’s unique 49- day deep dive to uncover the pathogenicity of the virus. The authors would describe their journey as “not necessarily a model to follow, but rather a live-and-learn memoir of our actions and mistakes under uniquely strenuous circumstances.”
“The team was working intensely in a very high stress, high stakes environment, without much preparation for what we would all come to realize was a once in a lifetime experience,” says Dr. Charney, now Director of The Charles Bronfman Institute for Personalized Medicine and Vice Chair of the Windreich Department of AI and Human Health. “Their mental health was front and center for me. What pulled them through, I believe, was their strong purpose and being part of the group that didn’t have to stay home.”
