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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: Parental refusal of the newborn HBV vaccine spiked from 2024 to 2025. Newborn girls are slightly less likely to receive the vaccine compared with newborn boys. Parental refusal of the newborn hepatitis B virus vaccine surged in recent years, the latest in an ongoing trend that has more than doubled refusal rates since 2018, according to study results published in JAMA Network Open. An analysis of live birth data from three centers in the University of Pennsylvania health system found that parental refusal rates in 2025 were more than double those recorded in 2018. Researchers launched the study after clinicians observed an uptick in parents withholding the HBV vaccine before hospital discharge over the last 12 months.
\u201cThe study was a reaction to clinical observations that neonatologists in my group and those more widely across the country have noted amid rising parental refusal of various recommended newborn preventive care interventions,\u201d Sarah A. Coggins, MD, MSCE, a neonatologist at Children\u2019s Hospital of Philadelphia and assistant professor of pediatrics at University of Pennsylvania Perelman School of Medicine, told Healio. Coggins and colleagues noted that parents planning circumcision for their newborn sons were less likely to decline vitamin K prophylaxis, which is routinely recommended due to the bleeding risk associated with the procedure. However, this observation raised a broader question: Did parental acceptance of one newborn care intervention make them more receptive to others, including HBV vaccination, and would preventive care patterns be skewed by sex? In a retrospective cohort study of 93,163 newborns in Philadelphia from 2018 to 2025, the researchers reported that 777 (8.3 per 1,000) did not receive vitamin K prophylaxis, while 9,400 (100.9 per 1,000) failed to receive HBV vaccination. Notably, Coggins and colleagues found that 83% of the newborns whose parents refused vitamin K prophylaxis also refused HBV vaccination, indicating that parents who declined one preventive intervention often declined others as well. Study results demonstrated that newborn girls were twice as likely not to receive vitamin K prophylaxis vs. newborn boys (adjusted OR = 2.03; 95% CI, 1.74-2.35) and were slightly less likely to receive the HBV vaccine (aOR = 1.06; 95% CI, 1.01-1.1). Female infants were slightly less likely to receive the HBV vaccine than boys in 2025 (173.7 vs 166.3 per 1,000 births). Healio spoke with Coggins about potential drivers behind increasing parental refusal of the HBV birth dose, strategies clinicians can use to improve vaccine acceptance and how confusion surrounding national vaccine recommendations may be contributing to the trend. Healio: How has this increase in parental hesitancy toward newborn preventive-care interventions at your institution sparked concern? Coggins: It\u2019s not just my institution. We\u2019ve noticed nationally the growth of parental hesitancy toward preventive care interventions like vaccines and the newborn vitamin K prophylaxis shot. However, there hasn\u2019t been much numerical data to amplify the magnitude of the problem. Within the last year, there has been quite a bit of research that\u2019s come out trying to quantify rates of newborn hepatitis B vaccine hesitancy. This is something that neonatologists are jumping on because we\u2019re taking care of these newborns in the early part of life. We promote a bundle of interventions that are recommended in this critical period to make sure we have evaluated for conditions that could pose significant risks to their health. We\u2019re also there to help parents identify potential issues that need to be followed up to optimize their child\u2019s development. We give the HBV vaccine to prevent infection with the hepatitis B virus, which, when acquired in the perinatal period, can cause lifelong liver disease or progress to liver cancer. Recently, however, we have noticed that more parents are declining one or more parts of the recommended newborn care interventions. We have the benefit of history to understand why those interventions were initially implemented, which is why we are worrying now. If refusal of newborn preventive care interventions continues to rise, we are going to see a resurgence of predictable, preventable infant morbidity. Healio: What reasons do parents give for refusing the HBV vaccine? Coggins: Vaccine hesitancy is multifactorial. My colleagues and I frequently hear parents say that since they tested negative for HBV while they were pregnant, there is no way their baby could be infected. The reality is that most of those tests are done during the first trimester of pregnancy and generally aren\u2019t repeated. There is a small percentage of people that do acquire HBV later in pregnancy, and won\u2019t be identified because the test isn\u2019t performed again before delivery. Another misconception we often hear from parents is that HBV is only spread through sex, and since their baby isn\u2019t having sex, they don\u2019t need the vaccine. In that case, we remind them that contact with an infected person\u2019s bodily fluids can lead to infection. Exposure to HBV-infected bodily fluids could occur at daycare, via shared use of toothbrushes, or via contaminated surfaces like park benches or bus seats. Without disinfection, the HBV virus can live on these surfaces for up to 7 days. In short, the sex argument is not fully accurate. Even after education, some parents feel that the overall risk of their baby acquiring HBV is low and still choose to forego this vaccine. In that instance, we remind them about how incredibly serious perinatal HBV infection is. Compared with adults who get infected with HBV, infants with HBV infection are much more likely to be asymptomatic and much more likely to develop chronic hepatitis B infection, which can ultimately cause liver cirrhosis and liver cancer. 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