The legal framework
The United States introduced universal infant vaccination with a birth dose in 1991, and has one of the longer-running programmes. Two recent changes matter for adults: since 2022 vaccination is recommended for all adults aged 19 to 59 regardless of risk factors, and national guidance now advises that every adult be screened for hepatitis B at least once in their life.
Key points
| Birth dose | Within 24 hours of birth, since 1991 |
|---|---|
| Adult vaccination | Recommended for everyone aged 19 to 59 since 2022, without needing a risk factor |
| Adult screening | Recommended at least once in a lifetime for all adults |
| Antenatal screening | Universal, with repeat testing where risk is ongoing |
| Babies of carriers | Vaccine and immunoglobulin within 12 hours of birth |
| Coverage | Insurance must cover recommended vaccines without cost sharing |
| Higher prevalence groups | People born in Asia, Africa and parts of eastern Europe |
In practice
- Ask for hepatitis B vaccination even without a risk factor: it is recommended for all adults under 60.
- Ask for the triple panel — surface antigen, core antibody and surface antibody — in a single test.
- Insurance generally must cover recommended vaccines without cost sharing.
- After an exposure, seek vaccine and immunoglobulin within 24 hours where possible.
Cost and coverage
Recommended vaccines are covered without cost sharing by most insurance; free programmes exist for uninsured children.
Recent changes
The 2022 move to universal adult vaccination and the recommendation of once-in-a-lifetime adult screening were both intended to reach the large number of undiagnosed carriers.
Where to go
- Primary care and pharmacies for vaccination.
- Federally qualified health centres and health department clinics.
- Hepatitis B Foundation for information and support.
Worth knowing
The universal adult recommendation removed the need to disclose a risk factor in order to be vaccinated. You can simply ask for it.
Official sources and links
- CDC — STI — clinical and prevention guidance
- HIV.gov — testing locator and treatment programmes
- USA.gov — official guide to government services
- Congress.gov — federal legislation