Columbus County had the third-highest rate of chronic hepatitis B infections in North Carolina in 2023. But the number of cases dropped by more than half last year after the county health department ramped up vaccination efforts to protect against the virus that can cause serious liver damage.
Now, Columbus County Health Director Daniel Buck says he worries changes in federal vaccine guidelines will lead to more infections.
“The disappointing part about this is there’s been a huge effort to administer the hep B vaccine early on,” Buck said. “I know there’s controversy around it. But for us, with a higher than average number [of cases], our goal is to see all children vaccinated.”
Since the Centers for Disease Control and Prevention began in 1991 recommending the vaccine for all children at birth, acute hepatitis B cases have decreased by 99% in people under 19, according to the CDC’s Division of Viral Hepatitis.
But the CDC this month changed its vaccine guidelines for the two- or three-dose series of the hepatitis B vaccine, following pushes from President Donald Trump and U.S. Health and Human Services Secretary Robert F. Kennedy Jr. to review the childhood vaccination schedule. The CDC now recommends that babies get the vaccine’s first dose when they are at least 2 months old. (Children at high risk of infection, including those with an infected parent, should get the vaccine at birth, according to the new guidelines.)
“That’s two months they’re not protected,” said Toni Stocks, nursing director at the Columbus County Health Department. “What if they’re around someone who has hep B?”
About half of the people infected with hepatitis B don’t experience symptoms and don’t know they’re infected, according to the CDC. When symptoms do show up, they typically occur 90 days after exposure to the virus and include fever, dark urine, nausea, and jaundice (the yellowing of the skin and eyes).
Hepatitis B is spread through bodily fluids like blood and semen, and pregnant people can pass the virus to their baby. Most people with the virus contract it at birth, during sex, or from sharing needles and syringes.
“If we saw that something was harmful, we would stop promoting it tomorrow. But I just don’t have any authentic data to show that.”
Daniel Buck, Columbus County Health Director
People who contract the virus at a young age are more likely to develop a chronic case, according to the Mayo Clinic.
There currently isn’t a cure for hepatitis B, in part because the vaccine has been effective in preventing the virus, said Alba Ayala, a nursing supervisor in Cumberland County’s communicable disease clinic.
Changes to Guidelines
Cumberland County also has high rates of chronic hepatitis B, with 56 cases in 2025, Ayala said. In 2024, the county had 64 cases, the fourth-highest total in the state.
Ayala said the county health department has pushed for hepatitis B testing.
Columbus County had seven reported chronic hepatitis B cases in 2025, down from 15 in 2023, according to Stocks and data from the state Department of Health and Human Services.
Robeson County also saw a 50% drop in chronic hepatitis B cases between 2023 and June 2025, from 10 to five, according to additional data from the state.
Hepatitis B was among six viruses whose vaccines are no longer universally recommended as part of the CDC’s childhood vaccination schedule starting this year.
The changes follow a directive from Trump in December for the CDC to review vaccine recommendations and ensure they “align with such scientific evidence and best practices from peer-developed countries.”
The new vaccine schedule was developed in line with Denmark, which recommends vaccination against 10 diseases. Health experts told NPR in late December that the United States should recommend more childhood vaccines than European countries because of its racially diverse and large population, and its high cost of health care.
Some say the new U.S. guidelines increase parent autonomy in health care decisions. “We are restoring the balance of informed consent to parents whose newborns face little risk of contracting hepatitis B,” Jim O’Neill, the CDC’s acting director and deputy secretary of the U.S. Department of Health and Human Services, said in a press release in December before the recommendation was finalized.
Scientists say concerns about the hepatitis B vaccine, including a link to autism and other conditions, are unfounded. More than 40 years of science and over 400 scientific papers confirm the safety and effectiveness of the vaccine at birth, according to a review by the Vaccine Integrity Project, part of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“If we saw that something was harmful, we would stop promoting it tomorrow,” Buck said. “But I just don’t have any authentic data to show that.”
N.C. Won’t Follow Federal Recommendations
The birth dose of the hepatitis B vaccine has been integral in decreasing rates of the virus in Columbus County, Buck said, as many residents lack access and transportation to follow-up medical appointments to get vaccinated later. More than 4.5% of residents who responded to the county’s 2023 Community Health Assessment survey said transportation prevented them from getting necessary health care. In 2023, over 13% of adults living in the county were uninsured, according to data from the U.S. Census Bureau.
“We’ll try our best to give the correct information. But people can make their own decisions.”
Alba Ayala, nursing supervisor at Cumberland County’s communicable disease clinic
North Carolina isn’t changing its childhood vaccine requirements to align with the new federal recommendations. Children in care programs must have one dose of the hepatitis B vaccine by age 3 months, two doses at 5 months, and three doses by 19 months. Children need to have all doses by the time they enter kindergarten.
“Vaccines save lives and help children build protection against serious illness,” North Carolina Health and Human Services Secretary Dev Sangvai said in the press conference on January 8. “Childhood vaccines help children enjoy a healthy future, avoid missing school, and reduce the spread of disease to communities.”
But the new federal guidelines will likely make it harder for health officials to communicate the benefits of vaccinations, Ayala said.
“We’ll try our best to give the correct information,” she said. “But people can make their own decisions.”
Local health officials encouraged anyone with questions about any vaccine to speak with medical providers, including those at county health departments.
“We’re in that time where there is a lot of doubt,” Buck said. “For us, it’s really important to let people know that we’re here as part of the community. I don’t care who you are, we’re going to take care of you.”