The Trump administration’s recommendation against universal hepatitis B vaccination for babies on the day they’re born could lead to hundreds of infections and dozens of deaths, according to a study published Monday in JAMA Pediatrics.

The Centers for Disease Control and Prevention’s vaccine panel said in December babies born to hepatitis B-negative mothers shouldn’t be immunized against the disease until at least two months old, reversing the agency’s longstanding guidance.

The panel has taken a more vaccine-skeptical view since Health Secretary Robert F. Kennedy Jr. fired all 17 members in June and handpicked their replacements. Kennedy has falsely claimed vaccines, including the hepatitis B shot, are a likely cause of autism.

Hepatitis B can spread from mother to baby during birth, though household transmission also happens. The virus starts as acute, but sometimes turns chronic, especially in children. It’s incurable and may lead to lead to cirrhosis, liver failure and liver cancer.

The CDC logged about 18,000 new chronic cases and 1,800 deaths in 2023, the latest year for which data is available.

Many doctors and their professional associations still advocate for giving the shot during the first day of life, but the panel’s recommendation could hold sway for some parents as they navigate conflicting medical advice.

The study estimated outcomes for more than 3.6 million babies born in 2025 if their parents waited until they were 2 months old to have them immunized against hepatitis B. The projections showed 90 more infections and 29 more deaths than under universal vaccination. Lifetime medical costs rose by upward of $16 million across the infected individuals, according to the study.

Holding off on the hepatitis B shot until age 12 could lead to 190 additional infections and 50 deaths as well as nearly $30 million in extra medical spending, the study found.

“It’s one of those things that’s just pennies to prevent and costs many millions of dollars to treat when you think about it at a population level,” said Dr. Michael Aziz, a maternal and fetal medicine expert and Allegheny County Medical Society board member. He was not involved in the study.

Both infection and death counts were significantly higher when considering that many children might not get their second or third doses of the vaccine, reducing their protection from hepatitis B. In the two-month scenario with uneven uptake of additional doses, infections surged to 238 and deaths to 62.

Other studies have shown kids who don’t receive the first round of a vaccine on time are less likely to complete the series.

“When you disrupt this universal protocol and kind of open the door for delays for infants where the mother tests negative, then you don’t have a safety net anymore,” said Dr. Noele Nelson, a professor of practice at Cornell Public Health who coauthored the JAMA Pediatrics study.

Nelson and three other researchers got to work in September after the CDC’s vaccine panel publicly weighed whether to alter its hepatitis B recommendations. They submitted preliminary results to the group, known as the Advisory Committee on Immunization Practices, ahead of its December meeting.

“We wanted to put together this study in case it would be helpful to inform that meeting,” Nelson said. “As it turned out, we weren’t asked by the new ACIP committee our opinion and we didn’t really discuss our study at the meeting.”

The Department of Health and Human Services did not return a request for comment.

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