BACKGROUND: Hepatitis B is a viral infection spread by contact with infected blood, semen, or other bodily fluids. The availability of a safe and effective vaccine has played a tremendous role in decreasing the prevalence of the disease since 1981. However, according to the Center for Disease Control, when adjusting for under-ascertainment and under-reporting, there were approximately 14,000 acute hepatitis B cases in the USA in 2020. There have been multiple outbreaks of vaccine-preventable disease in sports leagues including mumps and measles. However, there is limited literature available assessing hepatitis B prevalence of immunity in NCAA athletes. METHODS: Hepatitis B immunization data from local NCAA Division I and III athletes were analyzed from the years 2016-2023 through Epic chart review. The age range of the cohort was set at 18-24, upon time of evaluation. An Epic Reportwriter ran a SlicerDicer query searching for athletes who presented to our healthcare system clinic and/or training room facilities meeting the appropriate criteria outlined above. All NCAA sports were included. Data obtained included gender, race, country of birth, hepatitis B vaccination records, and hepatitis B surface antibodies if available. RESULTS: We had a total of 379 athletes. The median age for the cohort was 20 years. Overall, 64.6% of the athletes had received the hepatitis B vaccine. Only 4 athletes (1.06%) had hepatitis B surface antibody results available in their chart. All 4 of those athletes had a negative titer. CONCLUSIONS: A majority of the athletes in this study had completed their hepatitis B vaccination. While 64.6% of athletes were vaccinated, the healthcare system needs to do a better job addressing vaccine adherence and hesitancy to prevent future outbreaks.