Panel recommends CDC end routine hepatitis B vaccinations for newborns
The Advisory Committee on Immunization Practices (ACIP), an independent group of physicians and public health officials that develops guidance about the use of vaccines in the country, voted on Friday 8-3 to upend the current practice of administering the hepatitis B vaccine to all newborns.
Instead, the panel recommended that pregnant women undergo hepatitis B screening, and that infants born to mothers who test positive continue to be vaccinated at birth and also receive antibodies, which help the immune system fight the virus that causes the disease.
For moms who are not infected with hepatitis B, the advisory board recommended that they consult their physician about the vaccine and weigh its benefits and risks.
These babies have an “extremely low risk of hepatitis infection during childhood and especially during the first month of life, and therefore do not need to be routinely vaccinated with the hepatitis B vaccine,” Vicky Pebsworth, a committee member and the research director of the National Vaccine Information Center, said during a presentation of findings from a working group that focuses on the vaccine schedule among children.
The panel also recommended that children undergo blood testing — to check for antibodies against hepatitis B — before receiving additional vaccine doses. The committee stated that insurance should cover the tests.
Existing hepatitis B recommendations
Prior to the shift, the Centers for Disease Control and Prevention recommended that all individuals receive three doses of the hepatitis B vaccine; the first was traditionally administered at birth.
The committee’s decisions are not legally binding. However, the CDC has historically based its vaccination schedule on this federal advisory board’s recommendations. Most U.S. states require the hepatitis B vaccine to attend public schools.
Ahead of the committee’s vote, several public health officials, physicians and medical societies emphasized the importance of vaccinating infants against hepatitis B. This viral disease attacks the liver and is likely to cause chronic illness in infants.
“I believe that the hepatitis B vaccine at birth or right after birth is a very appropriate one,” Teresa Lovins, a family physician in Indiana, told Straight Arrow News.
“There are moms who are unaware of their hepatitis status, and getting that into the baby much more quickly than later is a good thing,” she said. “I have seen where it gets missed. The patient may not get that one-month visit for whatever reason, and so then they’re at an increased risk of developing hepatitis down the road because they’ve missed a great opportunity.”
What is hepatitis B?
Hepatitis B can lead to liver cancer, liver failure and death. The virus spreads through bodily fluids, and can be transmitted through sexual contact, from mother to child at birth, and sharing needles or syringes.
The majority of people with Hepatitis B do not have symptoms; some experience fever, fatigue, joint pain and nausea.
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About 90% of infant hepatitis B infections become chronic, and 25% of those infected at birth die early from complications, CDC reports.
Hepatitis B can cause both acute and chronic infection. Acute infections develop quickly and last for only a short time. Chronic infections can last months or even a lifetime.
The World Health Organization estimated that around the world, 254 million people were living with chronic Hepatitis B infections in 2022 and more than 1 million people died from the disease.
In the U.S., the CDC estimated that 640,000 adults had chronic hepatitis B. In 2023, almost half of acute infections were among people 40-59 years old. The disease is most common among non-Hispanic Asian and Pacific Islander people.
The U.S. Food and Drug Administration has approved three different vaccines for hepatitis B alone and another three combination shots that protect against hepatitis B and other infectious diseases such as diphtheria, tetanus, pertussis and polio.
ACIP members raise concerns
Several panelists pointed out that Friday’s decision was based on incomplete scientific evidence.
“We do not have exactly all the data we would like to make decisions. That’s the nature of science. We do the best that we can,” said committee member Joseph Hibbeln, a psychiatrist, neuroscientist and former chief on nutritional neuroscience at the National Institutes of Health. “We have to make decisions with the data that we have, and we must use only the credible data to make the decision and not speculations and not hypotheses.”
Other committee members and attendees raised concerns.
“The hepatitis B vaccine recommendation is very well established. We know it’s safe, and we know it’s very effective,” said Cody Meissner, a committee member and former chief of pediatric infectious diseases at Tufts Medical Center, as panelists discussed the recommendation.
“To make the changes that are being proposed, we will see more children and adolescents and adults infected with hepatitis B,” he said.
Several physicians who did not serve on the board but provided comments during the committee’s debate warned the decision would have consequences.
“This vote is an unnecessary solution looking to find a problem to solve,” said physician Jason Goldman. “It will not fix your concerns of informed consent but only endanger children and increase the risk of death for millions.”
Earlier this year, Health and Human Services Secretary Robert Kennedy Jr. fired all 17 existing ACIP members. In September, the newly constituted panel voted to change its guidance around the measles-mumps-rubella, or MMR, shot which protects against those three infectious diseases. The committee no longer recommended giving the combined vaccine to children younger than 4 — a change from previous guidance, which recommended children receive the first MMR dose at 12-15 months, and a second dose between 4 and 6 years.
Last week, the U.S. Food and Drug Administration reported in an internal memo that at least 10 children died after receiving the COVID-19 vaccine. The memo did not detail investigative procedures or provide further information about the children who died. Researchers and public health experts questioned the finding. Vinay Prasad, the director of the FDA’s Center for Biologics Evaluation and Research, vowed to improve the FDA’s approach to vaccine regulation.
Why does RFK Jr. want to end hepatitis B vaccination for newborns?
Kennedy has been a vocal skeptic of vaccine safety and effectiveness. He has asserted there is a link between vaccines and autism and has vowed to investigate and improve the national strategy on vaccination.
Kennedy has noted that hepatitis B is not “casually contagious” and is more common among intravenous drug users; therefore, he said, infants should not be receiving the vaccine. Hepatitis B is about four times more common among people who use intravenous drugs than those who do not.
However, existing studies have reported that infants infected with the virus are more likely than adults to develop the chronic form of the disease. The CDC estimated that without medical care and vaccinations, some 90% of infections among infants become chronic and that 25% of people infected at birth die prematurely from complications of the disease. Only 5% of adults who become newly infected with the virus develop chronic hepatitis B.
The Department of Health and Human Services estimated that about 25,000 infants are born to mothers with hepatitis B infections, and about 1,000 of those newborns become infected with the virus.
ACIP first recommended that infants receive the hepatitis B vaccine in 1991. By 2000, 90% of young children were vaccinated against the disease, and by 2019, the rate of hepatitis B among adolescents had declined 99%.
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