At Friday’s ACIP vaccine advisory committee meeting, the group undid decades of science-based recommendations that a dose of the hepatitis B vaccine should be administered to all newborns. Instead, they came up with changes that are complicated and will be confusing for parents to navigate. How will this affect public health? What does this mean for parents?
Why Vaccinate Newborns Against Hepatitis B
The hepatitis B vaccine has universally been given to babies within 24 hours of birth since 1991. This birth dose dramatically decreases the incidence of acute hepatitis B, as you can see in my pre-ACIP meeting post. Chronic hepatitis B dropped by 99% after universal birth dosing was implemented. Vaccination also reduces later complications like chronic infection, cirrhosis, liver failure, and liver cancer, which occur in up to 25% of those infected.
The CDC’s expert vaccine advisory committee members were all fired by Robert F. Kennedy, Jr in June and replaced with a hand-selected panel of like-minded individuals. You can read about the new ACIP members and the background of the vote here.
What changed?
During this most recent meeting, the majority of the new ACIP committee went against decades of evidence-backed science and chose to only recommend the birth dose of vaccine if the mother has hepatitis B or if her status is unknown. If infected, up to 90% of babies go on to develop chronic hepatitis B infection. The risk of developing a chronic infection goes down as someone gets older. If the mom tests negative, they now recommend delaying vaccination for at least 2 months—something they pulled out of …wherever, with absolutely no scientific basis. Then they want you to decide if you want your child vaccinated, and when. They also suggest the baby have blood drawn to test for antibodies after the first dose.
ACIP assumes that all mothers have access to prenatal care and testing and that they live in a bubble.
Many people don’t know that they’ve been infected and became a chronic carrier. We also know that hepatitis B can be transmitted by contact with contaminated surfaces, which remain infective for at least a week. A person can unknowingly spread the infection via household items contaminated with blood or saliva, such as shared cups or toothbrush, or even minor cuts. About 10% of infections occur through household or community transmission. Infected children can spread the virus to uninfected people, especially young children. Having more people forgo vaccinations will lead to higher risk for all.
What Should Parents Do?
I’m an infectious disease physician and a mother. Obviously, I can’t tell people what the right choice for them is, but this is how I would approach thinking about the issue if I was a new parent and had to decide if and when to have my child vaccinated against Hepatitis B.
I would strongly recommend asking your doctor to give your newborn the hepatitis B vaccine within 12-24 hours of birth. Why? It is the safest choice and eliminates almost any chance of your baby becoming infected and developing these complications of cirrhosis or liver cancer, which has less than a 20% 5-year survival.
We know from decades of observation how safe the vaccine is and how risky not vaccinating is. After receiving the vaccine your child might experience a fever and some discomfort, as their body starts to produce antibodies which will go on to protect them from future infection, but the fever and discomfort is short-lived, and you are done, with the series providing almost 100% protection against disease.
As a mom, I was traumatized watching my baby have blood drawn when just a few days old. I wouldn’t want to put my child through that and then debate whether their titer was high enough not to need another vaccination, again, without any data. As a parent, I would want to avoid having to miss extra time off work to take my child to another appointment—in this case, needlessly—and to wonder whether insurers will cover the cost of the blood test. Imagine juggling work and such needless appointments if you have more than one child! It’s safer, more effective, easier and less traumatic for all to simply give the birth dose and then follow-up shots on a safe, well-established schedule.
This also has science to back it up. The alternative doesn’t. Making this process needlessly complicated will reduce the likelihood of a child completing all their immunizations—which seems precisely the goal of this administration.
Bonus tip: If your child is 9-years old or older, please get them the Human Papilloma Virus vaccine as soon as possible. The HPV vax (Gardasil) is safe and effective in preventing cervical and other cancers. One dose provides adequate protection. The HPV vaccine is a clear target of this administration and they are likely to severely restrict access or make it unavailable altogether.