IN hospital Liver specialist Brian McMahon, a tribal owner from Anchorage, Alaska, has battled the effects of hepatitis B for decades. In the 1980s, before a vaccine was available, he watched the virus claim young lives at an alarming rate in communities in the western part of the state.
One of his patients was 17 years old when he examined her for abdominal pain. McMahon discovered she had developed liver cancer caused by hepatitis B just weeks before graduating high school as valedictorian.
He died before the ceremony.
McMahon also recalls an 8-year-old boy who showed no signs of illness until he complained of pain – which turned out to be a rapidly growing tumor in his liver. You can still hear his voice.
“He was moaning in pain and saying, 'I know I'm going to die,'” he recalls. “We all cried.” A week later the boy died at home.
The hepatitis B virus is transmitted through blood and other body fluids, even in microscopic quantities, and can survive on surfaces for up to a week. Like many of his patients, McMahon explained that both children were infected with hepatitis B at birth or in early childhood.
Today, such an outcome can be prevented.
One dose of vaccine at birth, recommended for newborns since 1991, is up to 90% efficiency to prevent maternally transmitted infection when administered in the first 24 hours of life. If children receive all three doses, 98% develop immunity against this incurable virus, with protection that lasts at least 30 years.
In western Alaska communities, years of targeted testing and widespread vaccination campaigns have led to new cases. will be sharply reduced.
“Liver cancer has disappeared in children,” McMahon said. “We have not had a single case registered since 1995. As far as we know, we also do not have a single infected person under the age of 30.”
He worries that these hard-won gains could be reversed.
Should I delay the dose?
The Centers for Disease Control and Prevention's (CDC) Vaccine Advisory Committee, appointed by Health and Human Services Secretary Robert F. Kennedy Jr., is scheduled to discuss and vote Dec. 4 on whether to support the recommendation of a hepatitis B dose at birth.
This measure could limit children's access to the vaccine.
On Tucker Carlson's June podcast, Kennedy falsely claimed that birth dose of hepatitis B was the “probable cause” of autism.
He also said the hepatitis B virus is not “randomly infectious.” But decades of research show that the virus can be transmitted through indirect contact when traces of infected fluids, such as blood, enter the body through sharing personal items such as razors or toothbrushes.
The recommendations of this committee have great influence. Most private insurance is required to cover vaccines approved by the Advisory Committee on Immunization Practices (ACIP), and many government vaccination policies are based directly on these guidelines.
But neither ACIP nor CDC have regulatory functions: they cannot impose mandatory vaccines. This responsibility falls on the states. However, maintaining the recommendation for the vaccine at birth gives families the most options: they can choose to be vaccinated at birth, wait until later, or not get vaccinated. Insurance will continue to cover the cost of the vaccine as long as it is approved by the Food and Drug Administration (FDA).
Two senior FDA officials—Commissioner Marty Makary and chief vaccine regulator Vinay Prasad—suggested in late November that they might changes are coming in the vaccine approval process. All vaccines must be approved by the FDA for use in the United States.
IN internal emails received PBS NewsHour th Washington PostPrasad questioned the routine practice of “administering multiple vaccines at the same time.”
It is unclear whether he was referring to combination vaccines, which protect against multiple diseases in one dose. Three of the nine hepatitis B vaccines currently approved by the FDA are combination vaccines. However birth dose It is administered only as an individual vaccine.
“Sow mistrust”
Even if private insurance continues to cover the vaccine, misinformation arising from the meeting could lead some families to mistakenly believe it could harm their children, he warned. Sean O'LearyChairman of the Committee on Infectious Diseases of the American Academy of Pediatrics and Associate Professor at the University of Colorado School of Medicine.
“Whatever comes out of the disaster of this December meeting will be primarily aimed at sowing mistrust and sowing fear,” he said.
President Donald Trump, Kennedy and some new ACIP members misrepresented How is this liver disease transmitted?ignoring or minimizing the risk of indirect contamination.
Hepatitis B virus is much more contagious than HIV. Unvaccinated people, including children, can become infected through microscopic amounts of blood on a table or toy, even if the infected person has no symptoms.
McMahon cared for children who tested negative at birth and then became infected through indirect contact. IN study In the 1970s, nearly a third of these children developed chronic hepatitis B without any symptoms, he said.
“This is a highly contagious virus,” McMahon said. “That's why giving everyone a dose at birth is the best way to prevent it.”
The CDC recommends that all pregnant women be tested for hepatitis B, but it is estimated that up to 16% are not tested and are not included in the registry. O'Leary and other experts say testing immediately before or after birth is not possible because most hospitals lack staff and resources.
The three-dose vaccine has long safety record. Numerous studies show it is not associated with an increased risk child death, fever or sepsis, multiple sclerosis V autoimmune diseases. Serious reactions are rare.
“We have an excellent safety profile,” O’Leary said. “Nobody expects to crash in a car, right? But we all still wear seat belts. It's similar.”
The Centers for Disease Control and Prevention (CDC) estimates that 2.4 million people in the country have hepatitis B, and this half don't know they are infected. The disease can range from acute to chronic infection. often without symptoms. If left untreated, it can lead to cirrhosis, liver failure, and liver cancer. There is no cure for this.
Recommendation for parents: Consult a doctor.
William Schaffnera professor of preventive medicine at Vanderbilt University School of Medicine and a former voting member of ACIP, said some parents have a hard time understanding why a healthy newborn needs a vaccine so soon, especially against a virus they are convinced they don't have and that is often associated only with risky behavior. That perception, he noted, is coupled with growing mistrust of public health and skepticism about vaccines.
Her advice to potential parents who are hesitant is to talk to their doctor about vaccines. Even if a pregnant woman tests negative, it is still important to administer the birth dose because false negatives can occur and the virus can easily spread through contact with surfaces, she said.
Children who receive the full series of vaccines from birth have 84% less likely development of liver cancer.
“If you wait a month and the mother is positive or the child is infected by a caregiver, by then the infection will have already been established in the child's liver,” Schaffner explained. “It's too late to prevent this.”
He added that if fewer people are vaccinated, hepatitis B will spread more in American communities and the risk of infection will increase for those who are not vaccinated.
An increase in hepatitis B cases may also mean higher costs for both patients and the health care system.
The CDC estimates that treating a person with less severe disease costs between $25,000 and $94,000 per year. For those who need a liver transplant, annual medical costs can exceed $320,000, depending on the treatment.
Over the past 30 years, main side effects After dosing at birth, parents reported crying and irritability, symptoms that quickly resolved. Schaffner said this demonstrates the very high safety profile of the vaccine for newborns, protecting against the incurable disease.
“The data on this is very clear,” he added. “Now there are a number of countries that have started this program. They took her as a model for ours.”
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