The Centers for Disease Control and Prevention's (CDC) influential Vaccine Advisory Committee has voted to rescind its recommendation for universal vaccination of newborns against hepatitis B virus (HBV). The committee voted that instead of receiving the first dose within 24 hours of birth, children of mothers who test negative for the virus should receive the vaccine at 2 months of age.
The Advisory Committee on Immunization Practices (ACIP), which guides CDC vaccine policy, was recently reorganized by Secretary of Health and Human Services Robert F. Kennedy Jr. Now its members including prominent vaccine skeptics which sowed doubts about the established vaccination schedule for children.
The proposed changes have been widely criticized by medical associations, including American Academy of Pediatrics.
“No rational science was presented” to support the new recommendations, Dr. Joseph Hibbelnmember of the ACIP committee and former chief of the Division of Nutritional Neuroscience at the National Institutes of Health, said at the meeting.
“This has a lot of potential for harm, and I just hope that the committee will take responsibility when that harm is done,” Hibbeln said at the meeting when the vote was cast.
During the chaotic, multi-day meeting, the committee presented four different versions of the language, leaving several ACIP members expressing uncertainty about what they were voting on.
What is hepatitis B?
Hepatitis B, a viral infection, can easily go undetected because it does not always cause obvious symptoms. However, when the infection becomes chronic, it can cause liver damage and increase the risk of liver cancer. Infections are promoted by approximately one third of liver cancer deaths worldwide.
Persistent infection should be treated with medicines for lifeand organ damage may lead to the need for a liver transplant. Up to 1 in 4 four newborns Those infected with hepatitis B die prematurely from liver disease in adulthood.
This chronic form of the disease is especially common among people infected during childhood. According to WHO, in approximately 95% of cases, hepatitis B acquired in early childhood becomes chronic. World Health Organization (WHO). That's why the hepatitis B vaccine, first licensed in 1971, has been recommended for newborns in the United States since 1991.
According to WHOin countries where the virus endemic and infects people in large numbers, the most common routes of transmission being from mother to child at the time of birth, or from an infected person to an uninfected child in the child's first five years of life – they can become infected, for example, from a bite at a daycare center or from accidentally touching a friend's scraped knee, as the virus can be transmitted through contact with a small amount of blood. In the United States, vaccinating infants at birth prevents these two common modes of transmission.
A second dose of the vaccine was recommended between 1 and 2 months of age, followed by a third dose between 6 and 18 months of age. This three-dose series in childhood also later protects against types of transmission that are common in adults, such as unsafe intravenous drug use and sexual activity.
Historically, Vaccine advocates say the vaccine children do not need it because these last two routes of transmission are apparently irrelevant for them. As with other early childhood vaccines, anti-vaxxers claim that the safety of the vaccine schedule has not been studied (which it does) and that the vaccines cause autism spectrum disorders, which they do not.
The risk stratification approach of vaccinating only children of mothers known to be positive has been tried in the past and found to be ineffective. In 1990, when children began to be vaccinated against hepatitis B, but newborn vaccination had not yet been introduced, acute hepatitis B infection affected 3 per 100,000 people aged 19 years or younger in the US. Compare that to 2023, when the rate dropped to 0 per 100,000. The level of chronic infections, in turn, decreased only due to 0.4 per 100,000 people under 19 years of age diagnosed in 2023.
At the meeting, the committee also voted to recommend that patients check with their doctors after their first dose to see if they should have certain levels of HBV antibodies tested before getting their second and third shots.
