NEW YORK — This week, a federal vaccine advisory committee is expected to discuss whether newborns should still receive the hepatitis B vaccine, the first shot discovered to prevent cancer.
Federal health guidelines now suggest that all babies should be vaccinated against liver infection on their first day of life, but U.S. Health Secretary Robert F. Kennedy Jr.'s committee on Thursday is expected to change that, contradicting previous public health recommendations.
It's unclear what exactly the committee is considering, but the American Academy of Pediatrics will still push for dosing at birth, said the organization's Dr. Sean O'Leary.
“We're going to continue to recommend it because it saves lives,” he said.
Here's a look at the disease, the vaccine and the debate over changing recommendations.
Hepatitis B is a serious liver infection that lasts less than six months in most people. But for some, especially babies and children, it can become a long-term problem that can lead to liver failure, liver cancer, and scarring called cirrhosis.
In adults, the virus is transmitted through sexual contact or through sharing needles during injection drug use.
But it can also be passed from an infected mother to her child. About 90% of infants who contract hepatitis B have chronic infections, meaning their immune systems do not completely clear the virus.
About 2.4 million people in the United States have hepatitis B, and nearly half of them don't know they are infected, according to the Centers for Disease Control and Prevention.
Dr. Baruch Bloomberg, a federal scientist, identified the virus causing the infection in 1965. He received the Nobel Prize for this discovery, which led to the development of tests and vaccines. The first hepatitis B vaccine was licensed in the United States in 1981.
For decades, national vaccine recommendations have been influenced by a government-appointed panel of experts, the Advisory Committee on Immunization Practices. Its recommendations are generally accepted as national guidelines and are widely followed by physicians.
In 1991, the committee recommended that an initial dose of hepatitis B vaccine be administered at birth. The guidelines have changed slightly over the years and now suggest a dose within 24 hours of birth for all medically stable infants who weigh at least 4.4 pounds (2 kilograms), with subsequent vaccinations to be given at approximately 1 and 6 months.
Why dose immediately at birth? Health officials previously relied on screening expectant mothers to identify babies who may have been exposed to the virus. But many cases were missed, experts say, because some women were not tested or the test results were incorrect. Additionally, the virus can live on surfaces for more than seven days at room temperature, so unvaccinated children living with someone with a chronic infection can become infected.
Vaccination of newborns against hepatitis B is widely considered a public health success. Over about 30 years, the number of cases among children has dropped from about 18,000 per year to about 2,200.
A collaboration of public health researchers, the Vaccine Integrity Project, this week published analysis more than 400 studies and reports over 40 years. The panel concluded that the birth dose is safe and is an important reason for the decline in the incidence of hepatitis B in children in the United States.
Kennedy, a leading anti-vaccination activist before becoming the nation's top health official, fired all 17 members ACIP earlier this year and replaced them with a group that includes several voices against vaccination.
The expert group expressed concern about administering the vaccine to a child at such a young age.
“Are we asking our kids to solve an adult’s problem?” asked committee member Dr. Evelyn Griffin at the September meeting.
Questioning why the changes were needed, committee member Dr. Robert Malone said, “The signal that encourages this is not a signal of safety. It is a signal of trust… It's one of the parents who doesn't like that this medical procedure is being performed at birth in a rather one-sided way without significant informed consent.”
The committee took a vote at its September meeting, but is scheduled to make a decision at Thursday's meeting, according to the report. agendas. Federal officials did not answer questions about exactly how long the delay was proposed or disclose what studies are being used as the basis for such a decision.
Not knowing what the committee is considering makes it difficult to predict the potential impact. But some tried.
This week, public health researchers working with hepatitis advocacy organizations published report it is estimated that delaying the birth dose to 2 months could result in at least 1,400 hepatitis B infections in children and 480 deaths. The report, which has not yet been peer-reviewed or published in a medical journal, suggests the death toll would be higher if the first dose was administered even later.
However, changing the ACIP recommendation may have limited impact, O'Leary said.
The committee's most direct authority concerns what is covered by the state's childhood immunization program, which pays for vaccinations for uninsured children from low-income families. Hepatitis B vaccinations are often included in the final bill for childbirth. Thus, the new ACIP recommendation likely will not be an economic barrier to current practices continuing in many hospitals, he said.
But any changes could be confusing and frightening for parents, he added.
“If it's scary, it's shared” on social media, O'Leary said.
Several medical and public health organizations — and even some state government officials — said ahead of the meeting that changing the recommendation was a terrible idea. They include a newly formed coalition of government leaders from several northeastern states, which this week released a statement saying they will continue to urge families to receive the birth dose within 24 hours of birth.
U.S. Sen. Patty Murray, a Washington Democrat, called on Congress this week to force Kennedy to appear at the hearing and explain ACIP's actions.
“Reversing the decade-long recommendation that children born in the United States be vaccinated against hepatitis B is a heartless choice that allows children to die,” Murray said in a statement.
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