What to Know About the New Hep B Vaccine Guidance for Babies
Health Secretary Robert F. Kennedy Jr. scored another major victory in his quest to overhaul the nation’s vaccine policy on Friday, after the Centers for Disease Control and Prevention’s vaccine advisory panel voted to rescind its recommendation that all newborns be vaccinated against hepatitis B at birth. While research shows the hepatitis B vaccine is safe and highly effective, the panel, which is filled with some of Kennedy’s closest anti-vaccine allies, did not provide evidence to support the thinking behind this consequential change.
The new recommendations come months after the CDC announced it would no longer recommend the COVID-19 vaccine for healthy children and pregnant people. The hepatitis B decision alarmed physicians and other public-health experts, who rushed to point out that there has been a 99 percent reduction in infections among infants since the U.S. began recommending in 1991 that all babies receive their first vaccine dose at birth. “Today is a defining moment for our country,” Michael Osterholm, a public-health expert at the University of Minnesota, told the New York Times. “We can no longer trust federal health authorities when it comes to vaccines.”
Despite the change, new parents can ask for their babies to receive the vaccine at birth — a step the American Academy of Pediatrics continues to recommend. So what else did the panel say, and what does this mean for children going forward? Here’s what we know.
What is hepatitis B?
Hepatitis B is a virus that attacks the liver and can lead to complications such as cirrhosis, liver failure, liver cancer, and even death. Currently, there is no known cure for the disease. The virus can live on surfaces for up to seven days and be transmitted through bodily fluids including blood, saliva, semen, and tears. About half of patients infected with hepatitis B are not aware they have contracted the virus, according to the CDC.
Why have newborns received the hepatitis B vaccine at birth?
Research has found that a child’s age when they contract the disease is tied to their risk of developing a chronic infection: For those under the age of 6, the chances are between 70 to 90 percent, while for children ages 6 and older, the risk drops to 20 to 30 percent. Data also show that about 25 percent of children who develop chronic hepatitis B will die prematurely.
Prior to the CDC recommending universal vaccinations in 1991, an estimated 18,000 children contracted hepatitis B before age 10 each year. About half of those cases occurred because of mother-to-child transmission during delivery or shortly afterward, while the specific source of the other half of infections was unknown.
“There have been cases of infections in day care,” Andrew Pavia, a professor of pediatrics and medicine with the University of Utah and spokesperson for the Infectious Diseases Society of America, told NPR. “There have been cases of infection on sports teams. There have been documented infections from shared toothbrushes and from shared razors.”
For these reasons, the CDC has recommended for the past 34 years that children receive a three-dose schedule for the hepatitis B vaccine: the first shot within 24 hours of birth, the second at one to two months, and the third at six months. Universal vaccines made a massive impact in curbing the spread of the disease. Data show a 99 percent decline in infections among infants and children between 1991 and 2019. The U.S. now sees fewer than 20 cases of hepatitis B infection among children each year, according to recent CDC data.
Why did the CDC panel change its recommendation?
The CDC’s Advisory Committee on Immunization Practice is filled with some of Kennedy’s closest anti-vaccine allies. On Friday, the panel voted 8-3 to rescind its universal guidelines for receiving the hepatitis B vaccine at birth. Instead, it recommended the dose only for babies whose mothers test positive for the virus or who haven’t been tested. For other babies whose mothers tested negative, the panel said the decision to vaccinate at birth will be up to the parents and their health-care providers. The panel also recommended that in cases when a baby doesn’t receive the first vaccine shot at birth it be given to them “no earlier than 2 months of age.” These recommendations now go to CDC director Jim O’Neill for acceptance as official agency guidance, but any new guidelines are not expected to impact insurance coverage of the vaccines.
Committee member Vicky Pebsworth said on Thursday that the new recommendations were due to “pressure” from unnamed “stakeholder groups,” the Associated Press reported. The panelists who voted in favor of the changes argued the risk of infection is very low for infants, adding that they worried health providers may not be discussing the benefits and risks of the birth-dose vaccination at length with parents — without providing evidence to support their claims. Additionally, several members of the Trump administration, including the president himself and Secretary Kennedy, have argued hepatitis B is primarily a sexually transmitted disease and therefore babies do not need to be protected against the virus unless their mothers are infected. Kennedy has also claimed, without providing any scientific evidence, that the hepatitis B vaccine increases the risk of autism.
How is the medical community responding?
Physicians and public-health officials widely oppose the recommendations, emphasizing there is no scientific evidence that the hepatitis B vaccine is harmful to newborns. “We know it’s safe, and we know it’s very effective,” Dr. Cody Meissner, a professor of pediatrics at Dartmouth’s Geisel School of Medicine, told the Times.
Recent research has found that delaying vaccination by just two months after birth could lead to at least 1,400 additional cases of hepatitis B among children each year. If the CDC were to take up Donald Trump’s suggestion that the vaccine be delayed until a child turns 12, that could result in an additional 2,700 preventable infections per year, researchers said.
The American Academy of Pediatrics said it will continue to recommend the vaccine for all newborns. “This irresponsible and purposely misleading guidance will lead to more hepatitis B infections in infants and children,” Susan J. Kressly, the organization’s president, said in a statement. “I want to reassure parents and clinicians that there is no new or concerning information about the hepatitis B vaccine that is prompting this change, nor has children’s risk of contracting hepatitis B changed. Instead, this is the result of a deliberate strategy to sow fear and distrust among families.”
Members of the CDC vaccine panel who opposed the new guidance were also concerned about the consequences of rescinding the universal recommendations. “This has a great potential to cause harm, and I simply hope that the committee will accept its responsibility when this harm is caused,” Joseph Hibbeln, a psychiatrist and neuroscientist, said after voting against the changes.
What does this decision mean for other childhood vaccines?
To put it mildly, the panel’s decision suggests more seismic changes may be coming for childhood-immunization recommendations. In June, Kennedy fired all 17 members of ACIP and replaced them with many panelists who share his anti-vaccine views, particularly when it comes to children. The committee is currently reviewing all childhood immunizations, including the MMR, or measles, mumps and rubella, vaccine. Their next meeting is set to be held in late February.