NEW YORK (AP) — A federal vaccine advisory committee is expected to discuss this week whether newborns should still get the hepatitis B vaccine — the first vaccine found to prevent cancer.
Federal health guidelines now suggest that all babies be vaccinated against hepatitis on the first day of life, but US Health Secretary Robert F. Kennedy Jr.’s commission expects to change that, contradicting previous public health advice.
It’s not clear exactly what the committee has in mind, but the American Academy of Pediatrics will still urge a birth dose, said the organization’s Dr. Sean O’Leary.
“We will 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.
Liver disease can cause lifelong health problems
Hepatitis B is a serious liver infection that, for most people, lasts less than six months. But for some — especially infants 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 spread through sex or sharing needles during injection drug use.
But it can also be transmitted from an infected mother to a child. About 90 percent of children who contract hepatitis B have chronic infections, which means their immune systems do not completely clear the virus.
An estimated 2.4 million people in the U.S. have hepatitis B, and half don’t know they’re infected, according to information from the Centers for Disease Control and Prevention.
Dr. Baruch Blumberg, a federal scientist, identified the virus behind the infection in 1965. He won the Nobel Prize for the discovery, which led to tests and vaccines. The first hepatitis B vaccine was licensed in the US in 1981.
Newborn shots have been recommended for years
For decades, national vaccine guidelines have been influenced by a government-appointed panel of experts, the Advisory Committee on Immunization Practices. Its recommendations have usually been adopted as national guidelines that are widely followed by doctors.
In 1991, the committee recommended an initial dose of hepatitis B vaccine at birth. The guidelines have changed slightly over the years and currently suggest a dose within 24 hours of birth for all medically stable infants weighing at least 4.4 pounds (2 kilograms), plus follow-up vaccines to be given at approximately 1 month and 6 months.
Why a dose right at birth? Health officials used to rely on screening expectant mothers to find babies who might 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. The virus can also live on surfaces for more than seven days at room temperature, so unvaccinated children who live with a person with a chronic infection can get it.
Vaccinations of newborns against hepatitis B are widely considered to be a public health success story. Over about 30 years, cases among children dropped from about 18,000 a year to about 2,200.
A collaboration of public health researchers, the Vaccine Integrity Project, this week released its review of more than 400 studies and reports spanning 40 years. The group concluded that the birth dose is safe and is an important reason why pediatric hepatitis B infections in the US have declined.
The committee reviews the newborn’s recommendation
Kennedy, a leading anti-vaccine activist before becoming the nation’s top health official, fired all 17 members of ACIP earlier this year and replaced them with a group that includes more anti-vaccine voices.
The panel expressed concern about giving a vaccine to a child so early in life.
“Are we asking our children to solve an adult problem?” asked committee member Dr. Evelyn Griffin at a September meeting.
Filled with questions about why a change was needed, committee member Dr. Robert Malone said: “The signal that’s causing this is not one of safety. It’s one of trust… It’s one of parents who are uncomfortable with this medical procedure being done at birth in a fairly one-sided way without meaningful informed consent.”
The committee tabled a vote at its September meeting, but is scheduled to take action at Thursday’s meeting, according to the agenda. Federal officials did not respond to questions about exactly how long a delay is proposed or disclose what research is being used as the basis for such a decision.
What would happen if the shots are delayed?
Not knowing what the committee has in mind, it is difficult to guess the potential impact. But some have tried.
This week, public health researchers working with hepatitis-focused advocacy organizations released a report estimating that delaying the birth dose by 2 months could lead to 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 – estimated that the rate would be higher if the first dose was given even later.
But an ACIP change to the recommendation may have limited impact, O’Leary said.
The committee’s most direct power is over what is covered by the government’s Vaccines for Children program, which pays for vaccines for uninsured children in low-income families. Hepatitis B shots were often included in the final hospital bill for the birth. So a new ACIP recommendation probably wouldn’t be an economic obstacle to the current practice that continues at many hospitals, he said.
But any change means confusing and scaring parents, he added.
“If it’s scary, share it” on social media, O’Leary said.
Several medical and public health organizations — and even some state government officials — said before the meeting that changing the recommendation was a terrible idea. Among them is a newly formed coalition of government leaders from several northeastern states that this week issued a statement saying they will continue to urge families to receive a birth dose within 24 hours of birth.
US Senator Patty Murray, a Democrat from Washington, this week asked Congress to compel Kennedy to appear at a hearing and explain ACIP’s actions.
“Ending the decades-old recommendation that babies born in the U.S. be vaccinated against hepatitis B is a heartless choice to allow children to die,” Murray said in a statement.
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