An influential vaccine advisory committee to the Centers for Disease Control and Prevention (CDC) has voted to eliminate the recommendation for universal vaccination of newborns against the hepatitis B virus (HBV). The committee voted that instead of getting a first dose within 24 hours of birth, children of mothers who test negative for the virus get the vaccine at 2 months of age.
The Advisory Committee on Immunization Practices (ACIP), which steers the CDC’s vaccine policy, was recently overhauled by Health and Human Services Secretary Robert F. Kennedy Jr. Its members now include prominent vaccine skeptics who have sown doubt in the established childhood vaccine schedule.
The proposed changes have been widely criticized by medical associations, including the American Academy of Pediatrics.
“No rational science has been presented” to support the new recommendations, Dr. Joseph Hibbeln, ACIP committee member and former Chief of the Section on Nutritional Neurosciences at the National Institutes of Health, said in the meeting.
“This has a great potential to cause harm, and I simply hope that the committee will accept its responsibility when this harm is caused,” Hibbeln said in the meeting when the votes were cast.
During its chaotic, multi-day meeting, the committee rolled out four different versions of language, so multiple ACIP members expressed uncertainty as to what they were voting for.
What is Hepatitis B?
Hepatitis B, a viral infection, can easily go undetected because it doesn’t always cause overt symptoms. However, when the infection becomes chronic, it can cause liver damage and raise the risk of liver cancer. The infections contribute to about one-third of liver cancer deaths globally.
The permanent infection must be managed with medications for life, and the organ damage can lead people to need liver transplants. Up to 1 in 4 four newborns infected with hepatitis B die prematurely of liver disease as adults.
This chronic form of the disease is especially common among people who are infected as kids. In about 95% of cases, hepatitis B contracted in early childhood becomes chronic, according to the World Health Organization (WHO). That’s why the hepatitis B vaccine, first licensed in 1971, has been recommended to newborns in the U.S. since 1991.
According to the WHO, in countries where the virus is endemic and infects people in high numbers, the most common routes of transmission are from mother to child at the time of birth or from an infected person to an uninfected child in the first five years of the child’s life — they can pick the infection up from a biting incident at daycare or from accidentally touching a friend’s scraped knee, for instance, as the virus can be spread via contact with small quantities of blood. In the U.S., vaccinating babies at birth heads off these two common routes of transmission.
A second dose of the vaccine was recommended to be given at 1 to 2 months old, and then a third at 6 to 18 months old. This three-dose series in childhood also later protects against the types of transmission that are common in adults, such as unsafe intravenous drug use and sexual activity.
Historically, anti-vaccine advocates have argued that the shot is unnecessary for kids because these latter two routes of transmission presumably aren’t relevant to them. As with other vaccines given in early childhood, anti-vaxxers have claimed that the safety of the schedule hasn’t been studied — which it has — and that the vaccines cause autism spectrum disorder — which they do not.
The risk-stratified approach of only vaccinating children of mothers known to be positive has been tried in the past and found to be ineffective. In 1990 — when children had started to be vaccinated for hepatitis B but newborn vaccination had yet to be introduced — acute hepatitis B infections affected 3 per 100,000 people ages 19 and under in the U.S. Compare that to 2023, when that rate fell to 0 per 100,000. The rate of chronic infections fell, in turn, with only 0.4 per 100,000 people under 19 diagnosed in 2023.
In the meeting, the committee also voted to recommend that after the first dose, patients should consult with doctors to see whether they should test for certain levels of antibodies against HBV before giving the second and third shots.
