U.S. Newborn Hepatitis B Vaccination Recommendation Under Review
For over three decades, the universal hepatitis B vaccination of all newborns in the U.S. has been a standard practice. This recommendation is currently under review.
An advisory committee to the Centers for Disease Control and Prevention (CDC) is scheduled to vote on Thursday regarding a potential rescission of this universal recommendation. Pediatricians have expressed concerns about potential severe health consequences if the recommendation is withdrawn. Dr. Andrew Pavia, a professor of pediatrics and medicine at the University of Utah and an infectious disease specialist, stated earlier this year that such a change would be highly risky.
Understanding Hepatitis B and Its Risks
The hepatitis B virus targets the liver. The disease currently lacks a cure, and chronic infection is associated with outcomes such as liver cancer, cirrhosis, and death. Infants infected with the virus face significantly higher risks for these severe outcomes. Dr. Pavia, also a spokesperson for the Infectious Diseases Society of America, noted that approximately 25% of children who develop chronic hepatitis B succumb to the infection.
Potential Impact of Vaccination Delays
According to a recent analysis, delaying the birth dose of the vaccine by two months could lead to at least 1,400 additional preventable cases of hepatitis B annually for the duration of a revised recommendation. The analysis further indicated that delaying the vaccine until age 12, as suggested by President Trump this year, could result in at least 2,700 preventable infections each year. This study was released prior to peer review, in advance of this week's Advisory Committee on Immunization Practices meeting.
Historical Context and Transmission
Prior to the implementation of universal newborn vaccination in the U.S. in 1991, approximately 18,000 children annually were infected before reaching age 10. Dr. Pavia reported that around half of these infections occurred through mother-to-child transmission. Administering the vaccine immediately after birth is effective in preventing the virus from establishing itself.
While hepatitis B can be sexually transmitted, President Trump's earlier statements questioned the necessity of infant vaccination based on this fact. However, Dr. Pavia emphasized various potential non-sexual transmission routes for children, citing documented cases of infection in settings such as:
- Day care centers
- Sports teams
- Through shared toothbrushes and razors
The virus can be present in blood, saliva, semen, and other bodily fluids, including tears, and can survive on surfaces for up to seven days. Dr. Anita Patel, a pediatrician and pediatric critical care physician, explained that a child with a wound who comes into contact with a contaminated surface, even days later, could become infected. The Centers for Disease Control and Prevention estimates that about half of individuals infected with hepatitis B are unaware of their status but can still transmit the virus unknowingly. Dr. Patel further illustrated, "If you have a cut, that blood could potentially get on the infant. And if that infant has any sort of break in their skin — as infants frequently do — they can then get hepatitis B."
Personal Account and Vaccination Efficacy
Dr. Su Wang, an internist and researcher specializing in hepatitis at Cooperman Barnabas Medical Center in New Jersey, suspects she contracted hepatitis B as an infant from her grandparents. She suggests they were likely exposed through their medical professions in Taiwan, a country that implemented a national vaccination program in the 1980s following high rates of adult hepatitis B infection.
Dr. Wang underscored the significance of administering the vaccine at birth. Since the routine vaccination of newborns began in the U.S., case rates among individuals aged 19 and younger have decreased by 99%. Dr. Wang indicated that universal vaccination provided broad protection, impacting an entire generation of children.