CDC Advisers Recommend Changes to Infant Hepatitis B Vaccination Policy
The Centers for Disease Control and Prevention's (CDC) vaccine advisers have recommended revisions to the agency's hepatitis B immunization guidance for newborns. If approved by the CDC's acting director, this would modify a universal recommendation to initiate hepatitis B immunization at birth, a practice in the U.S. for over 30 years. This long-standing policy has been associated with a significant reduction in liver diseases caused by the virus.
Key Recommendations
The Advisory Committee on Immunization Practices (ACIP) voted 8-3 to recommend hepatitis B vaccination at birth specifically for infants born to women who test positive for the hepatitis B virus. For infants born to women with negative or unknown hepatitis B status, the recommendation advises discussion with healthcare providers regarding vaccination.
Medical Community Response
This proposal was met with objections from some medical community representatives. Dr. Grant Paulsen, representing the Pediatric Infectious Diseases Society, questioned the rationale for changing a policy he stated had been effective, citing concerns about theoretical rather than real safety issues.
Vaccination Regimen Adjustments
A separate vote addressed the number of vaccine doses. Standard infant immunization typically involves three doses: one at birth, a second at one to three months, and a third at six to 15 months of age.
The panel voted 6-4, with one abstention, to recommend testing children's antibody levels after each hepatitis B shot to determine if additional doses are necessary. This could result in some children receiving one or two doses instead of the standard three.
Dr. Adam Langer, a CDC official focusing on hepatitis prevention, noted during the discussion that clinical studies for approved hepatitis B vaccines were conducted using a three-shot regimen. He stated that concluding efficacy after one or two shots based on antibody testing would be an assumption not supported by existing data.
Committee Composition and Member Views
The vote results reflected divergent views among the committee members. Several members who participated in a subgroup reviewing the topic were among those who voted in favor of the changes.
The committee for this week's vote was appointed by Health Secretary Robert F. Kennedy Jr., who has previously expressed skepticism regarding certain vaccines. Some voting members have a documented history of expressing concerns about the safety of established vaccines.
Retsef Levi, a voting member and professor at the MIT Sloan School of Management, described the move as "a fundamental change in the approach to this vaccine." He suggested it would encourage parents to consider carefully whether to vaccinate their child and that they might choose to delay the vaccine for years, a decision he attributed to parents and their physicians.
Conversely, some members expressed concerns about the perceived lack of evidence supporting the changes and the potential for increased risk to children.
Dr. Cody Meissner, a professor of pediatrics at Dartmouth's Geisel School of Medicine and the sole current member with prior committee service, stated, "We know vaccines are safe... The hepatitis B vaccine recommendation is very well established. We know it is safe, and we know it is very effective, and to make the changes that are being proposed, we will see more children and adolescents and adults infected with hepatitis B." He registered a 'no' vote, stating, "Do no harm is a moral imperative. We are doing harm by changing this wording."
Background on Hepatitis B and Vaccination
The previous universal recommendation for healthy newborns aimed to ensure coverage for all at-risk infants. Hepatitis B can be transmitted from mothers to infants during childbirth and through contact with an infected person's bodily fluids, including saliva and blood.
Infancy immunization provides lifelong protection against the hepatitis B virus, which can lead to serious health issues such as liver cancer and cirrhosis. This immunization strategy has been a key component of efforts to eliminate hepatitis B in the U.S.