Federal Panel Alters Hepatitis B Vaccine Guidelines for Infants

A federal vaccine advisory panel has voted to modify the longstanding recommendation for administering the hepatitis B vaccine to newborns. On September 29, 2023, the Advisory Committee on Immunization Practices (ACIP) decided by an 8-3 margin that while infants born to mothers who test positive for the virus should still receive the vaccine at birth, parents of newborns whose mothers test negative will now have the option to consult their healthcare provider regarding vaccination timing.

This decision, reported by the New York Times, marks a significant departure from over three decades of public health policy. The hepatitis B vaccine is generally administered in a series of three shots, with the first typically given shortly after birth. The change has raised concerns among public health experts about the potential for increased susceptibility to hepatitis B, a virus that can lead to chronic liver disease and liver cancer.

Neil Maniar, director of the Master of Public Health program at Northeastern University, expressed alarm over the decision, highlighting that the vaccine has proven to be both safe and effective. “For over 30 years, the hepatitis B vaccine has reduced the likelihood of liver cancer in infants and young children by about 95%,” Maniar stated. He warned that loosening vaccination guidelines could endanger a new generation, making them more vulnerable to a disease that often goes undetected and is incurable when chronic.

The World Health Organization reported that in 2022, approximately 254 million people globally were living with chronic hepatitis B infections, with 1.2 million new infections occurring each year. In the United States, there were 17,650 newly reported chronic cases in 2023, according to the Centers for Disease Control and Prevention (CDC), alongside an estimated 14,400 new acute cases.

Experts like Wendy Parmet, a leading authority on public health law, warned that removing the initial vaccine dose from hospital settings could create barriers for parents. “Taking the first shot out of a hospital birth setting would make it more difficult for some parents to access the hepatitis B vaccine,” Parmet said. “Not everyone has access to or can afford to go to a pediatrician.”

The recent vote has been viewed as a victory for Robert F. Kennedy Jr., the Secretary of Health and Human Services, who has made controversial changes to the committee’s composition, including appointing members who are skeptical of vaccines. Under Kennedy’s oversight, the CDC altered its language on its website to indicate that the scientific consensus on vaccines and autism “is not an evidence-based claim.”

During the ACIP meeting, Dr. Tracy Beth Hoeg, the new acting director of the Center for Drug Evaluation and Research, noted that the U.S. stands apart from other high-income countries in recommending the hepatitis B vaccine for infants of mothers who test negative. She echoed concerns raised during the discussions about whether the vaccine’s side effects have been adequately reported.

Hepatitis B can be transmitted through childbirth, needle sharing, and sexual contact. Additionally, it can be contracted through contact with infected blood on surfaces such as razors or toothbrushes. Maniar emphasized the virus’s contagious nature, stating, “It takes just a couple of droplets of blood to transmit the virus.”

In a poignant address to the ACIP, Dr. Amy Middleman, representing the Society for Adolescent Health and Medicine, expressed her opposition to the revised guidelines. “This is the first time in my 21 years as a liaison to ACIP that its policy puts children in this country at higher risk rather than lower risk of disease and death,” Middleman said.

The ACIP suggested that mothers who test negative for hepatitis B should consider vaccinating their children no earlier than two months of age. Maniar cautioned that the decline in hepatitis B cases among children is largely attributable to vaccination efforts. “Once we take our foot off the pedal, we are likely to see an increase in these infections,” he noted.

This change in recommendations could have far-reaching implications for public health, prompting ongoing discussions about the accessibility and effectiveness of vaccination programs in the United States.