US states, doctors split with CDC on hepatitis B shots for newborns
Medical groups say vaccine can prevent silent infections and liver cancer
Major medical associations and state health departments are moving to maintain the standard of universal hepatitis B vaccination at birth, diverging from a recent vote by a Centers for Disease Control and Prevention (CDC) panel to end the long-standing recommendation.
The new CDC recommendation suggests limiting the birth dose only to infants whose mothers test positive for hepatitis B or whose status is unknown. However, most experts warn that this shift may eventually lead to a rise in liver cancer deaths among children.
“For over 30 years, the hepatitis B vaccine has proven to be very safe, very effective,” Neil Maniar, PhD, director of the master of public health program at Northeastern University, said in a university news story. “Since we implemented the hepatitis B vaccine recommendation, we’ve probably reduced the likelihood of liver cancer in infants and young children by about 95%.”
Calls to maintain prior protection
Before the committee’s meeting, dozens of public health and policy experts had filed a public comment concluding that the evidence overwhelmingly supports maintaining prior vaccination recommendations.
Now, doctors and advocacy groups across the U.S. are recommending that parents ensure their newborns receive the vaccine in line with prior recommendations. In some states, such as Maryland and Maine, health departments are issuing their own separate guidance reaffirming the previous recommendations.
“The hepatitis B birth dose has long represented one of the great success stories in public health,” Jennifer Mensik Kennedy, PhD, president of the American Nurses Association, said in an association press release. “Nurses … have both an ethical and professional obligation to advocate for evidence-based immunization practices that protect the most vulnerable. Especially newborns, who depend on us to keep them safe.”
The American Pharmacists Association echoed a similar sentiment, calling the new CDC recommendation “deeply disappointing.”
“Pharmacists have a long history of helping to prevent disease transmission through vaccine recommendation and administration, including against hepatitis B,” Brigid Groves, the association’s vice president of professional affairs, said in a press release. “… The science is clear: the hepatitis B birth dose saves lives, and there is no new evidence to justify delaying or removing this critical protection.”
Hepatitis B, the most common serious liver infection worldwide, typically does not cause symptoms until it has progressed to an advanced stage. This also allows the hepatitis B virus to spread silently via contact with bodily fluids from infected people.
The virus can pass from an infected mother to her child during birth, and the majority of unvaccinated babies who are exposed to the virus will develop a chronic infection that can set the stage for deadly liver cancer.
There is no cure for hepatitis B, but the infection can be prevented with vaccines. Since the 1990s, it’s been standard practice to administer the first dose of the hepatitis B vaccine on the day that a baby is born.
Gaps in the new policy
The new CDC recommendation says that if a mother has previously tested negative, they should consult with their providers to determine whether or not to vaccinate as a personal choice.
However, a person who tests negative can then get infected. The populations at highest risk of infection, such as people who are in sex work or who inject recreational drugs, are also among those least likely to have access to consistent medical care and reliable testing.
Wendy Parmet, a leading public health law expert, said that removing the initial hepatitis B vaccination from hospital birth settings would reduce accessibility for some parents, leading to cases of hepatitis B in children.
“It will require more medical appointments,” Parmet said. “And not everybody has access to or can afford going to a pediatrician.”
Amy Middleman, MD, representing the Society for Adolescent Health and Medicine, told the committee that this is the first policy in her 21 years as a liaison that “actually puts children in this country at higher risk rather than lower risk of disease and death.”
The recommendation, supported by a committee that was largely replaced by vaccine skeptics under the current Republican administration, comes amid widespread misinformation about vaccines.
While many people in the U.S. don’t think of hepatitis B as a common problem, experts stress the reason the disease isn’t common in the U.S. anymore is because vaccine campaigns have been so successful.
“Once we take our foot off the pedal, we are likely to see an increase in these infections,” Maniar said.
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