The U.S. government long advised that all babies be immunized against hepatitis B right after birth, but a federal vaccine advisory committee votedΒ Dec. 5 to do away with that recommendation.
U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. speaksΒ Nov. 20 during the Western Governors' Association meeting in Scottsdale, Ariz.
Health Secretary Robert F. Kennedy Jr.,Β a leading anti-vaccine activist before becoming the nation's top health official,Β fired all 17 members of the panel this year and replaced them with a group that includes several anti-vaccine voices.Β
The panel recommended a dose at birth only for babies whose mothers test positive for the virus or whose infection status is unknown. For other babies, it will be up to the parents and their doctors to decide. The committee voted to suggest that when a family decides not to get a newborn dose, the shots should begin when the child is 2 months old.
Committee members raised concerns about giving a vaccine to a baby so early in life and worried that doctors and nurses don't have full conversations with parents about the pros and cons.
Medical and public health leaders decried the group's decision, saying the hepatitis B vaccine prevents thousands of illnesses.
The committee "just condemned hundreds of children to a shorter life," said Dr. Paul Offit, a Children's Hospital of Philadelphia vaccine researcher and former government adviser.
Effects can last
Hepatitis B is a serious liver infection that for most people lasts less than six months. But for some β especially infants and children β it can become a long-lasting problem that can lead to liver failure, cancer and scarring called cirrhosis.
In adults, the virus spreads through sex or sharing needles for drug injection.
It also can be passed from an infected mother to a baby. Offit said babies alsoΒ can get it from relatively casual contact with someone who has chronic disease, such as touching a towel or toothbrush, because the virus can live on surfaces for more than seven days at room temperature. Up to 90% of infants who contract hepatitis B go on to have chronic infections, meaning their immune systems don't completely clear the virus.
About 2.4 million people in the U.S. are estimated to have hepatitis B, and as many as half are unaware they are infected, according to the Centers for Disease Control and Prevention.
Shots urged for years
For decades, the nation's vaccine guidance was influenced by a government-appointed panel of experts, the Advisory Committee on Immunization Practices. Its recommendations usually were adopted as national guidance that is widely heeded by doctors.
In 1991, the committee recommended an initial dose of hepatitis B vaccine at birth. The guidance was modified over the years and currently suggests a dose within 24 hours of birth for all medically stable infants who weigh at least 4.4 pounds, plus follow-up shots to be given at about 1 month and 6 months.
Health officials used to rely on screening expectant mothers to find babies that might have been exposed to the virus. But many cases were missed, experts say, partly because some women weren't tested or test results were incorrect.
Newborn hepatitis B vaccinations are considered to be a public health success story. Over about 30 years, cases among children fell from about 18,000 per year to about 2,200.
The Vaccine Integrity Project released its analysis of more than 400 studies and reports spanning 40 years. The group of researchers concluded the newborn dose is safe and an important reason U.S. pediatric hepatitis B infections fell.
U.S. Health Secretary Robert F. Kennedy Jr.βs committee voted to recommend the birth dose of the hepatitis B vaccine only for babies whose mothers test positive. The shots are widely considered to be a public health success for preventing thousands of illnesses.
Potential effects
A recent report estimated that delaying the hepatitis B vaccine to 2 months could result in at least 1,400 hepatitis B infections in children and 480 deaths. The report β which has yet to be peer reviewed or published in a medical journal β estimated the toll would be higher if the first dose was given later.
The vaccine committee's most direct power comes over what is covered by the federal Vaccines for Children program, which pays for shots for uninsured children from low-income families. Hepatitis B shots often were bundled into the final hospital bill for childbirth. So the new ACIP recommendation likely would not be an economic obstacle for the current practice continuing at many hospitals, said Dr. Sean O'Leary of the pediatrics academy. But he said the change may confuse and frighten parents.
Some state and local officials said they don't plan to heed the panel's advice to delay vaccination.
TheΒ American Academy of Pediatrics said it will continue to recommend routine hepatitis B vaccination for all newborns, with babies receiving a first dose within 24 hours of birth, a second dose at one to two months and a third dose at six months.
The pediatrics group was among 45 organizations that sent out a statement saying they are "deeply alarmed" by the committee's actions.
