Hepatitis B Vaccine Delay Leaves Parents Confused

For many years, Dr. Dean Blumberg, chief of pediatric infectious diseases at the University of California, Davis, said the Centers for Disease Control and Prevention has been the “voice of reason for vaccine information.” But last week’s move, when the Advisory Committee for Immunization Practices (ACIP) voted to delay the timing of the first dose of the hepatitis B vaccine for all infants, was another reminder that this is no longer the case.

“We can’t trust them anymore since ACIP was gutted of vaccine experts and replaced with people with little or no knowledge or experience with vaccine science, immunology or public health,” Blumberg told Salon. “It’s a challenging time with prominent voices fabricating distortions about vaccines.”

Since 1991, ACIP has recommended a hepatitis B vaccine for all infants. The recommendation has led to a 99% decrease in severe infections between 1990 and 2019. But with the recent change, the organization now recommends administering the first dose of the hepatitis B vaccine 30 days after birth to all children whose mothers have tested negative for the disease, rather than administering it within the first 24 hours of life. The committee that voted in favor of the delay is composed of members hand-picked by Health and Human Services Secretary Robert F. Kennedy, Jr., a long-time opponent of vaccines who fired all of the panel’s former members over the summer.

“I’m sorry to see this recommendation go forward; there is no evidence to support this change,” Blumberg said. “The hepatitis B vaccine is safe. We have been using it for decades, and there are no new safety concerns.”

The universal infant hepatitis B vaccine program has been “extraordinarily successful,” he added. “It’s foolish to step back from it.”

Blumberg’s concerns have been widely echoed throughout the medical and public health community. After the vote, public health officials gathered for a press conference. Chrissie Juliano, executive director of the Big Cities Health Coalition, emphasized that ACIP policy recommendations must be affirmed by the CDC Director. In response, they are calling on the CDC’s acting director Jim O’Neill to reject the recommendation.

“The science hasn’t changed — the people on the committee interpreting it has,” Juliano said. “All of our best studies and decades of experience point to continuing to vaccinate all newborns to protect them against hep B.”

Juliano also emphasized that pediatricians, parents, public health experts, and health insurance companies “still have a great deal of decision-making power” despite ACIP’s recommendation.

Hepatitis B is a viral infection that attacks the liver and can lead to both acute and chronic illness. It can cause cirrhosis, a chronic liver condition, liver failure, liver cancer, and in severe cases, death. Infections can be asymptomatic for years.

The virus is transmitted through bodily fluids, such as vaginal fluids and blood. The CDC estimates 640,000 adults have a chronic infection, but about half of them do not know they are infected and contagious. While pregnant people are routinely tested during the first trimester in the U.S., even if the mother is negative, the newborn can come into contact with others who might be infected, as the virus can live on surfaces for up to a week. In the 1980s, doctors only vaccinated high-risk individuals, and they did not see a significant decline in cases.

Dr. Lisa Costello, a pediatrician and associate professor of general pediatrics at the West Virginia University School of Medicine, who also cares for newborns, said the birth dose is very important.

“It provides vital protection at delivery and in the days and weeks after birth, when infants may be exposed to caregivers with unrecognized infection,” Costello said. “In the state in which I live and work, West Virginia, we have some of the highest cases of chronic hepatitis B in the country, and the majority of those cases are among those who are unvaccinated.”

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After completing the full hepatitis B vaccination series, 98 percent of healthy infants will have long-term immunity, Costello said.

“By eliminating or delaying the birth dose, we’re placing infants at preventable risk,” Costello said. “Without timely immunizations, some children will become infected, and unfortunately, some will die.”

Blumberg agreed.

“Yes, certainly this will lead to more infants being infected with hepatitis B, more chronically infected children, and more dying as a consequence,” Blumberg said. “Models suggest that this will result in an additional 1,400 infants infected every year in the US, and an additional 480 deaths due to these infections.”

Vaccines are usually covered by health insurance. For uninsured children, the CDC’s Vaccines for Children (VFC) program provides vaccines at no cost to eligible children through providers enrolled in the program. L. J. Tan, chief policy and partnerships officer at Immunize.org, told Salon that the VFC will still cover the hepatitis B vaccine despite the new recommendation. Private insurance plans said they will continue to cover the birth dose of hepatitis B vaccines for now.

Dr. Manisha Juthani, commissioner of the Connecticut Department of Public Health and an infectious diseases physician, said that the recommendation does not “inhibit” abilities for states to order the vaccine, or the ability of pediatricians to administer it and for insurance companies to cover it right now. But it does create “a lot of confusion on the part of parents.”

Juthani gave an example. Since false statements have been made about vaccines and autism, she is hearing anecdotally that many parents of children with autism are starting to “question and wonder” if they made the right decision to vaccinate their children.

“This type of confusion ends up changing the way people behave,” Juthani said.

Dr. Michelle Taylor, Commissioner of the Baltimore City Health Department, said this past weekend she encountered firsthand the confusion parents are experiencing when a pregnant woman approached her recently with questions about vaccine safety.

“She said, ‘listen, I want the ability to ask questions and receive information without judgment,’” Taylor said. “And I told her, ‘I appreciate you telling me that, I’m going to share it with every single person that I can, and I’m so glad that you came to me to talk to me about what it is that you’re hearing, and what’s true and what’s not true.’”

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