Cdc Vaccine Advisers Delay Hepatitis B Vote Amid Confusion

A panel of government vaccine advisers delayed a vote Thursday on whether to change guidance that everyone receive the hepatitis B vaccine on the day they’re born.

Members of the panel complained that they didn't have enough time to review what they were voting on. The panel now plans to take up the issue on Friday.

Last-minute changes to the hepatitis B vote language prompted the confusion. The shot protects against a virus that causes severe liver disease, but vaccine skeptics have long questioned giving it to everyone. Mothers can pass the virus to their babies, but the disease is mainly spread through sex and sharing needles. Leading medical experts emphasize that the shot is safe and serves as a safety net for infants.

When Robert Malone, the vice chair of the Advisory Committee on Immunization Practices, read the proposal to stop recommending the shot for children born to mothers who test negative for the virus, it was different from what the Centers for Disease Control and Prevention had posted to its website Wednesday — confusing several of the panel’s members. The vaccine advisers make recommendations to the CDC, which ultimately decides what goes on the nation’s vaccine schedule.

The proposal Malone read advises parents of children born to mothers who test negative for the virus to consult with their physician about whether their child should get the birth dose. It also says that those declining the birth dose should wait at least two months before starting the Hep B series, which typically consists of three shots administered by 18 months old.

The panel was planning to take a second vote advising that parents of children whose mother’s infection status is unknown should also have their child vaccinated.

The earlier version on the CDC website differed in that it said that parents of children whose mother’s infection status is unknown should make the decision in consultation with a doctor.

The latest proposals — if approved by CDC — would result in the government dropping its birth dose guidance for hepatitis B vaccination for children whose mother tested negative for the virus, but retaining it for those whose mother is positive or whose infection status is unknown.

ACIP has recommended that all infants get vaccinated against hepatitis B since 1991, updating the guidance in 2005 to recommend they do so at birth. The shift in recommendations coincided with a drastic reduction in hepatitis B cases, with incidence declining 98 percent from 1990 to 2006 in children under 15.

One of the vaccine advisers, Joseph Hibbeln, a psychiatrist and former acting chief of the Section of Nutritional Neurosciences at the National Institute on Alcohol Abuse and Alcoholism, compared the situation to "trying to evaluate a moving target."

“This is the third version of the questions that most of the ACIP members received in 72 hours," Hibbeln said. "We don't even have a slide explicitly describing what questions we're supposed to answer."

Seven members voted to delay the vote until Friday, while three voted to hold it Thursday.

The decision marks the second time the panel has delayed a vote on the hepatitis B birth dose, with the members tabling a vote on the same issue at the September meeting.

ACIP, which advises the CDC on changes to the immunization schedule, is composed of members selected by long-time vaccine skeptic and HHS Secretary Robert F. Kennedy Jr. after Kennedy fired the previous members in June.

Shakeups to the panel’s membership and leadership have resulted in chaotic meetings and delayed votes. In September, the panel had to redo a vote related to the Vaccines for Children program, which provides vaccines to underinsured or uninsured children, after members were confused about the implications of their original vote. The ACIP chair at that meeting, former Harvard biostatistician Martin Kulldorff, resigned earlier this week to take a job at the health department.