On Friday, the federal Advisory Committee on Immunization Practice, or ACIP, voted to change the recommendation that all babies receive a hepatitis B vaccine within their first 24 hours of life.
Hepatitis B is an incurable infection spread by bodily fluids, which attacks the liver and can lead to cirrhosis and cancer.
“Hepatitis B is a disease that can cause severe infection if you get it as an adult and a smaller percentage of patients who get an adult infection go on to have cirrhosis," says University at Buffalo Associate Pediatrics Professor and Oishei Children’s Hospital’s Chief of Pediatric Infectious Disease Dr. Mark Hicar.
Dr. Hicar says the real danger is if you get hepatitis B as a baby.
“Why we vaccinate infants is that a very large percentage of infants, if they get infected, will go on to have cirrhosis and a good number of those infants will eventually have hepatocellular carcinoma," said Dr. Hicar. "So it can lead to cancer and can lead to bad liver disease in about a quarter of children who are infected within that first few weeks of life.”
A new report from the Vaccine Integrity Project shows that about 90% of newborns infected perinatally, which is a vulnerable period after the baby is born, will develop a chronic hepatitis B infection, and 25% of those children with a chronic infection die prematurely.
However, after Friday’s vote, if approved by the CDC, only babies born to hepatitis B positive people will be recommended to receive the vaccine. Babies can still get hepatitis B from exposure to bodily fluids from people other than the person who birthed them. Dr. Hicar says there isn’t science to back the change.
“There doesn't really seem to be any indication to do that [change the recommendation] at all, and it's going to negatively affect outcomes," said Dr. Hicar.
That Vaccine Integrity Project report also showed that hepatitis B infections in kids have dropped by 99 percent since 1991, when the ACIP first recommended the vaccine be given soon after birth for all babies.
“So, we're going to see more cases of [hepatitis B] because of this [change]. And I don't see any new data in the last 30 years we've been doing this to suggest that the hepatitis B vaccination within the first day of life is unsafe compared to vaccinating at any other point in their life," said Dr. Hicar.
If the recommendation is finalized, pregnant people who test negative for hepatitis B, or who do not know their status, will have to consult with a doctor to get their baby vaccinated. Dr. Hicar said he hopes there are few people weighing if they should vaccinate.
“Just listen to your physicians. Listen to your pediatricians," said Dr. Hicar. "Many pediatricians allow you to check in with them before the infant is born to establish care in their practice and discuss with them their thoughts, if you have any concerns."
Dr. Hicar said that personally, even though his wife knew she wasn’t positive for hepatitis B, they still vaccinated their kids.
“I thought it was a no brainer," Dr. Hicar said.
In a statement, the American Academy of Pediatrics President Dr. Susan J. Kressly said the recommendation downgrade is a “dangerous move that will harm children” and the “American Academy of Pediatrics continues to recommend routine hepatitis B vaccination for all newborns: All babies should receive a first dose of the hepatitis B vaccine within 24 hours of birth, a second dose at one to two months, and a third dose at six months. The pacing of these doses has been rigorously tested and proven to be safe and effective over several decades.”
Additionally, in a press release, the New York State Department of Health said the federal changes do not impact state-level guidelines or requirements in New York, including:
"Newborn Care:
New York continues to recommend a birth dose within 24 hours for all newborns, and a birth dose and within 12 hours for infants born to a birthing parent who tests positive or whose hepatitis B status is unknown.
Completion of the Vaccine Series: All children should complete the full hepatitis B vaccine series by 18 months of age, or earlier when clinically indicated.
School Immunization Requirements:
Students must show proof of immunity to hepatitis B to attend school in New York State. The Department emphasizes that completing the full vaccine series is the most reliable and effective way to provide long-term protection. However, proof of vaccination or a positive blood test for hepatitis B surface antibody are both acceptable for school entry."
