A significant shift in vaccine recommendations is on the horizon as the CDC’s Advisory Committee on Immunization Practices (ACIP) is expected to vote on a proposal to delay the hepatitis B vaccine for infants until the age of four. This decision, influenced by recent changes within the committee, has raised concerns among healthcare professionals about the potential impact on public health.
Robert F. Kennedy Jr., the Secretary of Health and Human Services, has recently appointed new members to the ACIP, which is responsible for advising on immunization practices in the United States. According to Demetre Daskalakis, a former director at the CDC, the current focus of the committee is to reconsider the timing of the hepatitis B vaccine, specifically aiming to remove the birth dose that has been standard for over three decades.
The upcoming vote is scheduled for September 18-19, 2023, during which the panel will also discuss recommendations for other vaccines, including the combined measles, mumps, rubella, and varicella vaccine, as well as updates on COVID-19 vaccines. Pediatricians, however, have expressed strong opposition to the proposed delay. Dr. Eric Ball, a pediatrician, emphasized that delaying the hepatitis B vaccination could lead to increased cases of the virus among children, stating, “Age 4 makes zero sense. We recommend a universal approach to prevent those cases where a test might be incorrect or a mother might have unknowingly contracted hepatitis.”
The hepatitis B vaccine is currently administered to newborns shortly after birth, which has contributed to a significant decline in cases among American children. Over the past three decades, the disease, which can lead to severe liver complications, has been virtually eradicated in this age group. The CDC estimates that approximately half of those infected with hepatitis B are unaware of their condition, making the vaccine crucial for prevention.
Historically, the recommendation for newborn vaccination arose in 1991, with health officials advocating for the first dose to be given within 24 hours of birth. This early vaccination helps prevent the transmission of the virus during delivery. The proposed change has raised alarms among individuals living with hepatitis B, including Wendy Lo, who has dealt with the disease since birth. She expressed her frustration, saying, “I would not want anyone to have to experience that if it can be prevented.”
The current recommendation for universal vaccination is backed by decades of research. The CDC reported that in 1990, there were approximately 3.03 cases of hepatitis B per 100,000 individuals aged 19 and under. By 2022, following the implementation of the birth dose, this rate had plummeted to less than 0.1 cases per 100,000. Healthcare professionals argue that delaying vaccination could reverse this progress, exposing a new generation to the virus.
The potential for changes in vaccination guidelines is complicated by the fact that, typically, a thorough analysis of data precedes any adjustment in ACIP recommendations. As of late August, this analysis had not yet begun for the hepatitis B vaccine, raising concerns about the process and transparency of the decision-making. Daskalakis noted, “This is an atypical situation. There’s been no work group to discuss it.”
Despite these concerns, HHS spokesperson Andrew Nixon stated that the ACIP is committed to ensuring that vaccine policy is guided by scientific evidence, emphasizing that any updates to recommendations will be made transparently.
The implications of a significant change in the vaccination schedule could extend beyond individual health. If the ACIP alters its recommendation, health insurers may not be required to cover the cost of the hepatitis B vaccine, potentially leaving families to pay out-of-pocket for a critical immunization that has long been provided at no charge.
As the ACIP prepares for its upcoming meeting, the voices of healthcare professionals and individuals affected by hepatitis B are becoming increasingly urgent. William Schaffner, a professor of infectious diseases, has raised concerns that relaxing vaccination protocols could lead to renewed transmission of the virus. “We’ll see cases of hepatitis B once again occur,” he warned, emphasizing the need for preventive measures.
The outcome of the ACIP’s vote could have lasting effects on public health strategies and the fight against hepatitis B. The stakes are high, and many are closely watching to see if the committee will uphold the decades-long standard of universal vaccination for newborns.
