Panel suggests CDC stop routine hepatitis B vaccinations for newborns

The Advisory Committee on Immunization Practices (ACIP), a group of medical professionals and public health experts that guides vaccine use in the U.S., voted 8-3 on Friday to change the longstanding policy of giving the hepatitis B vaccine to all newborns. Instead, the panel recommended that pregnant women be screened for hepatitis B, and only infants born to infected mothers receive the vaccine along with antibodies to help protect against the virus.

For mothers without hepatitis B, the committee suggested discussing vaccination with a healthcare provider to assess potential benefits and risks. Vicky Pebsworth, a committee member and director of research at the National Vaccine Information Center, explained that newborns face "extremely low risk of hepatitis infection during childhood, particularly in the first month of life," and therefore routine vaccination may not be necessary.

Current Hepatitis B Guidance

Previously, the CDC recommended a three-dose hepatitis B series for everyone, with the first dose typically given at birth. While ACIP recommendations are not legally binding, CDC policies have historically aligned with the panels guidance. Many U.S. states require the vaccine for public school attendance.

Before the vote, health experts and medical groups stressed the importance of early vaccination, citing the risk of chronic liver disease in infants infected with hepatitis B. Teresa Lovins, a family physician in Indiana, noted that vaccinating at birth ensures protection even if postnatal visits are missed.

Understanding Hepatitis B

Hepatitis B is a viral infection that can lead to liver cancer, liver failure, and death. It spreads through bodily fluids, including sexual contact, from mother to child during birth, and via contaminated needles. Most infected individuals show no symptoms, though some may experience fever, fatigue, joint pain, or nausea. The infection can be acute, lasting a short time, or chronic, potentially persisting for life.

Globally, around 254 million people lived with chronic hepatitis B in 2022, and over 1 million deaths were reported. In the U.S., the CDC estimates 640,000 adults have chronic hepatitis B, with nearly half of acute cases in 2023 occurring in adults aged 40-59. The disease is more prevalent among non-Hispanic Asian and Pacific Islander populations.

The FDA has approved three hepatitis B vaccines and three combination shots that include protection against hepatitis B alongside other diseases such as diphtheria, tetanus, pertussis, and polio.

Concerns About the Decision

Some ACIP members expressed that the decision was made with incomplete data. Joseph Hibbeln, a committee member and neuroscientist, stated, "We have to make decisions with the data that we have, and we must use only credible evidence, not speculation."

Others warned that reducing newborn vaccination could increase infection rates. Cody Meissner, a pediatric infectious disease expert, emphasized the vaccines established safety and effectiveness. Independent physicians echoed these concerns, arguing that the policy change could put children at risk.

Policy and Leadership Context

Earlier this year, Health and Human Services Secretary Robert F. Kennedy Jr. replaced all 17 ACIP members. The reconstituted panel has already made changes to the childhood immunization schedule, including revising the recommended timing for the MMR vaccine. Kennedy has questioned the necessity of routine hepatitis B vaccination for newborns, arguing that the virus is not highly contagious in general populations but is more common among intravenous drug users. Experts note, however, that infants infected at birth are far more likely than adults to develop chronic hepatitis B.

The CDC estimates that without vaccination, approximately 90% of infants infected with hepatitis B develop chronic infections, with 25% facing premature death from complications. Currently, an estimated 25,000 infants are born to hepatitis B-positive mothers annually, with around 1,000 becoming infected.

Historical Impact of Hepatitis B Vaccination

ACIP first recommended hepatitis B vaccination for infants in 1991. By 2000, 90% of children were vaccinated, leading to a 99% decline in hepatitis B rates among adolescents by 2019.

Author: Sophia Brooks