A key Centers for Disease Control and Prevention panel voted Friday to reverse its longstanding recommendation that all newborns should be vaccinated for hepatitis B, a viral infection affecting more than 100,000 people in the Bay Area that’s often deadly.
The decision was met with a tidal wave of criticism from medical associations and experts concerned that it would spur more vaccine-preventable infections in children, and eventually, premature deaths. But Californians may be spared the major impacts of the decision.
The California Department of Public Health has already recommended that every newborn receive a dose of the hepatitis B vaccine, in line with the American Academy of Pediatrics’ guidance. A new state law requires that health insurers cover the cost.
Here’s what we know about the virus, the vaccine for newborns and the impact on the Bay Area, which has high rates of hepatitis B.What is hepatitis B?
Hepatitis B is a viral infection that’s preventable with vaccination. It is the top cause of liver cancer in the world – a cancer with a 20% survival rate over five years.
Globally, most people are infected with the virus as infants because they are not vaccinated, and their mother passes the virus, said Samuel So, a Stanford School of Medicine professor and surgeon whose specialty is managing chronic hepatitis B infections and the treatment of liver cancer . In adults, the virus can also spread during sex and drug use with syringes.
A chronic case of the virus brings a dangerous risk of liver issues, including cirrhosis and liver cancer. Symptoms might not present until it’s too late for effective treatment. It’s a “silent killer,” according to Stanford Medicine’s Asian Liver Center, which raises awareness about the infection that disproportionately affects Asian Americans, in one of the worst health disparities in the nation.
How effective is the hepatitis B vaccine?
A vaccine for hepatitis B has been available in the U.S. since the 1980s. According to the CDC, which is the top public health authority in the nation, the vaccine is safe and effective in preventing hepatitis B infection in 98% of healthy infants.
From 1991 until this week, the CDC’s Advisory Committee on Immunization Practices recommended three doses of the vaccine for all babies: the first quickly after birth, and then two within the next year and a half.
Since then, cases of children infected with hepatitis B dropped more than 95%, with 6 million infections prevented, Angela Ulrich, an infectious disease epidemiologist at the University of Minnesota who studies the vaccine, told reporters Thursday.
How high is the risk of infection in the Bay Area?
The Bay Area is a hotspot of hepatitis B.
More than 100,000 people in the Bay Area have the virus, a 2018 study found. Asian American and Pacific Islander residents are disproportionately affected — often, because they’re immigrants who came to California from another country where they were not vaccinated, said So, the Stanford liver surgeon.
In Santa Clara County, nearly 95% of people with hepatitis B are Asian American or Pacific Islander, according to the study by researchers at Stanford University.
However, new cases in kids are very rare, because almost every school-age child in the county is vaccinated against the virus, said Supervisor Betty Duong.
What did the CDC do on Friday?
The CDC’s Advisory Committee on Immunization Practices reversed the panel’s recommendation for 34 years that all newborn babies should get a dose of the hepatitis B vaccine. It now recommends the shot only for babies with mothers who are infected with the virus, or when the mother’s status is unclear.
The advisory committee is designed to be a panel of experts who meet several times a year to evaluate new evidence about the safety and effectiveness of vaccines. Then, the panel makes recommendations about who should get which shots and when. The CDC director typically follows the recommendation, but it’s not legally binding.
Why did the panel reverse the child vaccine recommendation?
U.S. Health Secretary Robert F. Kennedy Jr., a skeptic of vaccines, replaced the panel’s members earlier this year, and some of his picks are skeptical of vaccine safety and stalwarts of the anti-vaccine movement in the U.S.
The panel’s members said hepatitis B is a rare infection and that vaccine resources should be directed toward children at high risk. Some were skeptical that the vaccine was safe.
Kennedy himself has linked the hepatitis B vaccine to autism, without evidence.
How did medical experts and doctors’ associations react?
Experts implored the committee not to rescind the recommendation and condemned it after the vote Friday.
The American Academy of Pediatrics, Hepatitis B Foundation, Vaccine Integrity Project and 40 other leading medical associations slammed the panel.
“The apparent goal of this meeting was to sow doubt in vaccines rather than advance sound vaccine policy, and we will all pay a price for that,” the groups said in a statement. “The evidence remains clear: the hepatitis B birth dose is safe and an essential component in helping children develop immunity against a serious, potentially lifelong disease.”
So, of Stanford, said “there’s no scientific rationale for withholding the vaccine for newborns.”
Ulrich, of the University of Minnesota, said delaying the birth dose will raise the risk of infection “during that very critical period.” She said 90% of those infants who are infected will develop a chronic case of the virus. Of those, a quarter will die prematurely from liver scarring or cancer, she said.
Will parents in the Bay Area still be able to get a dose of the hepatitis B vaccine for their newborns?
Yes. The new CDC recommendation means that most parents will have the choice to vaccinate their newborn against hepatitis B.
“If your doctors are not asking you if you want it for your child, please, please, ask them to vaccinate your child,” said Rochelle Walensky, who led the CDC from 2021 to 2023.
However, a new state law gave the California Department of Public Health the power to issue its own vaccine recommendations. The department recommends a birth dose of the vaccine.
