TARGETING SCIENCECDC Advisers Drop Decades-Old Universal Hepatitis B Birth Dose Recommendation, Suggest Blood Testing After One Dose
Scientists say that hepatitis B vaccine is safe and effective, and that dropping the decades-old practice of a universal dose at birth will have only one result: hepatitis B rates and resulting liver cancer, cirrhosis, and premature death will rise among the unvaccinated or undervaccinated—whether in infancy or later in life, when unprotected adults will be vulnerable to infection.
On Friday morning, after contentious discussion, the Advisory Committee on Immunization Practices (ACIP) voted 8-3 to drop the recommendation for a universal birth hepatitis B vaccine dose and 6-4 to suggest that parents use serologic testing—which detects antibodies in the blood—to determine whether more than one dose of the three-dose series are needed.
Under the first recommendation, only infants born to mothers who test positive for hepatitis B would receive a birth dose, while parents of other babies would be advised to postpone the first dose for at least two months.
ACIP makes vaccination recommendations to the Centers for Disease Control and Prevention (CDC), including those for different age-groups and disease risk status, as well as on US immunization schedules for children, adolescents, and adults. The CDC director has ultimate discretion whether to approve ACIP’s advice, and physicians can make their own decisions about whether to comply, but ACIP recommendations have historically affected insurance coverage of vaccines.
Lack of Evidence Supporting Decisions
The historic decisions came a day after the committee, installed by US Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., decided to postpone the vote following a contentious discussion filled with anti-vaccine rhetoric and racial innuendo. Kennedy has claimed, without evidence, that the hepatitis B vaccine causes autism.
Friday’s votes occurred despite some members urging another delay, heated exchanges during which members cited abundant evidence supporting the efficacy and safety of the current recommendations, a lack of evidence to support the changes, and an ad hoc two-minute rule for speaking that cut off some members before they could finish their statements.
The first part of the discussion, led by Robert Malone, MD, a vaccinologist at Louisiana State University, centered on the risks and benefits of the universal hepatitis B vaccine birth dose, which the CDC has recommended, regardless of the mother’s risk factors, since 1991.
The second, very brief, discussion segment focused on whether children need more than one hepatitis B vaccine dose and the proposed use of serologic testing to investigate whether vaccinees are protected against hepatitis B. A proposal touted a threshold of at least 10 milli-international units per milliliter (mlIU/mL) of antibody, which proponents said correlates to adequate protection against infection, despite a lack of evidence that it does.
