A vote by a Trump administration advisory panel to eliminate decades-old guidelines recommending the routine vaccination of newborns for hepatitis B could release a new wave of chronic infections, say local experts in disease management.
In the series “Hepatitis B: A Silent Killer,” The San Francisco Public Press detailed how, in the early 2000s, the Bay Area Asian and Pacific Islander communities saw a wave of late-stage liver failure and cancer in people in their 30s after unknowingly having been exposed as infants.
See our July episode of “Civic,” which follows San Francisco advocates working to improve hepatitis B education and outreach.
On Dec. 5, the Advisory Committee on Immunization Practices reversed the recommendation that all newborns receive the vaccine, a policy set by the same body in 1991.
The proposal makes an exception only for mothers who have tested positive for Hepatitis B or whose status is unknown. If determined to be negative, a parent would have to consult with a doctor to determine “when or if” the child should be inoculated, and then only after what is now the standard second booster shot at 2 months of age.
The Centers for Disease Control and Prevention is all but certain to agree to the recommendations. U.S. Secretary of Health Robert F. Kennedy Jr. this year dismissed the entire 17-member committee, and most replacement members were people who have long promoted anti-vaccination policies despite their lack of scientific backing and the consensus in the medical community that vaccines are generally safe and save lives.
Community reaction
Richard So, executive director of Hep B Free, a San Francisco-based nonprofit organization promoting medical research and health programs, said the decision was “outrageous and not based on decades of scientific evidence to the safety and effectiveness of the vaccine.”
The CDC’s own statistics show that 80% of U.S. newborns receive the vaccination, and 92% get all three shots by 19 months. By removing the recommendation for medical providers, the new guidelines would be expected to dramatically reduce those numbers, leaving many children exposed to the virus. Childhood vaccinations have dramatically reduced new infections. Patient advocates call hepatitis B a “silent killer” because, in the U.S., seven in 10 of those with chronic infection are unaware of their condition.
While mother-to-child transmission at birth is the most common infection route in newborns, it is by no means the only one.
Hepatitis B is 50 times more infectious than HIV, and while it is often transmitted sexually, it can also infect a child through contact with the blood of infected people, contaminated razors, toothbrushes and other shared items.
Eliminating childhood vaccinations is especially confounding to advocates because it sidesteps some morality focused parental arguments against children getting vaccines. Sexually transmitted viruses such as human papilloma virus can be prevented with early vaccination, but some parents oppose the shots because they believe it might encourage their children to become sexually active.
The greatest danger for anyone getting a chronic hepatitis B infection is in early childhood, when the rate is as high as 90%. Only 5% of adult exposures become chronic.
Hep B Free’s So said activists and healthcare providers will face new challenges as federal recommendations become more confusing. “Now public health and health providers must scramble to try to ensure infants are protected,” So said, “all the while fighting renewed vaccine fears and skepticism.”
Regional health mobilization
In September, California joined Hawaii, Oregon and Washington to create the West Coast Health Alliance in anticipation of changes to childhood vaccination guidelines as the Advisory Committee on Immunization Practices began to take up the matter.
“Committee members did not employ standard scientific methods to evaluate information presented to them,” said a statement from the California Department of Public Health.
The new alliance affirms prior government recommendations, which align with the views of the American Academy of Pediatrics. “Restoring a process for systematically reviewing the evidence and a framework for translating the evidence into recommendations will restore scientific rigor and transparency and maintain vaccine choice for all families,” said the health department’s statement.