Changes to Hepatitis B Vaccination Recommendations for Newborns Spark Controversy
In a controversial move, the Advisory Committee on Immunization Practices (ACIP) has voted 8-3 to change its long-standing recommendation for universal hepatitis B vaccination at birth. The committee now recommends that only newborns whose mothers test positive for the virus receive the vaccine immediately after birth. For babies born to mothers who test negative during pregnancy, the committee suggests waiting until the two-month mark for the first dose – a significant policy shift made without new scientific evidence to support it.
The decision has triggered alarm among medical professionals, with pediatric infectious disease specialist Cody Meissner, who voted against the change, stating: “We’ve heard ‘do no harm’ is a moral imperative. With the altered recommendation, we are doing harm.” His concern was echoed by Dr. Jason Goldman, ACIP liaison for the American College of Physicians, who warned that the change “will only endanger children.”
The vote came during a contentious two-day meeting where some committee members – recently appointed by Health and Human Services Secretary Robert F. Kennedy Jr., known for his anti-vaccine stance – attempted to question the vaccine’s safety despite overwhelming evidence to the contrary. Just before the meeting, the University of Minnesota’s Vaccine Integrity Project released a comprehensive review of 40 years of research, encompassing more than 400 studies, which reaffirmed both the dangers of hepatitis B infection in newborns and the safety and efficacy of the birth dose.
Dr. José Romero, former ACIP chair and member of the American Academy of Pediatrics’ Committee on Infectious Diseases, emphasized the scientific consensus: “Hepatitis B remains a real and serious risk to infants. The hepatitis B vaccine is one of the most important tools we have for protecting newborns.” The stakes are particularly high because infants face the greatest risk from hepatitis B infection – about 90 percent of infected newborns develop chronic hepatitis B, an incurable condition that damages the liver and increases cancer risk. One in four children with chronic infection will die prematurely from complications.
The universal birth dose has been crucial in protecting American children, especially given gaps in the healthcare system. While pregnant women are routinely screened for hepatitis B, up to 18 percent don’t receive this test, and around 2 percent get no prenatal care at all. Moreover, infection can occur between testing and delivery, tests can yield false negatives, and newborns can be infected by other household members or caregivers – approximately half of the estimated 2 million Americans with hepatitis B are unaware of their infection status. The virus is highly contagious and can survive on surfaces for more than a week.
The success of universal vaccination has been remarkable. Since its implementation in 1991, with refinements in 2005 (recommending vaccination before hospital discharge) and 2018 (specifying within 24 hours of birth), cases of hepatitis B in infants and young children have plummeted by 99 percent – from approximately 16,000 in the early 1990s to fewer than 20 perinatal infections annually in recent years. Dr. Su Wang, who has chronic hepatitis B herself and treats patients with the disease, shared her personal experience at the meeting, explaining how she likely contracted the virus from a grandparent as an infant and didn’t learn of her condition until college. As Dr. Wang aptly summarized, “With hepatitis B, we cannot predict the child’s future risk,” highlighting why universal protection has been so effective in preventing this serious disease.
