CDC Panel Weighs Ending Universal Hepatitis B Birth Dose for Newborns

In Atlanta this Thursday and Friday, the CDC's Advisory Committee on Immunization Practices sits down to reconsider a piece of guidance that has stood for decades: that every newborn in the United States should receive a hepatitis B vaccine shortly after birth. A vote to roll that recommendation back could come on Thursday.

The committee is expected to weigh a return to a case-by-case approach. Under it, the birth dose would be aimed only at babies whose mothers are proven to already have the disease, rather than offered to all infants.

The virus is usually passed from mother to baby during birth. A vaccine given right afterward generally gets ahead of the infection, and the later series of childhood shots locks in the protection. The stakes are high: hepatitis B eventually kills about one in four people who were infected as newborns. That is part of what surprises people about a disease commonly thought of as sexually transmitted.

Dr. Robert Wiskind, an Atlanta pediatrician and past president of the Georgia Chapter of the American Academy of Pediatrics, calls the possible change a mistake. The vaccine was developed within his lifetime, and the universal birth dose arrived two years after he got his Georgia medical license. He says he cannot recall treating an infected child in his practice. "It's worked fantastically," he said, adding that the earlier targeted approach worked somewhat but missed people.

The administration is on the other side. President Donald Trump said in September that there is no reason to give a nearly newborn baby the vaccine, and suggested waiting until the child is 12. Dr. Marty Makary, the surgeon who heads the FDA under Health and Human Services Secretary Robert F. Kennedy Jr., said in a Fox News interview that he personally doesn't think the evidence for the universal birth shot is solid. He framed it as an effort to prevent a sexually transmitted infection, noting that kids are not sexually active until they reach sexual age.

Mainstream pediatric scientists dispute that framing. The University of Minnesota's Vaccine Integrity Project recently posted that more than 17,000 infants are born each year to women with the virus, yet 18 percent of pregnant women do not get tested for hepatitis B. Only 35 percent of women who test positive receive all the recommended follow-up care. Delaying the first dose, the project wrote, leaves infants exposed both to undiagnosed maternal infection and to exposure after birth.

The project also points out that babysitters can pass the virus to babies through cuts or contact with mucous membranes, and that half of infected adults do not know they have it. Its researchers reviewed more than 400 studies and found the vaccines safe, with side effects limited to a brief fever and redness where the shot is given.

The effects would reach Georgia, which records about 126,000 births a year. Insurance coverage for the shots may depend on what the federal committee and the state recommend. A spokeswoman for the Georgia Department of Public Health said it is too early to judge the implications until the committee settles on language and votes.

Wiskind says harm is already happening, with parents hesitating over the birth dose. "This is already making a pediatrician's job harder," he said. Delaying the vaccine by a month may not sound like much, he said, but it will lead to children getting hepatitis B unnecessarily and facing long-term complications. The exact wording of any vote will determine what changes for insurers and for Georgia families.