The CDC’s Advisory Committee on Immunization Practices voted 8-3 in favor of limiting national recommendations on which infants should receive a hepatitis B vaccine at birth.
The panel voted Dec. 5 to exclusively recommend the first hepatitis B shot to infants born to mothers who are HBsAg-positive or have an unknown status. ACIP voted down recommending the first vaccine in a three-dose series to infants born to mothers who test HBsAg-negative.
The recommendation moves to revoke a stance the CDC has held since 1991, which is to vaccinate all healthy newborns against hepatitis B before hospital discharge, regardless of whether the mother tests positive or negative for the virus.
Hepatitis B “is a vaccine-preventable liver infection,” according to the CDC. The infection can range from a mild, weekslong illness to a serious, chronic illness, which can cause liver damage, cirrhosis, liver cancer and even death. Many individuals infected with hepatitis B will not experience symptoms, according to the agency.
ACIP also voted 6-4, with one abstention, to recommend parents consult with clinicians to determine whether to administer post-vaccination serology testing when assessing the need for a subsequent vaccine dose.
The CDC currently advises a hepatitis B vaccine within 24 hours of birth among infants who weigh at least 4.4 pounds and are medically stable, or the first dose at hospital discharge or when the infant is 1 month old, whichever is first.
A second dose is recommended for infants between 1 and 2 months old, and a third dose between 6 and 15 months old.
For infants who do not receive a hepatitis B vaccine at birth, ACIP recommended they receive the first dose before turning 2 months old.
The CDC does not have to adopt ACIP’s consensus but usually does.
ACIP planned to conduct this vote at its last meeting, but confusion and disagreement about the wording of the vote’s question led to its postponement. The committee then scheduled the vote for Dec. 4 during a two-day meeting but delayed again for the same reason.
A Dec. 2 report from the Vaccine Integrity Project, recently created by Minneapolis-based University of Minnesota’s Center for Infectious Disease Research and Policy, said pediatric HBV incidence has declined by 99% since 1991.
Another study, published Dec. 3 in JAMA, estimates the public health burden if the CDC adopts the ACIP’s recommendation.
“Eliminating the birth dose for infants of HBsAg-negative mothers … would raise the number of cases to 674, an 8% increase,” according to the study. “Restricting the birth dose only to infants born to HBsAg-positive mothers would raise perinatal HBV cases to 1,101 — an additional 63%, or a 76% increase from current [cases].”
The American Medical Association said ACIP’s decision “is reckless and undermines decades of public confidence in a proven, lifesaving vaccine.” The AMA called for the CDC to reject the recommendation to delay the hepatitis B birth dose.
Several other national healthcare groups, including the American Nurses Association, the American Association of Immunologists and the American Academy of Pediatrics, also condemned ACIP’s recommendations.
