The US Centers for Disease Control and Prevention (CDC) on Tuesday ended a long-standing recommendation that all US newborns receive the hepatitis B vaccine.
The agency’s move follows a vote from health secretary Robert F Kennedy Jr.’s vaccine advisory panel that a birth dose should only be given to newborns whose mothers test positive for hepatitis B or whose status is unknown.
The CDC will now advise parents to consult a healthcare provider to decide whether infants born to hepatitis B-negative mothers should get the vaccine, including the birth dose.
“We are restoring the balance of informed consent to parents whose newborns face little risk of contracting hepatitis B,” acting director of the CDC and deputy health secretary Jim O’Neill said in a statement.
If parents choose not to vaccinate their newborn at birth, but feel vaccination is warranted, the agency now recommends that they wait at least two months to get the child a first dose of the vaccine.
The policy change marks an abrupt end to 30 years of established medical guidance. Since 1991, US health officials have recommended universal vaccination for infants against hepatitis B, with the first of three shots administered right after birth.
Experts have voiced concern around the policy change, which the CDC describes as “individual-based decision making”.
“This is going to lead to an increase in preventable infections among children,” Michaela Jackson, program director of prevention policy at the Hepatitis B Foundation, told the Guardian after the vaccine advisers’ vote earlier this month. She anticipates that “parents are not going to know who to trust any longer”.
Jackson also said that the policy change is “removing choice by causing barriers to access.” The agency’s recommendations affect US health insurance coverage and play a key role in assisting physicians who are choosing appropriate vaccines for patients.
Hepatitis B can lead to serious liver disease and is primarily spread through blood, semen, or certain other body fluids, and can also be spread by close contact with people who do not know they are infected.
Hepatitis B infections have fallen nearly 90% in the US from 9.6 per 100,000 individuals before vaccination became widespread in 1982 to about one per 100,000 in 2018.
Experts warn the new recommendation, which the CDC described as individual-based decision-making, could expose more children to the harmful virus and could lead to more families opting out of vaccination in the absence of a firm federal policy in place. Kennedy is a longtime anti-vaccine activist who has made far-reaching changes to the US vaccination policy.
Dr Emily Landon, an infectious diseases expert at the University of Chicago Medicine, said the CDC’s advisory panel’s job is to help clinicians interpret piles of science and help them make good decisions on how to care for their patients.
“This recommendation is ignoring the science. The fact that the acting director of the CDC would sign on to this just continues to reinforce that they are no longer committed to science-based recommendations for improving health,” Landon said.
