Infectious disease pediatrician Sharon Nachman, MD, talks about how the new recommendations will defer immunization, leading to a whole host of issues and negative impacts on long-term public health.
Last week, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) had a 2-day meeting to discuss the birth dose of the hepatitis B vaccine.
Prior to the meeting, the previous universal hepatitis B vaccine recommendation was for all neonates to be given their first dose of the hepatitis B vaccine within 12 to 24 hours of their birth. This public health policy, which has been in existence for decades, has led to a significant reduction in disease. Between 1991 and 2019, HBV infection among children and adolescents dropped 99%, preventing tens of thousands of cases of cirrhosis, liver cancer, and death.1
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"For infants born to HBsAg [HB surface antigen]-negative women: ACIP recommends individual-based decision making, in consultation with a health care provider, for parents deciding when or if to give the HBV vaccine, including the birth dose. Parents and health care providers should consider vaccine benefits, vaccine risks, and infection risks. For those not receiving the HBV birth dose, it is suggested that the initial dose is administered no earlier than 2 months of age."
“I think the change in timing of the hepatitis B vaccine to infants is going to result in many more children getting infected with hepatitis B at birth,” said Sharon Nachman, MD, chief of pediatric infectious diseases, Stony Brook Children's Hospital.
In thinking about families, Nachman says the message from CDC’s ACIP is deferment of HBV vaccines.
“That message of deferment tells families you don't need it now; I don't know that you need it later; and I don't know when you need it,” she said. “So we are going to see children who do not get the birth dose, whose mothers are truly not infected with hepatitis B, so their risk at birth of acquiring it is zero, or close to zero. But, if they don't get the vaccine at 2 months, or at 2 years or some other time, they're going to grow up to be adolescents and adults with no memory that they've never gotten this vaccine. They're going on to have behaviors that may include some risk, and they're going to acquire this infection—which is silent at an age when they're quite vulnerable—and get chronic active Hepatitis B, a disease that we could have easily prevented.”
She points to the fact this new HBV vaccine recommendation will have long-term consequences that may take a generation to fully realize.
“We will be missing the identification of those infections, missing prevention, and unfortunately, those children are programmed now to go on to get chronic hepatitis, cirrhosis, and perhaps liver cancers and die, and that will take 20 plus years,” Nachman said. “We will not see a change in children's health over the next 5 to 10 years, and that means 20 plus years from now, when that cohort of children starts getting sick, we're never going to remember who caused this damage, because it's going to be lost into the annals of history."
And with history, she points to the past around other childhood immunizations, prior to their development, and the impact the vaccines have made to greatly reduce disease.
"I am of the age when many of the vaccines that we use at 2,4,6 months in infancy were not available. So I saw all the deaths from pneumococcal disease, from HIB disease [Haemophilus influenzae type b], from pertussis, not having those vaccines all given together at 2 months, spacing them out or deferring them means that's the exact age children will now start dying,” Nachman said.
“In the 1980s, we tracked how many kids died of HIB, how many kids died of pneumococcal disease, and in 1990, when we started vaccinating with Prevnar [pneumococcal immunization], we saw the rate of death plummet to almost none.”
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