The Trump administration is continuing its push to revise federal guidelines to delay the hepatitis B vaccine newborn dose for most children. This comes despite a failed attempt to do so at the most recent meeting of the Centers for Disease Control and Prevention鈥檚 Advisory Committee on Immunization Practices.
Both President Donald Trump and some newly appointed ACIP members have mischaracterized how the liver disease spreads, according to medical experts, including those working at the CDC. The ACIP panel鈥檚 recommendations can determine insurance coverage for immunizations.
At a White House press conference on Sept. 22, Trump, in advocating for delaying the newborn vaccine dose, falsely claimed that hepatitis B is solely a sexually transmitted infection.
鈥淗epatitis B is sexually transmitted. There鈥檚 no reason to give a baby that鈥檚 almost just born hepatitis B. So I would say wait till the baby is 12 years old and formed and take hepatitis B,鈥 Trump said.
Hepatitis B is a highly infectious virus that attacks the liver and is transmitted through contact with infected bodily fluids, including blood. It can also be passed from mother to baby.
A reporter asked if Trump had spoken with Health and Human Services Secretary Robert F. Kennedy Jr., who oversees the CDC, about making the change, and Trump said he had, as Kennedy looked on.
Although hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, , including career CDC scientists, note that the virus can be transmitted in ordinary situations too, including among young children.
At the latest ACIP meeting, held Sept. 18 and 19, members debated postponing the hepatitis B newborn dose until 1 month of age.
CDC scientist outlined research showing incidences of unvaccinated children born in the U.S. to mothers who tested negative, later becoming infected with hepatitis B. Langer serves as acting principal deputy director for the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention.
Langer told the vaccine advisory panel that the virus can survive for outside the body on surfaces. During that time, contact with even microscopic traces of infected blood on a is enough for a child to be infected. This means unvaccinated children not considered at high risk can still be exposed in everyday environments, or by an infected caregiver.
鈥淲e do have data that says that it can happen and that it is likely to happen,鈥 he said. Though the exact cause of infection may not be clear in documented cases of children of hepatitis B-negative mothers becoming infected, 鈥淚 can tell you that it didn鈥檛 come from the mother and it didn鈥檛 come from injection drug use and it didn鈥檛 come from sexual contact, so that means that it had to have been some kind of casual contact,鈥 Langer said.
Yet during the debate, some members gave little credence to the risk of transmission to children through household contact.
鈥淭his is a very, very important vaccine that should be given to the high-risk populations,鈥 said ACIP voting member , a professor of operations management at the MIT Sloan School of Management. 鈥淭he high-risk populations seem to be babies born to hep B-positive mothers, drug addicts, and other populations at high risk,鈥 he said, despite Langer鈥檚 presentation highlighting other avenues of possible transmission.
Contrary to research that was presented, Levi later said the risk of not vaccinating children of hepatitis B-negative mothers was 鈥減robably close to zero鈥 in the first few years of life.
The CDC estimates 2.4 million people in the U.S. have hepatitis B and half they are infected. The disease can range from an acute, mild infection to a chronic infection, often with . The disease has no cure and, if left untreated, can lead to serious conditions like cirrhosis, liver failure, and liver cancer later in life.
During debate on the vote to delay the newborn dose, ACIP member said that the proposed one-month gap would leave some children vulnerable to the virus, even if their mothers test negative for hepatitis B.
鈥淭his assumes implicitly that all the infections are coming from moms,鈥 Hibbeln said. 鈥淵ou can鈥檛 decide on that simply by the mother鈥檚 status. You would have to look at the entire household鈥檚 status.鈥
ACIP member Evelyn Griffin, an obstetrician and gynecologist, asserted that doctors could ascertain an entire household鈥檚 hepatitis B status by asking the mother.
鈥淗ow are they going to know?鈥 Hibbeln said. 鈥淚f 50% of people don鈥檛 know that they are hepatitis B-positive, you can ask all you want, and nobody knows.鈥
The committee members, all handpicked by Kennedy, ultimately decided to table the vote on whether to delay the newborn dose after Hibbeln brought up inconsistencies in the wording of the text of the resolution.
鈥淭he notion that hepatitis B is only confined to transmission for prostitutes, drug users, etc. is such an ignorant and uninformed way of approaching infectious disease,鈥 internist , the president of the American College of Physicians and its liaison to ACIP, said when reached after the meeting.
鈥淭he virus does not care what your behavior or lifestyle is. The virus goes from person to person through bodily fluids,鈥 Goldman said. It can be transmitted when an unvaccinated person touches infected bodily fluids on common surfaces and then accidentally touches the eyes or mouth. 鈥淲hat if someone was in a car accident and got exposed to blood?鈥
鈥淚t is not only mother-to-fetus transmission, it is not only certain risk groups,鈥 he said. 鈥淭his is why it’s universal; everyone should get this for their protection, and it is unfortunate that it is being politicized into a sexually transmitted disease and that’s it. That’s not an appropriate way to evaluate science.鈥
Pediatric vaccination recommendations are widely credited with nearly eliminating the virus in American-born children.
Babies infected at birth have a 90% chance of developing chronic hepatitis B, and a quarter of those children go on to have severe complications, like liver cancer, or to die from the disease.
In 1991, federal health officials determined newborns should receive their first dose of a hepatitis B vaccine within , which can block the virus from taking hold if transmitted during delivery. From 1990 to 2022, case rates of hepatitis B declined by more than 99%. While parents may opt out of the shots, many day care centers and school districts of hepatitis B vaccination for enrollment.
The next meeting of the ACIP is scheduled to begin Oct. 22. Agendas are usually posted weeks in advance, but so far, no information on the substance of the upcoming meeting has appeared on the CDC鈥檚 website. The agenda for the September meeting was posted less than a week before the meeting鈥檚 start.
