Para reducir costos, muchos cambiaron a planes de salud con deducibles altos. Estos planes ofrecen pagos mensuales más bajos, pero los pacientes pueden enfrentar gastos altos de su propio bolsillo cuando necesitan atención médica.

Estos planes son bastante comunes. En 2023, el 30% de las personas que obtenían seguro a través de su empleador tenían un plan con deducible alto, frente a solo el 4% en 2006.

Madison Burgess, una maestra de escuela primaria de San Diego, tiene seguro de salud a través de su trabajo. Pero cuando evaluó agregar a su esposo a su plan, resultó demasiado costoso, así que empezó a buscar en el mercado una opción más económica para él.

Cuanto más revisaba las opciones de planes, más abrumador le parecía. La jerga de los seguros hacía difícil entender cuánto tendría que pagar su familia si su esposo se enfermaba. (La prima es el pago mensual de tu póliza y el deducible es lo que debes pagar de tu bolsillo antes que la aseguradora comience a pagar. Generalmente los planes con primas bajas tienen deducibles altos, y viceversa).

“No sabía qué era un deducible, así que elegí lo que era barato, y ahora me arrepiento”, dijo.

A cambio de esa prima mensual más baja, la cobertura de su esposo no comenzará a pagar la mayoría de los servicios hasta que hayan gastado $5.800 en facturas médicas. Burgess no sabía que debía cumplir con el deducible antes de que el seguro cubriera parte de los gastos.

驴Cómo prepararse para pagar miles de dólares por adelantado?

Una opción es una cuenta de ahorros para la salud (HSA, por sus siglas en inglés), que permite ahorrar dinero antes de impuestos y ahora está disponible para personas inscritas en planes de menor nivel en los mercados estatales y federales, incluidos los planes bronce y de cobertura catastrófica. Estos planes suelen tener las primas más bajas en el mercado, pero los costos más altos del propio bolsillo cuando se necesita atención.

Burgess eligió un plan Bronce y no sabía que las HSA eran una opción.

“Nunca había pensado en tener que ahorrar dinero para un deducible”, dijo.

Burgess y otras personas suelen estar más preocupadas por ahorrar para gastos inesperados como reparaciones del auto, de la casa o del veterinario.

Si, como Burgess, elegiste una cobertura de salud más económica para este año y luego te diste cuenta de que debes cubrir un deducible alto, estos consejos pueden ayudar a prepararte.

1. Podrías calificar para una HSA y no saberlo.Si estás inscrito en un plan Bronce o en uno catastrófico, calificas para abrir una cuenta de ahorros para la salud. Es como una alcancía médica con beneficios fiscales. Depositas dinero antes de impuestos, lo que reduce tu ingreso gravable. El dinero crece libre de impuestos y, cuando lo usas para , esas transacciones también están libres de impuestos. A esto se le llama una “triple ventaja fiscal”.

Estas cuentas crean un fondo para futuros gastos de salud, como visitas al doctor, medicamentos recetados e incluso productos como medicinas sin receta, tampones y protector solar.

Por lo general, el dinero no puede usarse para pagar primas mensuales, pero la cuenta es tuya y puedes usarla para gastos médicos calificados para tí, tu cónyuge o tus dependientes en cualquier momento en el futuro. El dinero sigue siendo tuyo, incluso si cambias de trabajo o de plan de salud.

Una HSA no es lo mismo que una cuenta de gastos flexibles (FSA por sus siglas en inglés). Las FSA también tienen beneficios fiscales, pero solo se ofrecen a través de empleadores. El dinero vence cada año y pierdes cualquier saldo restante cuando dejas ese trabajo.

1. 驴Te interesa una HSA? Así puedes abrir una.Puedes abrir una cuenta de ahorros para la salud a través de un banco u otra institución financiera. La institución te dará una tarjeta de débito para hacer pagos desde la HSA.

Puedes en cualquier momento del año siempre que tengas un plan elegible. Puedes elegir dónde abrir la cuenta, pero revisa si hay cargos y compara opciones.

Si obtienes seguro a través de tu trabajo, tu empleador puede exigir que uses una compañía específica aprobada por el Servicio de Impuestos Internos (IRS, por sus siglas en inglés).

Muchas personas creen que no pueden aportar dinero a una HSA. Para algunos hogares, la necesidad de ahorrar para gastos médicos compite con la de pagar la renta y comprar alimentos.

Pero hay un detalle que puede hacerlo más manejable: las contribuciones no tienen que ser grandes. Incluso unos pocos dólares al mes pueden ser un comienzo.

Sin embargo, hay un límite. El IRS establece un tope anual sobre cuánto puedes aportar a una HSA. En 2026, el límite es de $4.400 para una persona, o $8.750 para un plan familiar. Dentro de ese límite, tú decides cuánto aportar.

1. Los servicios preventivos deben estar cubiertos sin costo.Todos los planes vendidos en los mercados deben cubrir sin costo para el paciente, siempre que la atención sea dentro de la red. Estos servicios incluyen vacunas de rutina y pruebas de detección de cáncer.

Más allá de la atención preventiva, entender cuánto cuestan distintos servicios puede ayudarte a decidir qué tipo de consulta médica es mejor para tus necesidades y tu presupuesto. Por ejemplo, algunos planes cobran menos por una consulta de telemedicina que por ver a tu doctor en persona.

Revisa el de tu plan para más detalles.

1. Busca atención temprano en el año.La mayoría de los deducibles reinician el 1 de enero. Programar citas o cirugías temprano en el año puede ser estratégico si descubres una afección que requiere atención continua. Si puedes pagarlo, cumplir con el deducible antes puede hacer que el resto del año sea mucho más económico, dijo Caitlin Donovan, directora senior en la Patient Advocate Foundation.
2. Considera pagar en efectivo en lugar de usar el deducible.Algunos hospitales, clínicas u otros proveedores ofrecen precios más bajos si pagas en efectivo. Tienes derecho a recibir y una explicación de cuánto costaría un servicio de salud si pagas de tu bolsillo. Pide ese cálculo antes de recibir atención. Luego compáralo con lo que te dice tu aseguradora que costaría si usas tu seguro. Si decides pagar en efectivo, deberás hacerlo en el consultorio antes de que se envíen los cargos a tu aseguradora.

Pagar en efectivo puede ahorrarte dinero, pero generalmente ese monto no contará para tu deducible ni para el máximo de gastos de tu bolsillo.

“Si no crees que vas a alcanzar tu deducible 鈥攅res joven y tu deducible es de $10.000鈥�, negocia el precio en efectivo”, aconsejó Donovan.

1. 驴Tienes un plan de la Ley de Cuidado de Salud a Bajo Precio (ACA)? Actualiza tus ingresos y usa una HSA para evitar sorpresas fiscales.Si tienes un plan de ACA y eres elegible para subsidios, ten en cuenta lo siguiente: si y no actualizas tu solicitud en el mercado, podrías deber miles de dólares al momento de declarar impuestos. La : reporta aumentos de salario, nuevos trabajos o ingresos adicionales cuando ocurran. Si tus ingresos aumentan, ahorrar dinero en una HSA puede ayudar, ya que ese dinero no cuenta como ingreso gravable.

Cuando reportas un aumento en tus ingresos, eso puede significar primas más altas (si ya no calificas para el mismo subsidio), pero los expertos dicen que es mejor pagar más ahora que enfrentar una gran factura después.

“Uno de los mayores problemas que veo es que alguien queda desempleado, se inscribe en un plan diciendo que no tiene ingresos, luego consigue trabajo y no lo reporta, y termina con una gran deuda de impuestos al final”, dijo Donovan.

Por eso, Donovan recomienda actualizar tu perfil en el mercado tan pronto como cambien tus ingresos, lo que también podría hacer que califiques para Medicaid o para un plan que cubra una mayor parte de tus gastos médicos.

Taylor Cook contribuyó con este artículo.

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An elementary school teacher chose a low-price health insurance plan but soon realized she wasn’t clear about what it would mean for her family’s finances.

“Once I got the insurance card, I compared our old plan to our new plan, and that’s when I really got worried, because I didn’t really understand what a deductible was. It got me thinking, how do I use this insurance?”

鈥� Madison Burgess, 31, of San Diego

When enhanced federal subsidies expired at the end of 2025, a lot of people buying their own health insurance on the state and federal exchanges saw their expected monthly rates jump. To keep costs down, many switched to a high-deductible health plan. These plans offer lower monthly payments, but in exchange patients can face steep out-of-pocket costs when they need care.

The plans are pretty common. In 2023, 30% of people who got insurance through their employer had a high-deductible plan, up from only 4% in 2006.

Madison Burgess, a teacher in San Diego, gets health insurance through her teaching job. But when she investigated adding her husband to her plan, it was just too expensive, so she started shopping on the exchange for a cheaper option for him.

The longer she scrolled through the plan options, the more overwhelming it felt. Insurance jargon made it hard to tell what her family would owe if her husband got sick.

“I didn’t know what a deductible was, so I just went with what was cheap, and now I have regret,” she said.

In exchange for that lower monthly premium payment, her husband’s coverage won’t kick in for most care until they’ve paid $5,800 in medical bills. Burgess didn’t know that the deductible must be met before insurance picks up part of the tab.

Deductible:

The amount you as the patient have to pay before insurance picks up part of the tab

Premium:

The monthly bill for your policy, paid to the insurance company

How do you prepare for thousands of dollars in upfront costs? One option is a health savings account, or HSA, which lets you save pretax money and is now available to people enrolled in lower-tier state and federal exchange plans, including bronze and catastrophic coverage. These plans generally have the lowest premiums on the exchange but the highest out-of-pocket costs when you need care.

Burgess had chosen a bronze plan and didn’t know HSAs were an option.

“I’ve never thought about having to put money away for a deductible,” she said.

Burgess and others are often more worried about socking away money for unexpected car and house repairs or vet bills.

If, like Burgess, you chose cheaper health coverage for this year only to discover you’re on the hook for meeting a high deductible, these tips can help you prepare.

1. You might qualify for an HSA and not know it.

If you’re enrolled in a bronze or catastrophic plan, you qualify to open a health savings account. Think of it as a medical piggy bank with tax perks. You put in pretax money, which lowers your taxable income. The money grows tax-free, and when you spend it on , those transactions are also tax-free. That’s what people call a “triple tax advantage.”

These accounts build a cushion for future health costs, such as doctor visits, prescriptions, and even products like over-the-counter medicine, tampons, and sunscreen.

The money typically can’t be used for monthly premiums, but the account is yours to use for qualified medical expenses for yourself, your spouse, or your dependents anytime in the future. The money in the account is yours, even if you change jobs or health plans.

An HSA is not the same as a flexible spending account, or FSA. FSAs are tax-advantaged too but are offered only through employers. The money expires annually and you lose any remaining money when you leave that job.

2. HSA-curious? Here’s how to open one.

You open a health savings account through a bank or other financial institution. The institution will issue you a debit card so you can make purchases from the HSA.

You can at any point during the year as long as you’re covered by an eligible plan. You can choose where to open the account, but be sure to check for any fees financial institutions charge and shop around.

If you get insurance through your job, your employer may require you to use a specific IRS-approved company.

Many people decide they can’t afford to contribute to an HSA. For some households, the desire to set aside money for medical expenses competes with the need to pay rent and buy groceries.

But there’s a detail that can make it feel more manageable. Contributions don’t have to be large. Just a few dollars a month can get you started.

There is, however, a limit. The IRS sets an annual cap on how much you’re allowed to contribute to an HSA. In 2026, an individual is limited to $4,400, or $8,750 for a family plan. Under that ceiling, the amount is up to you.

3. Preventive services should be covered at no cost to you.

All plans sold on marketplaces must cover at no cost to the patient as long as the care is provided in-network. Those services include routine immunizations and cancer screenings.

Beyond preventive care, understanding what different services cost can help you decide which type of medical appointment works best for your health needs and your wallet. For example, some plans charge less for a telehealth visit than to see your primary care doctor in person.

Check out your for more details.

4. Seek care early in the year.

Most deductibles reset on Jan. 1. Scheduling appointments or surgeries early in the year can be strategic if you discover a condition that requires ongoing care. If you can afford it, meeting your deductible sooner can make the rest of the year significantly cheaper, said Caitlin Donovan, a senior director at the Patient Advocate Foundation.

5. Consider paying cash instead of spending down your deductible.

Some hospitals, clinics, or other providers offer cheaper prices if you pay cash. You have the and explanation of how much a health service would cost if you paid out-of-pocket. Ask for the estimate before you get care. Then, compare that price with what your insurance company tells you it would cost if you used your insurance. If you decide to go with a cash payment, you’ll need to pay while you’re still at the doctor’s office, before charges get submitted to your insurance company.

Paying cash may save you money, but the amount you pay generally won’t count toward your deductible or out-of-pocket maximum.

“If you don’t think you’re ever going to hit your deductible 鈥� you’re that young invincible, and your deductible is $10,000 鈥� negotiate the cash price,” Donovan said.

6. On an ACA plan? Update your income and use an HSA to avoid a tax surprise.

If you’re on an ACA plan and you’re eligible for subsidies, be aware: If your and you don’t update your marketplace application, you could owe thousands of dollars at tax time. The . Report raises, new jobs, or side gigs as they happen. If your income goes up, stashing money in an HSA can help because the money you put in the account doesn’t count toward your taxable income.

As soon as you report an increase in your income, that could mean higher premiums (if you no longer qualify for the same subsidy), but experts say it’s better to pay now than owe a big bill that you have to pay all at once.

“One of the biggest problems I see is someone is newly unemployed and they sign up for coverage, they say that they’re not making any money, and then eventually they get a job and don’t report it, and then they have this huge tax bill at the end,” Donovan said.

She advises updating your marketplace profile as soon as your income changes, which could newly qualify you for Medicaid or a plan that contributes more toward your medical bills.

Taylor Cook contributed to this report.

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. Share your story. The crowdsourced project is a joint production of NPR and 麻豆女优 Health News.

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Just three of those聽that聽the Centers for Disease Control and Prevention says it will no longer routinely recommend 鈥� against hepatitis A, hepatitis B, and rotavirus 鈥� have prevented聽nearly 2聽million hospitalizations and 90,000 deaths in the past 30 years, according to聽.听

Federal and private insurance聽.听

Experts on childhood disease聽were baffled聽by the change, which聽the Department of聽Health and聽Human聽Services聽said followed “a scientific review of the underlying science.”聽

The vaccines are “held to a safety standard higher than any other medical intervention that we have,” said聽,聽a聽pediatric infectious disease specialist at the Children’s Hospital of Philadelphia. “The value of routine recommendations is that it really helps the public understand that this has been vetted upside聽down and backwards in every which way.”

Public health officials say the guidance puts the onus on parents to research each vaccine and its importance.听Here’s聽what they prevent:聽

RSV.聽Respiratory syncytial virus is the most common cause of hospitalization for infants聽in the U.S. It spreads in fall and winter, producing cold-like symptoms and causing聽tens of thousands of hospitalizations and hundreds of deaths yearly.听

Hepatitis A.聽Hepatitis A vaccination, recommended for all toddlers since 2006, has led to a more than 90% drop in the disease since 1996. The foodborne virus, which causes a wretched illness, still plagues adults, particularly聽people who are homeless or聽abuse drugs or alcohol, with聽聽reported in 2023.听

Hepatitis B.聽The disease causes liver cancer, cirrhosis, and other serious illnesses and is聽particularly dangerous聽when contracted by babies and young children. The hepatitis B virus聽is transmitted聽through blood and other bodily fluids, even in microscopic amounts, and can survive on surfaces for a week. From 1990 to 2019, vaccination resulted in a 99% decline in reported cases of acute hepatitis B among children and teens. Liver cancer among American children also plummeted with universal childhood vaccination.听

Rotavirus.聽Before routine administration of the current rotavirus vaccines began in 2006,聽70,000 young children聽were hospitalized聽and聽50聽died yearly from the virus, known as “winter vomiting syndrome,” said Sean O’Leary, a University of Colorado pediatrician. “It was a miserable disease that we hardly see anymore.”聽

Meningococcal disease.聽About 600 to 1,000 U.S. cases of meningococcal disease聽are reported聽yearly, killing more than 10% of those it sickens and聽leaving聽1 in 5 survivors聽with a聽disability.听

Flu.聽The聽virus has聽killed hundreds of children in recent years, though it聽tends聽to be much more severe in older adults.

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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Solo tres de las seis vacunas que los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés) dejarán de recomendar de manera rutinaria 鈥攃ontra la hepatitis A, hepatitis B y el rotavirus鈥� han prevenido casi 2 millones de hospitalizaciones y más de 90.000 muertes en los últimos 30 años, según .

Las vacunas contra esas tres enfermedades, así como contra el virus respiratorio sincitial (VRS), la enfermedad meningocócica, la gripe y covid, ahora solo se recomiendan para niños con alto riesgo de enfermedad grave o luego de “tomar decisiones clínicas de manera compartida”, es decir, una consulta entre médicos y padres.

Los CDC mantienen sus recomendaciones para 11 vacunas infantiles: contra el sarampión, las paperas y la rubéola; la tos ferina, el tétanos y la difteria; la enfermedad bacteriana conocida como Hib; la neumonía; la polio; la varicela; y el virus del papiloma humano (VPH).

Según del Departamento de Salud y Servicios Humanos (HHS, por sus siglas en inglés), los seguros médicos públicos y privados seguirán cubriendo las vacunas contra las enfermedades que los CDC ya no recomiendan de manera universal; los padres que quieran vacunar a sus hijos contra esas enfermedades no tendrán que pagar las dosis de su bolsillo.

Expertos en enfermedades infantiles se mostraron desconcertados ante el cambio en la guía. El HHS explicó que las modificaciones se hicieron tras “una revisión científica de la evidencia” y que están alineadas con programas de vacunación de otros países desarrollados.

El secretario del HHS, Robert F. Kennedy Jr., un activista antivacunas, señaló a Dinamarca como modelo. Sin embargo, los calendarios de vacunación de la mayoría de los países europeos son más parecidos al estándar estadounidense que acaba de modificarse.

Por ejemplo, Dinamarca, que no vacuna contra el rotavirus, registra cerca de 1.200 hospitalizaciones al año por esta infección 聽en bebés y niños pequeños. Esa tasa, en un país de 6 millones de habitantes, es similar a la que tenía Estados Unidos antes de introducir la vacuna.

“Ellos aceptan tener 1.200 o 1.300 niños hospitalizados, lo cual es solo la punta del iceberg en cuanto al sufrimiento infantil”, dijo Paul Offit, director del Centro de Educación sobre Vacunas del Hospital Infantil de Philadelphia y coinventor de una vacuna contra el rotavirus aprobada. “Nosotros no lo aceptamos. Deberían tratar de imitarnos a nosotros, no al revés”.

Funcionarios de salud pública señalaron que la nueva guía pone sobre los padres la responsabilidad de investigar y comprender cada vacuna infantil y por qué es importante.

El siguiente es un resumen de las enfermedades que previenen las vacunas que se han dejado de lado:

VRS. El virus respiratorio sincitial es la causa más común de hospitalización en bebés en Estados Unidos.

Este virus respiratorio suele circular en otoño e invierno y provoca síntomas parecidos a los de un resfriado, aunque puede ser mortal para los niños pequeños. Cada año causa decenas de miles de hospitalizaciones y cientos de muertes. Según la Fundación Nacional de Enfermedades Infecciosas (National Foundation for Infectious Diseases), aproximadamente el 80% de los niños menores de 2 años hospitalizados con el VRS no tienen factores de riesgo identificables. Las esperadas vacunas contra esta enfermedad se introdujeron en 2023.

Hepatitis A. La vacunación contra la hepatitis A, que se empezó a aplicar gradualmente a finales de los años 90 y se recomendó para todos los niños pequeños a partir de 2006, ha provocado una reducción de más del 90% de los casos desde 1996. Este virus transmitido por alimentos causa una enfermedad muy desagradable que aún afecta a adultos, especialmente personas sin hogar o que consumen drogas o alcohol. En 2023 se reportaron de 1.648 casos y 85 muertes.

Hepatitis B. Esta enfermedad provoca cáncer de hígado, cirrosis y otros padecimientos graves, y es particularmente peligrosa cuando la contraen bebés o niños pequeños. El virus de la hepatitis B se transmite por sangre y otros fluidos corporales, incluso en cantidades microscópicas, y puede sobrevivir en superficies durante una semana. Entre 1990 y 2019, la vacunación generó una reducción del 99% en los casos reportados de hepatitis B aguda en niños y adolescentes. El cáncer de hígado en menores también ha disminuido considerablemente gracias a la vacunación infantil universal. Sin embargo, el virus sigue presente, con entre 2.000 y 3.000 casos agudos reportados cada año entre adultos no vacunados. En 2023 se diagnosticaron más de 17.000 casos de hepatitis B crónica. Los CDC estiman que cerca de la mitad de las personas infectadas no saben que lo están.

Rotavirus. Antes de que comenzara la administración rutinaria de las actuales vacunas contra el rotavirus, en 2006, cada año se internaban a unos 70.000 niños pequeños, y morían alrededor de 50 a causa del virus. “Se conocía como el síndrome del vómito invernal”, explicó Sean O’Leary, pediatra de la Universidad de Colorado. “Era una enfermedad terrible, que casi ya no vemos”.

Sin embargo, el virus sigue siendo común en las superficies que tocan los bebés, y “si bajan las tasas de vacunación, habrá de nuevo niños hospitalizados”, advirtió Offit.

Vacunas meningocócicas. Estas vacunas han sido requeridas principalmente para adolescentes y estudiantes universitarios, quienes son especialmente vulnerables a enfermedades graves causadas por esta bacteria. En Estados Unidos se reportan entre 600 y 1.000 casos al año, pero más del 10% de los enfermos mueren, y 1 de cada 5 sobrevivientes queda con discapacidades permanentes.

Gripe y covid. Estos dos virus respiratorios han causado la muerte de cientos de niños en años recientes, aunque suelen ser más graves en adultos mayores. Actualmente hay un repunte de la gripe en el país, y durante la temporada pasada murieron 289 menores por esta causa.

驴Qué es la toma de decisiones clínicas compartida?

Con los nuevos cambios, la decisión de vacunar a los niños contra la gripe, covid, el rotavirus, la enfermedad meningocócica y las hepatitis A y B dependerá ahora de lo que las autoridades llaman “toma de decisiones clínicas compartida”, es decir, que las familias deberán consultar con un proveedor de salud para determinar si la vacuna es apropiada para sus hijos.

“Significa que el proveedor debe tener una conversación con el paciente para explicar los riesgos y beneficios y tomar una decisión personalizada”, dijo , especialista en enfermedades infecciosas pediátricas del Hospital Infantil de Philadelphia.

Antes, los CDC usaban ese término solo en circunstancias muy específicas, como al decidir si una persona en una relación monógama necesitaba la vacuna contra el VPH, que previene una infección de transmisión sexual y ciertos tipos de cáncer.

Según Handy, el nuevo enfoque de los CDC no se alinea con la evidencia científica, dado el beneficio protector comprobado que las vacunas ofrecen a la gran mayoría de la población.

En su informe justificando los cambios, los funcionarios del HHS Tracy Beth Høeg y Martin Kulldorff afirmaron que el sistema de vacunación de Estados Unidos requiere más investigación sobre seguridad y mayor elección por parte de los padres. Dijeron que la pérdida de confianza en la salud pública, causada en parte por un calendario de vacunación demasiado extenso, ha llevado a más familias a rechazar vacunas contra amenazas importantes como el sarampión.

Las vacunas en el calendario que fue modificado por los CDC ya contaban con amplia investigación sobre seguridad cuando fueron evaluadas y aprobadas por la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés).

“Estas vacunas tienen un estándar de seguridad más alto que cualquier otra intervención médica que tenemos”, dijo Handy. “El valor de las recomendaciones rutinarias es que ayudan al público a entender que estas vacunas han sido examinadas por todos lados”.

, pediatra en el condado de Orange, California, apuntó que el cambio en la guía provocará más confusión entre los padres, quienes podrían pensar que es la seguridad de una vacuna lo que está en duda.

“Para la salud pública, es fundamental que las recomendaciones sobre vacunas sean muy claras y precisas”, dijo Ball. “Cualquier cosa que genere confusión solo llevará a que más niños se enfermen”.

Ball explicó que, en lugar de enfocarse en las necesidades médicas del niño, muchas veces tiene que usar el tiempo limitado de consulta para asegurar a los padres que las vacunas son seguras. El hecho de que una vacuna quede bajo “toma de decisiones clínicas compartida” no tiene nada que ver con preocupaciones de seguridad, pero muchos padres podrían interpretarlo así.

Los cambios del HHS no afectan las leyes estatales de vacunación y, por lo tanto, deberían permitir que los médicos responsables sigan recomendando las vacunas como hasta ahora, según , abogado y profesor en la Universidad George Washington, quien lidera demandas contra Kennedy por los cambios en materia de vacunas.

“Uno puede esperar que cualquier pediatra siga la evidencia científica sólida y recomiende que sus pacientes se vacunen”, dijo. La ley protege a los proveedores que siguen las pautas profesionales de atención, agregó, y “el VRS, la enfermedad meningocócica y las hepatitis siguen siendo amenazas graves para la salud de los niños en este país”.

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Just three of the six immunizations the Centers for Disease Control and Prevention says it will no longer routinely recommend 鈥� against hepatitis A, hepatitis B, and rotavirus 鈥� have prevented nearly 2 million hospitalizations and more than 90,000 deaths in the past 30 years, according to .

Vaccines against the three diseases, as well as those against respiratory syncytial virus, meningococcal disease, flu, and covid, are now recommended only for children at high risk of serious illness or after “shared clinical decision-making,” or consultation between doctors and parents.

The CDC maintained its recommendations for 11 childhood vaccines: measles, mumps, and rubella; whooping cough, tetanus, and diphtheria; the bacterial disease known as Hib; pneumonia; polio; chickenpox; and human papillomavirus, or HPV.

Federal and private insurance will still cover vaccines for the diseases the CDC no longer recommends universally, according to a Department of Health and Human Services ; parents who want to vaccinate their children against those diseases will not have to pay out-of-pocket.

Experts on childhood disease were baffled by the change in guidance. HHS said the changes followed “a scientific review of the underlying science” and were in line with vaccination programs in other developed nations.

HHS Secretary Robert F. Kennedy Jr., an anti-vaccine activist, pointed to Denmark as a model. But the schedules of most European countries are closer to the U.S. standard upended by the new guidance.

For example, Denmark, which does not vaccinate against rotavirus, registers around 1,200 infant and toddler rotavirus hospitalizations a year. That rate, in a country of 6 million, is about the same as it was in the United States before vaccination.

“They’re OK with having 1,200 or 1,300 hospitalized kids, which is the tip of the iceberg in terms of childhood suffering,” said Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a co-inventor of a licensed rotavirus vaccine. “We weren’t. They should be trying to emulate us, not the other way around.”

Public health officials say the new guidance puts the onus on parents to research and understand each childhood vaccine and why it is important.

Here’s a rundown of the diseases the sidelined vaccines prevent:

RSV. Respiratory syncytial virus is the most common cause of hospitalization for infants in the U.S.

The respiratory virus usually spreads in fall and winter and produces cold-like symptoms, though it can be deadly for young children, causing tens of thousands of hospitalizations and hundreds of deaths a year. According to the National Foundation for Infectious Diseases, roughly 80% of children younger than 2 who are hospitalized with RSV have no identifiable risk factors. Long-awaited vaccines against the disease were introduced in 2023.

Hepatitis A. Hepatitis A vaccination, which was phased in beginning in the late 1990s and recommended for all toddlers starting in 2006, has led to a more than 90% drop in the disease since 1996. The foodborne virus, which causes a wretched illness, continues to plague adults, particularly people who are homeless or who abuse drugs or alcohol, with of 1,648 cases and 85 deaths reported in 2023.

Hepatitis B. The disease causes liver cancer, cirrhosis, and other serious illnesses and is particularly dangerous when contracted by babies and young children. The hepatitis B virus is transmitted through blood and other bodily fluids, even in microscopic amounts, and can survive on surfaces for a week. From 1990 to 2019, vaccination resulted in a 99% decline in reported cases of acute hepatitis B among children and teens. Liver cancer among American children has also plummeted as a result of universal childhood vaccination. But the hepatitis B virus is still around, with 2,000-3,000 acute cases reported annually among unvaccinated adults. More than 17,000 chronic hepatitis B diagnoses were reported in 2023. The CDC estimates about half of people infected don’t know they have it.

Rotavirus. Before routine administration of the current rotavirus vaccines began in 2006, about 70,000 young children were hospitalized and 50 died every year from the virus. It was known as “winter vomiting syndrome,” said Sean O’Leary, a pediatrician at the University of Colorado. “It was a miserable disease that we hardly see anymore.”

The virus is still common on surfaces that babies touch, however, and “if you lower immunization rates it will once again hospitalize children,” Offit said.

Meningococcal disease. Vaccines have been required mainly for teenagers and college students, who are notably vulnerable to critical illness caused by the bacteria. About 600 to 1,000 cases of meningococcal disease are reported in the U.S. each year, but it kills more than 10% of those it sickens, and 1 in 5 survivors have permanent disabilities.

Flu and covid. The two respiratory viruses have each killed hundreds of children in recent years 鈥� though both tend to be much more severe in older adults. Flu is currently on the upswing in the United States, and last flu season the virus killed 289 children.

What is shared clinical decision-making?

Under the changes, decisions about vaccinating children against influenza, covid, rotavirus, meningococcal disease, and hepatitis A and B will now rely on what officials call “shared clinical decision-making,” meaning families will have to consult with a health care provider to determine whether a vaccine is appropriate.

“It means a provider should have a conversation with the patient to lay out the risks and the benefits and make a decision for that individual person,” said , a pediatric infectious disease specialist at the Children’s Hospital of Philadelphia.

In the past, the CDC used that term only in reference to narrow circumstances, like whether a person in a monogamous relationship needed the HPV vaccine, which prevents a sexually transmitted infection and certain cancers.

The CDC’s new approach doesn’t line up with the science because of the proven protective benefit the vaccines have for the vast majority of the population, Handy said.

In their report justifying the changes, HHS officials Tracy Beth Høeg and Martin Kulldorff said the U.S. vaccination system requires more safety research and more parental choice. Eroding trust in public health caused in part by an overly large vaccine schedule had led more parents to shun vaccination against major threats like measles, they said.

The vaccines on the schedule that the CDC has altered were backed up by extensive safety research when they were evaluated and approved by the FDA.

“They’re held to a safety standard higher than any other medical intervention that we have,” Handy said. “The value of routine recommendations is that it really helps the public understand that this has been vetted upside down and backwards in every which way.”

, a pediatrician in Orange County, California, said the change in guidance will cause more confusion among parents who think it means a vaccine’s safety is in question.

“It is critical for public health that recommendations for vaccines are very clear and concise,” Ball said. “Anything to muddy the water is just going to lead to more children getting sick.”

Ball said that instead of focusing on a child’s individual health needs, he often has to spend limited clinic time reassuring parents that vaccines are safe. A “shared clinical decision-making” status for a vaccine has no relationship to safety concerns, but parents may think it does.

HHS’ changes do not affect state vaccination laws and therefore should allow prudent medical practitioners to carry on as before, said , an attorney and a George Washington University lecturer who is leading litigation against Kennedy over vaccine changes.

“You could expect that any pediatrician is going to follow sound evidence and recommend that their patients be vaccinated,” he said. The law protects providers who follow professional care guidelines, he said, and “RSV, meningococcal, and hepatitis remain serious health threats for children in this country.”

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Una de sus pacientes tenía 17 años cuando la examinó por dolor estomacal. McMahon descubrió que había desarrollado cáncer de hígado causado por hepatitis B, apenas unas semanas antes de graduarse de la secundaria como la mejor estudiante.

Murió antes de la ceremonia.

McMahon también recuerda a un niño de 8 años que no mostraba signos de enfermedad hasta que se quejó de dolor: resultó ser un tumor de rápido crecimiento en el hígado. Aún puede escuchar su voz.

“Gemía de dolor diciendo: 鈥楽é que voy a morir pronto’”, recordó. “Todos estábamos llorando”. El niño murió en casa una semana después.

El virus de la hepatitis B se transmite a través de la sangre y otros fluidos corporales, incluso en cantidades microscópicas, y puede sobrevivir en superficies durante una semana. Como muchos de sus pacientes, McMahon explicó que ambos niños contrajeron hepatitis B al nacer o en la infancia temprana.

Ese desenlace hoy se puede prevenir.

Una dosis de la vacuna al nacer, recomendada para recién nacidos desde 1991, es hasta para prevenir la infección transmitida por la madre si se administra en las primeras 24 horas de vida. Si los bebés reciben las tres dosis, el contra este virus incurable, con una protección que .

En las comunidades del oeste de Alaska, años de pruebas dirigidas y campañas amplias de vacunación lograron que los casos .

“El cáncer de hígado ha desaparecido en los niños”, dijo McMahon. “No hemos visto un solo caso desde 1995. Tampoco tenemos, que sepamos, nadie menor de 30 años que se haya infectado”.

Le preocupa que estos avances obtenidos con mucho esfuerzo puedan retroceder.

驴Retrasar la dosis?

Un comité asesor sobre vacunas de los Centros para el Control y 聽Prevención de Enfermedades (CDC, por su siglas en inglés), nombrado por el secretario de Salud y Servicios Humanos Robert F. Kennedy Jr., tiene previsto discutir y votar el 4 de diciembre si se mantiene la recomendación de administrar la dosis de hepatitis B al nacer.

La medida podría limitar el acceso de los niños a la vacuna.

En el podcast de Tucker Carlson en junio, Kennedy afirmó falsamente que la dosis de hepatitis B al nacer es una “causa probable” de autismo.

También dijo que el virus de la hepatitis B no es “casualmente contagioso”. Pero demuestran que el virus puede transmitirse por contacto indirecto, cuando restos de fluidos infectados, como la sangre, entran al cuerpo al compartir objetos personales como rasuradoras o cepillos de dientes.

Las recomendaciones de este comité tienen gran influencia. La mayoría de los seguros privados están obligados a cubrir las vacunas que el Comité Asesor sobre Prácticas de Inmunización (ACIP, por sus siglas en inglés) aprueba, y muchas políticas estatales de vacunación se basan directamente en esas guías.

Pero ni el ACIP ni los CDC tienen funciones regulatorias: no pueden imponer vacunas obligatorias. Esa responsabilidad . Sin embargo, mantener la recomendación de administrar la vacuna al nacer permite que las familias tengan la mayor cantidad de opciones: pueden elegir vacunar desde el nacimiento, esperar hasta más adelante o no vacunar. Y el seguro continuará cubriendo el costo de la vacuna mientras siga estando aprobada por la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés).

Dos altos funcionarios de la FDA 鈥攅l comisionado Marty Makary y el principal regulador de vacunas Vinay Prasad鈥� sugirieron a finales de noviembre que podrían en el proceso de aprobación de vacunas. Todas las vacunas deben estar aprobadas por la FDA para ser administradas en Estados Unidos.

En obtenidos por y , Prasad cuestionó la práctica rutinaria de “aplicar múltiples vacunas al mismo tiempo”.

No está claro si se refería a las vacunas combinadas, que protegen contra varias enfermedades en una sola dosis. Tres de las nueve vacunas contra la hepatitis B actualmente aprobadas por la FDA son combinadas. Sin embargo, la se aplica solamente como una vacuna individual.

“Sembrando desconfianza”

Aunque los seguros privados continúen cubriendo esta vacuna, la desinformación que surja de esa reunión podría llevar a que algunas familias crean erróneamente que puede hacerle daño a sus bebés, advirtió , presidente del Comité de Enfermedades Infecciosas de la Academia Americana de Pediatría (American Academy of Pediatrics) y profesor asistente en la Escuela de Medicina de la Universidad de Colorado.

“Lo que salga de este desastre de reunión en diciembre estará principalmente diseñado para sembrar desconfianza y esparcir miedo”, expresó.

El presidente Donald Trump, Kennedy y algunos de los nuevos miembros del ACIP han distorsionado cómo se transmite esta enfermedad hepática, ignorando o minimizando el riesgo del contagio indirecto.

El virus de la hepatitis B es . Las personas no vacunadas, incluidos los niños, pueden infectarse con cantidades microscópicas de sangre en una mesa o un juguete, incluso si la persona infectada no presenta síntomas.

McMahon ha atendido a niños que dieron negativo al nacer y luego se infectaron por contacto indirecto. En de la década de 1970, casi un tercio de esos niños desarrolló hepatitis B crónica sin mostrar síntomas, explicó.

“Es un virus muy contagioso”, dijo McMahon. “Por eso dar la dosis al nacer a todos es la mejor manera de prevenirlo”.

Los CDC recomiendan que todas las personas embarazadas se hagan la prueba de hepatitis B, pero estiman que hasta un 16% no se la realiza y queda fuera de los registros. O’Leary y otros expertos dicen que hacer pruebas justo antes o después del parto no es factible, ya que la mayoría de los hospitales no tiene el personal ni los recursos suficientes.

La vacuna de tres dosis tiene . Numerosos estudios demuestran que no está asociada con un mayor riesgo de , , ni . Las reacciones graves son poco comunes.

“Tenemos un perfil de seguridad excelente”, dijo O’Leary. “Nadie espera chocar en auto, 驴cierto? Pero igual todos usamos el cinturón de seguridad. Esto es similar”.

Los CDC estiman que 2,4 millones de personas en el país tienen hepatitis B, y que . La enfermedad puede ir desde una infección aguda hasta una crónica, . Si no se trata, puede provocar cirrosis, insuficiencia hepática y cáncer de hígado. No tiene cura.

Recomendación para padres: hablar con su doctor

, profesor de medicina preventiva en la Escuela de Medicina de la Universidad de Vanderbilt y ex miembro con voto del ACIP, dijo que algunos padres tienen dificultad para entender por qué un recién nacido sano necesita una vacuna tan pronto, especialmente contra un virus que están convencidos de no tener y que a menudo asocian solo con conductas de riesgo. Esa percepción, señaló, se mezcla con la creciente desconfianza en la salud pública y el escepticismo hacia las vacunas.

Su consejo para futuros padres que están indecisos es hablar con su médico sobre las vacunas. Incluso si la embarazada dio negativo en la prueba, dijo, sigue siendo importante administrar la dosis al nacer, ya que pueden ocurrir falsos negativos y el virus se puede propagar fácilmente a través del contacto con superficies.

Los bebés que reciben la serie completa de vacunas desde el nacimiento tienen de desarrollar cáncer de hígado.

“Si uno espera un mes y la madre resulta ser positiva, o el bebé se contagia de un cuidador, para entonces la infección ya está establecida en el hígado del bebé”, explicó Schaffner. “Ya es demasiado tarde para prevenirla”.

Agregó que, si menos personas se vacunan, la hepatitis B circulará más en las comunidades estadounidenses y el riesgo de infección aumentará para quienes no se vacunen.

Y más casos de hepatitis B también podrían significar mayores costos tanto para los pacientes como para el sistema de salud.

Los CDC calculan que tratar a una persona con una forma menos grave de la enfermedad cuesta entre $25.000 y $94.000 al año. Para quienes necesitan un trasplante de hígado, los gastos médicos anuales pueden superar los $320.000, dependiendo del tratamiento.

Durante los últimos 30 años, los que han reportado los padres tras la aplicación de la dosis al nacer han sido llanto e irritabilidad, síntomas que desaparecen rápidamente. Schaffner dijo que eso demuestra un perfil de seguridad muy sólido para una vacuna en recién nacidos que protege contra una enfermedad incurable.

“Los datos son clarísimos sobre esto”, agregó. “Ahora hay toda una serie de países que han iniciado este programa. Lo han tomado como modelo del nuestro”.

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Working out of a in Anchorage, Alaska, liver specialist Brian McMahon has spent decades treating the long shadow of hepatitis B. Before a vaccine became available in the 1980s, he saw the virus claim young lives in western Alaskan communities with stunning speed.

One of his patients was 17 years old when he first examined her for stomach pain. McMahon discovered she had developed liver cancer caused by hepatitis B, just weeks before she was set to graduate from high school as valedictorian. She died before the ceremony.

McMahon thinks often of an 8-year-old boy who showed no signs of illness until he complained of pain from what turned out to be a rapidly growing tumor on his liver.

McMahon can still hear his voice.

“He was moaning in pain, saying, 鈥業 know I am going to die soon,’” he recalled. “We were all crying.” The boy died at home a week later.

The hepatitis B virus is transmitted through blood and bodily fluids, even in microscopic amounts, and the virus can survive on surfaces for a week. Like many of his patients, McMahon said, both children contracted hepatitis B at birth or in early childhood.

That outcome is now preventable. A birth dose of the vaccine, recommended for newborns since 1991, is up to in preventing infection from the mother if given in the first 24 hours of life. If babies receive all three doses, have immunity from the incurable virus, with the protection lasting at least .

In the communities of western Alaska, years of targeted testing and widespread vaccination efforts led to .

“Liver cancer has disappeared in children,” McMahon said. “We haven’t seen a case since 1995. Nor do we have any children under 30 that have gotten infected that we know of.”

He worries those hard-won gains could soon be rolled back.

Pushing Back the Dose?

A Centers for Disease Control and Prevention vaccine advisory panel appointed by Health and Human Services Secretary Robert F. Kennedy Jr. is scheduled the hepatitis B birth dose recommendation during its two-day meeting starting Dec. 4, potentially limiting children’s access.

On Tucker Carlson’s podcast in June, Kennedy falsely claimed that the hepatitis B birth dose is a “likely culprit” of autism.

He also said the hepatitis B virus is not “casually contagious.” But shows the virus can be transmitted through indirect contact, when traces of infected fluids like blood enter the body when people share personal items like razors or toothbrushes.

The committee’s recommendations carry weight. Most private insurers must cover the vaccines the Advisory Committee on Immunization Practices endorses, and many state vaccination policies are directly linked to its guidelines.

Neither ACIP nor the CDC is regulatory. They cannot mandate immunizations. It’s to do that. But keeping the recommendation for a hepatitis B vaccine at birth preserves the widest range of options for families. They can choose to vaccinate at birth, wait until later in childhood, or not vaccinate at all, and insurance will continue to cover the cost of the shot as long as it remains approved by the Food and Drug Administration.

Two senior FDA officials 鈥� Commissioner Marty Makary and top vaccine regulator Vinay Prasad 鈥� suggested at the end of November that the vaccine approval process may be coming. Vaccines must be approved by the FDA to be administered in the United States.

In obtained by and , Prasad questioned the routine practice of “giving multiple vaccines at the same time.” It’s not clear whether he was referring to combination vaccines that offer immunity against multiple diseases with a single shot. Three of the nine hepatitis B vaccines currently approved by the FDA are combination vaccines. The of the hepatitis B vaccine is given only as a stand-alone vaccine.

Contacted for comment, Health and Human Services spokesperson Emily Hilliard said in a statement that “ACIP will review the evidence at its meeting this week and issue recommendations based on gold standard, evidence-based science and common sense.”

鈥楽owing Distrust’

If private insurers opt to still cover the shot, misinformation from the meeting still could lead families to falsely believe the vaccine could harm their babies, said , chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and an assistant professor of pediatrics at the University of Colorado School of Medicine.

“Whatever comes out of this disaster of a meeting in December is going to be mainly designed around sowing distrust and spreading fear,” he said.

President Donald Trump, Kennedy, and some newly appointed ACIP members have mischaracterized how the liver disease spreads, ignoring or downplaying the risk of transmission through indirect contact. The hepatitis B virus is than HIV. Unvaccinated people, including children, can get infected from microscopic amounts of blood on a tabletop or toy, even when the infected person is asymptomatic.

McMahon has cared for children who tested negative at birth and later became infected through indirect contact. In a , nearly a third of such children went on to develop chronic hepatitis B without ever showing symptoms, he said.

“It’s a very infectious virus,” McMahon said. “That’s why giving everybody the birth dose is the best way to prevent it.”

The CDC recommends that all pregnant people be screened for hepatitis B, but it estimates that up to 16% are not tested and fall through the cracks. O’Leary and other experts say testing mothers for the virus shortly before or after delivery is unfeasible, because most hospitals lack the staff and resources.

The three-dose vaccine has a of safety. Numerous studies show it is not associated with an increased risk of , , , or , and severe reactions are rare.

“We have an incredible safety profile,” O’Leary said. “No one expects to get in a car wreck, right? And yet we all put our seat belts on. This is similar.”

The CDC estimates that 2.4 million people in the U.S. have hepatitis B and that half they are infected. The disease can range from an acute infection to a chronic one, often with . If the disease is left untreated, it can lead to serious conditions such as cirrhosis, liver failure, and liver cancer. There is no cure.

Expert’s Advice to Parents: Talk to a Doctor

, a professor of preventative medicine at the Vanderbilt University School of Medicine and a former voting member of ACIP, said some parents struggle to understand why a healthy newborn needs a vaccine so soon after birth, especially for a virus they feel certain they don’t have and often wrongly associate only with risky behaviors. Those perceptions, he said, mix with declining trust in public health and rising skepticism about vaccines.

His advice to expectant parents who are on the fence is to talk to their doctor about the shots. Even if the pregnant woman has tested negative, he said, it’s still important to give the baby the birth dose, because false negatives are possible and because the virus can spread so easily from surface contact. Babies who receive the full vaccine series starting from birth have their chance of .

“If you wait a month and if the mom happens to be positive, or the baby picks it up from a caregiver, by that time the infection is established in that baby’s liver,” Schaffner said. “It’s too late to prevent that infection.”

He said that if fewer people get vaccinated, hepatitis B will circulate at higher rates in American communities and the risk of contracting the virus will rise for everyone who doesn’t get the shots.

And more hepatitis B cases could mean higher costs for patients and the broader health care system. The CDC estimates treating someone with a less severe form of the disease costs $25,000 to $94,000 per year. For patients who require a liver transplant, annual medical expenses can climb above $320,000, depending on their treatment.

Over the past 30 years, the parents have reported from their babies receiving the birth dose have been fussiness and crying, both of which pass quickly. Schaffner said that’s a very strong safety profile 鈥� for a newborn vaccine with a track record of protecting babies from an incurable disease.

“The data are so clear about this,” Schaffner said. “A whole array now of other countries have initiated this program. They’ve modeled it on us.”

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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’s 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.

“Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B. So I would say wait till the baby is 12 years old and formed and take hepatitis B,” 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.

“We do have data that says that it can happen and that it is likely to happen,” he said. Though the exact cause of infection may not be clear in documented cases of children of hepatitis B-negative mothers becoming infected, “I can tell you that it didn’t come from the mother and it didn’t come from injection drug use and it didn’t come from sexual contact, so that means that it had to have been some kind of casual contact,” Langer said.

Yet during the debate, some members gave little credence to the risk of transmission to children through household contact.

“This is a very, very important vaccine that should be given to the high-risk populations,” said ACIP voting member , a professor of operations management at the MIT Sloan School of Management. “The high-risk populations seem to be babies born to hep B-positive mothers, drug addicts, and other populations at high risk,” he said, despite Langer’s 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 “probably close to zero” 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.

“This assumes implicitly that all the infections are coming from moms,” Hibbeln said. “You can’t decide on that simply by the mother’s status. You would have to look at the entire household’s status.”

ACIP member Evelyn Griffin, an obstetrician and gynecologist, asserted that doctors could ascertain an entire household’s hepatitis B status by asking the mother.

“How are they going to know?” Hibbeln said. “If 50% of people don’t know that they are hepatitis B-positive, you can ask all you want, and nobody knows.”

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.

“The 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,” internist , the president of the American College of Physicians and its liaison to ACIP, said when reached after the meeting.

“The virus does not care what your behavior or lifestyle is. The virus goes from person to person through bodily fluids,” 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. “What if someone was in a car accident and got exposed to blood?”

“It is not only mother-to-fetus transmission, it is not only certain risk groups,” he said. “This 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.”

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’s website. The agenda for the September meeting was posted less than a week before the meeting’s start.

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From confusing policy language to coding errors to shifting insurer rules, a new episode of NPR’s “Life Kit” podcast explores why denials happen and how to avoid common pitfalls.

麻豆女优 Health News reporter Jackie Fortiér and “Life Kit” host Marielle Segarra discuss the intricate and sometimes infuriating process of dealing with denied health claims. It’s an issue lots of people run into 鈥� but don’t necessarily talk about.

Fortiér and Segarra offer tips backed by real-life examples and expert advice, so you’ll know whom to call, what to say, and how being a pest in the right way might save you money.

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“There is going to likely be a discussion about hepatitis B vaccine, very specifically trying to dislodge the birth dose of hepatitis B vaccine and to push it later in life,” said Demetre Daskalakis, of the National Center for Immunization and Respiratory Diseases. “Apparently this is a priority of the secretary’s.”

The vote was expected to take place during the next meeting of the CDC’s Advisory Committee on Immunization Practices, scheduled for Sept. 18-19.

For more than 30 years, the first of three shots of hepatitis B vaccine has been recommended for infants shortly after birth. In that time, the potentially fatal disease has been virtually eradicated among American children. Pediatricians warn that waiting four years for the vaccine opens the door to more children contracting the virus.

“Age 4 makes zero sense,” pediatrician Eric Ball said. “We recommend a universal approach to prevent those cases where a test might be incorrect or a mother might have unknowingly contracted hepatitis. It’s really the best way to keep our entire population healthy.”

In addition to the hepatitis B vaccine, the panel and vote on recommendations for the combined measles, mumps, rubella, and varicella vaccine and covid-19 vaccines. Pediatricians worry changes to the schedules of these vaccines will limit access for many families, leaving them vulnerable to vaccine-preventable diseases.

Typically, ACIP would undertake an analysis of the data before recommending a change to vaccine guidelines. As of the end of August, this process had not begun for the hepatitis B vaccines, Daskalakis and another former official said.

“This is an atypical situation. There’s been no work group to discuss it,” Daskalakis said.

The second former senior official spoke to NPR and 麻豆女优 Health News on the condition of anonymity.

In response to questions from 麻豆女优 Health News, HHS spokesperson Andrew Nixon wrote, “ACIP exists to ensure that vaccine policy is guided by the best available evidence and open scientific deliberation. Any updates to recommendations will be made transparently with gold standard science.”

The draft agenda for the upcoming ACIP meeting was released to the public less than a week before it is scheduled to begin.

At the last ACIP meeting, in June, Martin Kulldorff, the chair and one of seven new members handpicked by Kennedy, questioned the need to vaccinate every newborn, citing only two of the many ways the virus can spread. Kulldorff is a former Harvard Medical School professor who became known for during the pandemic.

“Unless the mother is hepatitis B positive, an argument could be made to delay the vaccine for this infection, which is primarily spread by sexual activity and intravenous drug use,” he said.

The virus spreads via direct exposure to an infected bodily fluid like blood or semen. The disease has no cure and can lead to serious conditions like cirrhosis and liver cancer later in life. The CDC advisory panel may maintain the recommendation to inoculate newborns whose mothers have hepatitis B or are considered at high risk of the disease, the former officials said.

Protection From Birth

In 1991, federal health officials determined it was advisable for newborns to receive their first dose of the hepatitis B vaccine within , which blocks the virus from taking hold if transmitted during delivery. While parents may opt out of the shots, many day care centers and school districts of hepatitis B vaccination for enrollment.

The prospect of ACIP’s altering the recommendation has left some people living with the virus deeply unsettled.

“I am goddamn frustrated,” said Wendy Lo, who has lived with the liver disease, likely since birth. Years of navigating the psychological, monetary, medical, and social aspects of chronic hepatitis B has touched almost every aspect of her life.

“I would not want anyone to have to experience that if it can be prevented,” she said. Lo learned she had the disease due to a routine screening to study abroad in college.

Lo credits the vaccines with protecting her close family members from infection.

“I shared with my partner, 鈥業f you get vaccinated, we can be together,’” she said. He got the vaccine, which protects him from infection, “so I’m grateful for that,” she said.

The CDC estimates half of people with hepatitis B they are infected. It can range from an acute, mild infection to a chronic infection, often with . Most people with chronic hepatitis B were born outside of the U.S., and Asians and Pacific Islanders Black people have the highest rates of newly reported chronic infections.

When her children were born, Lo was adamant that they receive the newborn dose, a decision she says prevented them from contracting the virus.

The earlier an infection occurs, , according to the CDC. When contracted in infancy or early childhood, hepatitis B is far more likely to become a chronic infection, silently damaging the liver over decades.

Those who become chronic carriers can also unknowingly spread the virus to others and face an increased risk of long-term complications including cirrhosis and liver cancer, which may not become evident until much later in life.

“Now I’m in my 50s, one of my big concerns is liver cancer. The vaccine is safe and effective, it’s lifesaving, and it protects you against cancer. How many vaccines do that?” Lo said.

Thirty Years of Universal Vaccination

Treatments like the antivirals Lo now takes weren’t available until the 1990s. Decades of the virus’s replicating unchecked damaged her liver. Every six months she gets scared of what her blood tests may reveal.

After a vaccine was approved in the 1980s, public health officials initially focused vaccination efforts on people thought to be at highest risk of infection.

“I, and every other doctor, had been trained in medical school to think of hepatitis B as an infection you acquired as an adult. It was the pimps, the prostitutes, the prisoners, and the health care practitioners who got hepatitis B infection. But we’ve learned so much more,” said , a professor of infectious diseases at the Vanderbilt University School of Medicine and a former voting member of ACIP.

As hepatitis B rates remained stubbornly high in the 1980s, scientists realized an entire vulnerable group was missing from the vaccination regime 鈥� newborns. The virus is from an infected mother to baby in late pregnancy or during birth.

“We may soon hear, 鈥楲et’s just do a blood test on all pregnant women.’ We tried that. That doesn’t work perfectly either,” Schaffner said.

Some doctors didn’t test, he said, and some pregnant women falsely tested negative while others acquired hepatitis B after they had been tested earlier in their pregnancies.

In 1991, Schaffner was a liaison representative to ACIP when it voted to for hepatitis B before an infant leaves the hospital.

“We want no babies infected. Therefore, we’ll just vaccinate every mom and every baby at birth. Problem solved. It has been brilliantly successful in virtually eliminating hepatitis B in children,” he said.

In 1990, there were 3.03 cases of hepatitis B per 100,000 people 19 years old or under in the U.S., according to the CDC.

Since the federal recommendation to vaccinate all infants, cases have dramatically decreased. shows that in 2022 the rate among those 19 or under was less than 0.1 per 100,000.

While hepatitis B is often associated with high-risk behaviors such as injection drug use or having multiple sexual partners, note that it is possible for the virus to be transmitted in ordinary situations too, including among young children.

The virus can survive for outside the body. During that time, even microscopic traces of infected blood on a can pose a risk. If the virus comes into contact with an open wound or the mucous membranes of the eyes, an infection can occur. This means that unvaccinated children not considered at high risk can still be exposed in everyday environments.

Future Access Uncertain

If the CDC significantly alters its recommendation, health insurers would no longer be required to cover the cost of the shots. That could leave parents to pay out-of-pocket for a vaccine that has long been provided at no charge. Children who get immunizations through the federal program would lose free access to the shot as soon as any new ACIP recommendations get approved by the acting CDC director.

The two former CDC officials said that plans were underway to push back the official recommendation for the vaccine as of August, when they both left the agency, but may have changed.

Schaffner is still an alternate liaison member of ACIP, and hopes to express his support for universal newborn vaccination at the next meeting.

“The liaisons have now been excluded from the vaccine work groups. They are still permitted to attend the full meetings,” he said.

Schaffner is worried about the next generation of babies and the doctors who care for them.

“We’ll see cases of hepatitis B once again occur. We’ll see transmission into the next generation,” he said, “and the next generation of people who wear white coats will have to deal with hepatitis B, when we could have cut it off at the pass.”

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