The Centers for Disease Control and Prevention
Jeff Amy / AP
A CDC panel voted on Friday to recommend the hepatitis B vaccine only to the babies of mothers who test positive for the virus, and to suggest that, for all other babies, doctors and parents should have a conversation about the risks and benefits of the shot, a process known as “shared clinical decision-making.”
That goes against what the federal government has recommended for nearly 35 years and against the guidance of medical organizations such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.
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That’s why Washington state’s health department, and the West Coast Health Alliance (WCHA), are continuing to recommend the vaccine for all newborns who weigh more than 4.5 pounds. The WCHA is a group of experts convened by the governors of Washington, Oregon, California and Hawaii to give independent, science-based guidance on vaccines.
“Our hope is [that providers] will continue to care for their patients using the best science available,” a Washington health department spokesperson said in an email Friday. “Vaccinating babies within 24 hours of birth protects them from chronic hepatitis B infection and serious consequences such as liver failure or liver cancer.”
Not all mothers get tested for hepatitis B; not all test results are accurate, or accurately reported to the hospital where the baby is delivered; and newborns can be exposed to the virus by other family members or close contacts.
That’s why, since 1991, the CDC has recommended the shot for all newborns. That policy has led to a 99% drop in juvenile cases of hepatitis B in the U.S.
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Helen Chu is an infectious disease doctor and epidemiologist at UW Medicine. Early in her career, she said, she cared for a 19-year-old woman who was born before the CDC’s recommendation for universal hepatitis B vaccination and was dying of liver cancer. Both her parents tested negative for the virus, Dr. Chu said, so the teenager “likely acquired hepatitis B sometime in early childhood, probably from someone around her.”
“Hepatitis B is a very, very infectious virus,” Chu added.
“She was in college,” Chu said, “and I remember having those conversations with her parents and with her younger siblings about how this 19-year-old was going to die of a vaccine-preventable disease.”
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The CDC’s new recommendation “takes us back to that time,” Chu added, when people whose mothers do not have hepatitis B or do not get tested for it acquire the infection in early childhood.
“And hepatitis B is silent, and it doesn’t really cause disease until much later in life, and so we’re really not going to see the effects of this policy change for 10 to 20 years down the line, when [unvaccinated babies] become teenagers or young adults and they develop liver cancer,” Chu said.
The CDC’s new recommendation won’t be official till the agency’s director signs off on it.
