U-M expert can comment: ACIP shifts away from universal hepatitis B vaccination for newborns
A national advisory committee's recent decision to drop the universal hepatitis B vaccine requirement for newborns is raising questions and stirring debate among public health experts. Last week, the Advisory Committee on Immunization Practices (ACIP) voted to shift away from universal birth-dose vaccination, instead recommending that parents and healthcare providers make individual decisions about whether to vaccinate infants whose mothers test negative for hepatitis B.
Anand Parekh, MD, MPH, Chief Health Policy Officer at the University of Michigan School of Public Health, offers his insights on the recommendation change:
Why this represents a break from established vaccination strategy
"For several decades, the ACIP has recommended universal hepatitis B vaccination within 24 hours of birth, followed by completion of the vaccine series to prevent infant infection which can lead to chronic hepatitis B and liver disease. The birth dose prevents perinatal transmission due to a lack of testing or failures in reporting test results. It also provides protection to infants at risk from household exposure after the perinatal period.
"This updated recommendation, made by a newly constituted ACIP with many members who lack a background in infectious diseases and immunization, moves away from universal vaccination and encourages individual decision-making for parents deciding whether to give the hepatitis B vaccine, including the birth dose, to infants born to women who test negative for the virus.
"History has taught us that a universal vaccination strategy has been associated with dramatically reduced cases of chronic hepatitis B infections among young people. The recent ACIP recommendation did not include any new data uncovering risks of the vaccine and seemingly ignored the overwhelming amount of scientific evidence in favor of universal vaccination."
Impact on vaccine-hesitant Americans
"ACIP's recommendation will undoubtedly create confusion amongst the public. It will also substantially increase the need for patient education about the importance of the hepatitis B vaccine series to prevent infection and chronic liver disease in children."
How this affects physicians
"Changes to recommendations that are not based on new scientific evidence and data place clinicians and public health officials in a difficult situation when speaking to patients and the public, respectively. The tragic irony is that while current health policy leaders have the goal of reversing the children's chronic disease epidemic, this recommendation would increase the risk for chronic liver disease in children."
Additional concerns about antibody testing recommendation
"ACIP also recommended that parents request clinicians to obtain blood antibody levels after the first vaccine dose to determine whether additional shots are needed. This recommendation is also not supported by evidence. Rather, data continues to demonstrate that the full three-dose vaccination series produces robust, long-term protection from hepatitis B infection.
"While one would hope that the CDC will reject the ACIP's recommendation, this is unlikely to occur. The bottom line is that individuals should turn to their personal clinician if they have any questions about the hepatitis B vaccine."
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