Research Signals Government Decision to Delay Hepatitis B Vaccine Will Come at a Cost

A new report is warning that a decision by the federal government to delay the infant hepatitis B shot will likely raise infections while also adding millions of dollars to overall health care costs. Here is a closer look at the results of the studies and what precipitated the warning.

Body of Research Signals Decision to Delay the Hepatitis Vaccine Could be Costly

A group of studies published this week in JAMA Pediatrics is ringing the alarm bell about the negative impacts of a decision to delay the hepatitis B vaccine, historically given to infants hours after birth. Federal vaccine advisers reporting to the U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. voted late last year to delay the first shot of the vaccine series until at least two months of age if the mother tests negative for the virus. This change was then approved by the U.S. Centers for Disease Control and Prevention (CDC).

The move was met with skepticism within the U.S. medical community. Dozens of medical groups came out in opposition to the decision, warning that it was not rooted in science and could bring harm to children. While there are medications available to control hepatitis B, there is no cure for the infection.

The JAMA studies looked at the long-term impact of the decision to replace the universal birth dose with a shot at two months of age. One of the studies found that delaying the first vaccine for hepatitis B for just two months would increase lifetime health care costs by at least $16 million.

An accompanying editorial published alongside the results of the studies in JAMA Pediatrics noted that the vaccine advisory panel did not stick to the historical standards when making the decision to delay the immunization schedule. The editorial expressed concern that the panel did not look at key evidence and instead focused on "theoretical risks of the vaccine."

Infants are at a particularly high risk of contracting hepatitis B. The virus has been proven to cause infections, liver disease, and cancer. According to the CDC, approximately 90% of infants infected with the virus go on to develop chronic disease, compared to just 5% of adults overall.

Newborns are the most at risk as the virus is present in blood and vaginal fluid, making it easy to pass from the mother during childbirth. The virus can also spread through tiny particles on nail clippers and toothbrushes. Many people in the U.S. are infected with hepatitis B and are not aware.

History of the Hepatitis B Vaccine Policy

U.S. public health officials have recommended that all new babies receive the first dose of this vaccine within 24 hours of birth since 1991. Experts have said that this recommendation has resulted in almost a 99% drop in infections in children.

However, members of the Advisory Committee on Immunization Practices (ACIP) appointed by Kennedy have gone against this long-standing policy, saying that the blanket recommendation was not needed for low-risk infections. The committee's vote to rescind the universal recommendations came after Kennedy fired all 17 members of the ACIP and installed his own members. Several of the new members have a reputation for being critical of vaccines.

The ACIP December vote resulted in the recommendation that babies should receive the shot within 24 hours of birth if the mother had tested positive for hepatitis B or had not been tested. But the panel said that babies born to mothers who tested negative for hepatitis B could wait until the infant turns two months old to receive the first dose of the vaccine.

Infectious disease experts said that the new policy does not consider the logistical challenges facing new parents in the U.S. Many babies are not seen by their pediatricians in a timely manner after birth, creating gaps in vaccination coverage.

The confusion has only intensified after a federal judge put the new recommendations on hold. The judge found that Kennedy was out of his lane when he replaced the entire ACIP panel, saying that the members did not have relevant experience. The ruling means that the prior hepatitis B vaccine guidance of getting the first dose at birth is back in effect.

Those in favor of keeping the official guidance as is say that the universal birth-dose policy is an important public health safety net. Almost 15% of pregnant women in the U.S. do not receive hepatitis B screening. Compounding that issue is that more than half of the women who test positive do not receive the right follow-up care, creating massive gaps in newborn infection detection.

Experts on the virus say that delaying the first dose will also decrease the odds that a child completes the recommended three-shot series. Babies often slip through the cracks, even with a universal birth-dose policy. The infection numbers would increase even more if the vaccine were not widely administered within 24 hours after birth.

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