Doctors warn that delaying hepatitis B vaccine could lead to deadly conditions: shots

Work from a Tribal-owned hospital 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 the lives of young people in western Alaska communities with astonishing speed.

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

McMahon often thinks of an 8-year-old boy who showed no signs of illness until he complained of pain due to a rapidly growing tumor in his liver.

McMahon can still hear his voice.

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

Hepatitis B virus is transmitted through blood and bodily fluids, even in microscopic quantities, and the virus can live on surfaces for a week. Like many of his patients, both children were infected with hepatitis B at birth or in early childhood, McMahon said.

This outcome can now be prevented. The recommended birth dose of vaccine for newborns since 1991 is up to 90% effective In preventing infection from the mother if given within the first 24 hours of life. If children receive all three doses, 98% of them They have immunity to the incurable virus, with at least lasting protection 30 years.

And in western Alaska communities, years of targeted testing and widespread vaccination efforts have led to… The number of cases is declining.

“Children’s liver cancer has disappeared,” McMahon said. “We haven’t seen a case since 1995. We also don’t have any children under the age of 30 who have been infected that we know of.”

He worries that those hard-won gains could soon be reversed.

Pay the dose again?

A vaccine advisory committee to the Centers for Disease Control and Prevention is scheduled to be formed by Health and Human Services Secretary Robert F. Kennedy Jr. For discussion and voting Birth dose recommendation for hepatitis B during its two-day meeting beginning Dec. 4, which could limit children’s access to the drug.

On Tucker Carlson’s podcast in June, Kennedy falsely claimed that the birth dose of hepatitis C was the “likely cause” of autism.

He also said that hepatitis B virus is not “accidentally contagious.” but Decades of research It appears that the virus can be transmitted by indirect contact, when traces of infected fluids such as blood enter the body when people share personal items such as razors or toothbrushes.

The committee’s recommendations have weight. Most private insurance companies must cover vaccines approved by the Advisory Committee on Immunization Practices, and many government vaccination policies are directly tied to its guidelines.

Neither ACIP nor CDC is regulatory. They cannot impose fortifications. that it Even countries To do this.

But maintaining the recommendation for 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 vaccination as long as it remains FDA-approved.

Two top FDA officials — Commissioner Marty McCurry and chief vaccine regulator Vinay Prasad — suggested at the end of November that Changes to The vaccine approval process may be coming. Vaccines must be approved by the Food and Drug Administration (FDA) to be administered in the United States.

in Internal agency emails He got it PBS Newshour and The Washington PostPrasad questioned the routine practice of “administering multiple vaccines at the same time.” It is not clear whether he refers to combination vaccines that provide immunity against multiple diseases in a single dose. Three of the nine hepatitis B vaccines currently approved by the FDA are combination vaccines. the Birth dose The hepatitis B vaccine is only given as a stand-alone vaccine.

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

“Sowing seeds of distrust”

If private insurers choose to continue covering the vaccination, misinformation from the meeting could lead families to wrongly believe the vaccine could harm their children, he said. Sean O’Learychair of the Committee on Infectious Diseases of the American Academy of Pediatrics and assistant professor of pediatrics at the University of Colorado School of Medicine.

He added: “Whatever comes out of the disaster of the meeting in December, it will mainly revolve around sowing seeds of mistrust and spreading fear.”

President Donald Trump, Kennedy, and some newly appointed ACIP members did so You misdescribed how liver disease spreadsIgnoring or underestimating the risk of transmission through indirect contact. Hepatitis B virus is Much more contagious From HIV. Unvaccinated people, including children, can become infected from microscopic amounts of blood on the surface of a table or game, even when the infected person is asymptomatic.

McMahon cared for babies who tested negative at birth and subsequently became infected through indirect contact. In a Study in the seventiesHe said that nearly a third of these children had chronic hepatitis C without showing any symptoms.

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

The CDC recommends hepatitis B screening for all pregnant women, but estimates that up to 16% don’t get tested and fall through the cracks. O’Leary and other experts say testing mothers for the virus before or shortly after birth is not possible because most hospitals lack staff and resources.

The three-dose vaccine contains: Proven track record Of safety. Several studies show that it is not associated with an increased risk of infection Infant death, Fever or sepsis, Multiple sclerosisor Autoimmune conditionsSevere reactions are rare.

“We have an incredible safety profile,” O’Leary said. “Nobody expects to get into a car accident, right? And yet we all wear our seatbelts. It’s similar.”

The Centers for Disease Control and Prevention estimates that 2.4 million people in the United States are infected with hepatitis B and that’s half I don’t know They are infected. The disease can range from acute to chronic infection, and is often accompanied by Few or no symptoms.

If left untreated, it can lead to serious conditions such as cirrhosis, liver failure, and liver cancer. There is no cure. It can sometimes include treatment Antiviral or immunomodulatory medicationsIf the benefits outweigh the risks of severe side effects.

Expert advice for parents: Talk to a doctor

Some parents may have difficulty understanding why a newborn would need a vaccine so soon after birth, especially against a virus they feel they do not have, and often incorrectly associate only with risky behaviors. William Schaffnerprofessor of preventive medicine at Vanderbilt University School of Medicine and a former voting member of ACIP.

These perceptions are mixed with declining confidence in public health and increasing skepticism about vaccines, Schaffner said.

His advice for expectant parents who are on the fence is to talk to their doctor about shots. Even if a pregnant woman tests negative, he said, it is still important to give the baby the birth dose, because false negative results are possible and because the virus can spread easily from surface contact.

Children who receive the full series of vaccines starting at birth have a chance Reduced incidence of liver cancer by 84%.

“If you wait a month and the mother tests positive, or the child catches the infection from a caregiver, by that time the infection will have settled in the child’s liver,” Schaffner said. “It is too late to prevent this infection.”

If fewer people are vaccinated, he said, hepatitis B will spread at higher rates in American communities and the risk of contracting the virus will rise for everyone who does not get vaccinated.

More cases of hepatitis B could mean higher costs for patients and the broader health care system. The Centers for Disease Control and Prevention estimates that treating someone with a less severe form of the disease costs between $25,000 and $94,000 per year. For patients who need a liver transplant, annual medical expenses can rise to more than $320,000, depending on their treatment.

Over the past thirty years, Major adverse events Parents have reported that their babies who received the birth dose experienced fussiness and crying, both of which passed quickly. This is a very strong safety profile — for a newborn vaccine with a proven track record of protecting children from an incurable disease, Schaffner said.

“The data is very clear on this,” Schaffner said. “A whole bunch of other countries have now started this program. They’ve modeled it after us.”

This story comes from NPR’s health reporting partnership with KFF Health News a national newsroom that produces in-depth journalism on health issues and is one of its core operating programs KFF – An independent source for health policy research, polling and journalism.