Public health experts told TribLive Friday they fear a federal panel’s advice to stop giving most babies hepatitis B shots immediately after birth will fuel infection rates and erode confidence in vaccines more broadly.

The advisory committee voted 8-3 on Friday that pregnant women who test negative for the virus should talk to their doctor and decide if their child should be vaccinated against the virus at birth.

That reverses a 1991 recommendation for doctors to give the first vaccine dose to infants within 24 hours of birth if their mothers are not known to be infected.

“Giving the vaccine within the first 24 hours of life significantly decreases the transmission of hepatitis B from the mom to the baby,” said Dr. Joseph Aracri, system chair of pediatrics at Allegheny Health Network’s Pediatric Institute. “It’s incredibly safe to give this vaccine at birth. We’ve been doing it since ‘91. The benefits way outweigh the risks.”

Two later doses are often administered. A second vote Friday, passed 6-4 with one abstention, says parents should consider having their child’s immune response tested after the first shot to see if additional doses are needed.

Giving all three shots remains a “crucial strategy for protecting our population,” Dr. Lauren Trimelon, director of Independence Health System’s mother-baby program, said in a statement.

Health and Human Services Secretary Robert F. Kennedy, who handpicked the committee, has expressed concerns about the safety of the vaccine and downplayed the risk of transmission from mothers who test negative for the virus.

On Tucker Carlson’s podcast in June, for instance, 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.”

Hepatitis B is a serious infection that can either be short-term or chronic. When it sticks around in the body — a more likely outcome in children versus adults — it significantly raises risks of liver failure, liver cancer and cirrhosis.

Side effects from the vaccine are usually mild and temporary, according to the Centers for Disease Control and Prevention. The agency oversees the vaccine panel and is under Department of Health and Human Services control.

The acting director of the CDC, Jim O’Neill, still must decide whether to accept the panel’s recommendation. He’s been urged by Bill Cassidy, a Republican senator from Louisiana and doctor specializing in liver disease, not to do so.

About 32,000 new hepatitis B infections were reported in 2023, according to the latest CDC data. Transmission can happen from mother to baby during birth, but about half of cases come from infected blood and body fluids.

“If you live in a house with someone with hepatitis B, you having a high risk of getting hepatitis B,” said Dr. Paul Offit, a vaccine expert based at Children’s Hospital of Philadelphia. “This virus is about 50 to 100 times more contagious that HIV.”

The committee now says the shot should be delayed until at least two months old, a timeline panned by public health experts as arbitrary.

“The vaccine is as safe and effective at two months as it is at birth,” Offit said.

The recommendation stands to give the first dose within 12 hours to infants of mothers who’ve tested positive for hepatitis B. But screening measures are imperfect.

A mother may be tested in the first trimester, for instance, but become infected just weeks before giving birth. About 20% of women lacking access to or opting out of prenatal care don’t get tested at all, Offit said.

There’s also the chance of false negatives, Aracri said.

‘Concerted attack’

Dr. Amesh Adalja, a Pittsburgh-based infectious disease expert and a professor at Johns Hopkins University, said the consequences of the decision go beyond hepatitis B.

“This is a concerted attack on the way vaccines are used and developed in the United States,” Adalja said.

He’s been bracing for this outcome since the committee discussed loosening its hepatitis B vaccine recommendations in September, but delayed a vote. The group holds three public meetings each year.

Now, he expects Kennedy and the panel to turn their focus to how flu shots are approved and the use of aluminum in vaccines, which is widely considered a safe way to boost immune response.

“This isn’t the end of it,” Adalja said.

The Department of Health and Human Services did not return a request for comment.

The Allegheny County Health Department said it is “deeply concerned” about the recommendation.

It called the vaccine one of the most “effective and equitable” public health measures in the country, contributing to a 99% decline in chronic hepatitis B infection among children.

“We will continue to work with partners at the local, state and national levels to uphold strong, evidence-based guidance,” county Health Director Dr. Iulia Vann said.

“Universal hepatitis B vaccination at birth remains a critical component of safeguarding infant health across every community we serve.”

The health department said it will continue promoting hepatitis B vaccinations at birth.

The decision to reverse the longstanding guidance marks a significant departure from decades of evidence and from the positions of major medical and public health organizations, the department’s statement said.

Fortunately, in Adalja’s view, many doctors are likely to disregard the panel’s recommendations and continue administering the shots as before. There’s nothing binding about Friday’s votes, even if doctors and patients traditionally look to federal health officials for guidance.

The American Academy of Pediatrics is still recommending the vaccination be given at birth.

But the roughly 20% of parents who don’t allow their baby to get the hepatitis B vaccine at birth may still grow “if it doesn’t have the same full force of recommendation or the public is now just confused,” according to Adalja.

Dr. Donald Yealy, chief medical officer for UPMC, affirmed his support for the vaccine, adding patients are strongly encouraged to discuss the matter with their doctor.

UPMC did not immediately respond to a question about whether the panel’s vote would affect its insurance coverage.

Highmark Health, AHN’s insurance provider, will continue to cover the shot at birth, according to a spokesman.

“Right now, we’re still recommending and giving the vaccination in the hospital,” Aracri said.

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