CNN
—
A group of independent vaccine advisors from the U.S. Centers for Disease Control and Prevention meets this week, and a key item on the agenda is the hepatitis B vaccine.
Following presentations on hepatitis B disease and vaccine safety, the Advisory Committee on Immunization Practices, or ACIP, is expected to vote on whether to abandon the universal hepatitis B vaccination recommendation for infants.
Hepatitis B is a liver infection caused by a virus.
After an acute hepatitis B infection, many adults shed the virus. But acute infection can lead to chronic hepatitis B, which is linked to an increased risk of liver cancer, organ failure, and cirrhosis, or scarring of the liver. People with chronic hepatitis B are 70 to 85 percent more likely to die prematurely.
At Thursday’s ACIP meeting, Dr. Sandra Fryhofer, who spoke as a liaison for the American Medical Association, said she spent time treating patients in a hepatitis B ward when she was a medical student.
“Those were the sickest patients I’ve ever seen in my life,” he said. “I have treated patients with hepatitis B liver disease, hepatitis B cirrhosis, hepatitis B liver cancer, and hepatitis B death.”
Infants and children who become infected with hepatitis B are more likely to develop chronic disease, including about 90% of infants and 30% of children ages 1 to 5 years.
The hepatitis B virus is highly infectious. It is transmitted when blood, semen, or other body fluid from a person infected with the virus enters the body of someone who is not infected.
Certain medical conditions, behaviors and other factors increase the risk of acquiring hepatitis B—including injection drug use and sexual activity—but anyone can get it. The hepatitis B virus can also be easily transmitted during childbirth, from a pregnant woman to her child, whether in a vaginal delivery or by cesarean section.
Many people with hepatitis B have no symptoms, and more than half may not know they are infected.
The most recent data from the CDC shows that there were about 2,200 new reported cases of acute hepatitis B in 2023, but estimates suggest that the actual number of cases was more than six times higher, about 14,400.
The CDC also estimates that about 640,000 adults in the US have chronic hepatitis B.
Globally, the World Health Organization estimates that 254 million people live with chronic hepatitis B infection, with approximately 1.2 million new infections each year.
There is no treatment for acute hepatitis B, but there are some medications that can be used to treat chronic cases. Treatment for chronic hepatitis B can be lifelong; There is no cure for the disease.
The best way to prevent hepatitis B infection is vaccination. Vaccines are highly effective in preventing infection in infants and in providing long-term protection into adulthood.
According to the CDC, most people with hepatitis B were infected as infants or young children, when their immune systems were not fully developed. Currently, the agency recommends that all infants be vaccinated at birth, before leaving the hospital.
Infants typically receive a three-dose series of hepatitis B vaccine, and a review of scientific evidence by the Vaccine Integrity Project shows that 95% of healthy infants have sufficient protection against infection after the third dose. Vaccination has also been shown to reduce the risk of infection in infants born to mothers with hepatitis B by almost 70%.
More than 90% of people who received the primary series of vaccines showed evidence of protection 30 years later, according to data posted on the CDC website.
Universal hepatitis B vaccination was first recommended for newborns in 1991, and is credited with reducing the number of hepatitis B infections in children from about 18,000 cases a year to about 20 cases a year today. However, anti-vaccine activists, including HHS Secretary Robert F. Kennedy Jr., have long questioned the need and safety of this vaccine, despite decades of evidence supporting it.
Women are also often tested for hepatitis B during the first three months of pregnancy, but maternal infections may be missed if a woman contracts the virus after being tested. Additionally, maternal testing does not protect infants from exposure to other positive family members or caregivers.
“We established during the data presented today that our detection of these hepatitis B-positive mothers is not 100%, so we have a gap there that certainly needs to be closed,” Fryhofer said at Thursday’s ACIP meeting.
“We have a duty to protect these little babies, and I am especially concerned about this early postnatal transmission.”
Infectious disease experts say vaccinating all babies provides a critical safety net to protect those at risk when maternal testing misses them.
“When these little babies are born, between the time they are born and when we might delay a dose of hepatitis B, we don’t know who is going to take care of them,” Fryhofer said. “Are we going to test every person who has access to or touches that baby? That’s really not feasible.”
The Vaccine Integrity Project scientific review concluded that giving the hepatitis B vaccine at birth “has consistently been shown to be safe.”
Only “mild to moderate and short-lived reactions,” such as redness and swelling at the injection site and low-grade fever, have been reported, and there was “no increased incidence of serious and life-threatening adverse events related to the vaccine.”
Dr. Anthony Fiore, an infectious disease doctor and former CDC official who worked in the hepatitis division, called it a “remarkably safe vaccine” that has been studied in many ways before and after its approval. The US vaccine safety monitoring systems “have looked at this very carefully, investigating concerns people may have about increased fever or other chronic conditions.”
“None of these concerns have been confirmed,” Fiore said. “Nothing has been shown to have long-term consequences, and certainly nothing that comes close to the consequences of chronic hepatitis B virus infection.”
