Docs blast move to end universal hep B vaccination: Here are the top perspectives capturing the backlash
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I worry that the trust in our public health infrastructure is gone forever. The organizations have turned political, rather than scientific. I’m not sure that is a change that can be undone.
—@0ldertwin via Reddit
The professional societies like the AAP will go back to making vaccine policy on their own like it was in the 80s. Some states will have their own schedules. Pray to the god the insurance companies follow. I am really worried about VFC and Medicaid since they are federal.
—An infectious disease expert and pediatrician on Reddit @Laudablepus
In a reversal of policy that has stood for more than three decades, the Advisory Committee on Immunization Practices (ACIP) has voted to end the longstanding recommendation that all newborns receive a dose of the hepatitis B vaccine within 24 hours of birth. []
Under the new guidance, for infants born to mothers who test negative for hepatitis B surface antigen (HBsAg), the decision about whether and when to vaccinate becomes subject to “individual-based decision-making.”
And doctors are predictably outraged, arguing the decision is not based on science and will likely lead to an increase in preventable infections. Below: Our favorite quotes from doctors in response to the shift.
Why the change?
During the deliberations, ACIP members pointed to evolving epidemiology and measures beyond neonatal vaccination that have reduced the burden of hepatitis B in the US.
Proponents argued that infants born to HBsAg-negative mothers—who represent the large majority in the US—face extremely low risk for horizontal (post-birth) infection. Hence, universal birth-dose vaccination may no longer be justified. []
But many doctors fear that the consequences of these new guidelines could result in a sharp increase of hepatitis B infections in children—and even lead to death.
Docs react
On the r/medicine subreddit, physicians are discussing their worst fears about the recent policy shift. "I worry that the trust in our public health infrastructure is gone forever. The organizations have turned political, rather than scientific. I’m not sure that is a change that can be undone," said Reddit user @0ldertwin, an internal medicine physician/pediatrician.
Reddit user @Ythapa, a pharmacist, echoed similar sentiments: "It’s just a shame what the CDC/ACIP has turned into. I’m just sad for the children who haven’t any choice in the matter," they said.
And Reddit user @cafe262, an MD, pointed out that RFK's appointees are ignoring the risk of horizontal/household transmission: "Even if the mother is HBV-negative, the baby can still be infected by another household member/caregiver (shared grooming items or blood contact from small cuts)," they said. "Prior to the HBV vaccine universal birth dose, ~18,000 children were infected with HBV each year. About 50% were infected at birth, and the other 50% were infected after leaving the hospital. The universal birth dose acts as a safety net to cover these kinds of cases."
"There was no evidence at all that this change was needed and it will result in harm," added Reddit user @LaudablePus, an infectious disease doctor. "The professional societies like the AAP will go back to making vaccine policy on their own like it was in the 80s. Some states will have their own schedules. Pray to the god the insurance companies follow. I am really worried about VFC and Medicaid since they are federal."
Our favorite response? Zachary Rubin, MD, an allergy specialist and pediatrician, used a metaphor to to help patients understand why this new guidance is harmful: "Removing the hepatitis B vaccine birth dose recommendation because cases are low is like canceling your car insurance because you haven't crashed today."
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