The Abridged version:
- Dr. Dean Blumberg of UC Davis said hepatitis B vaccines have been a “tremendous success,” decreasing infant infection by over 99%.
- A CDC committee is no longer recommending the hepatitis B vaccine at birth. Blumberg said there’s “no evidence behind these recommendations.”
- Blumberg said it is a “confusing time with conflicting recommendations” for parents.
- He recommends parents discuss vaccines with their their pediatrician or family doctor to get the best advice.
Since the early 1990s, new parents have been advised to vaccinate their babies against hepatitis B on the day they are born. But in an reversal, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted on Dec. 5 to no longer recommend the vaccine to newborns.
Abridged visual journalist Tyler Bastine interviewed Dr. Dean Blumberg, professor and chief of pediatric infectious diseases at UC Davis Children’s Hospital, about his reaction to the recent changes.
Watch a shortened video of Blumberg’s answers. Read the full Q & A below.
Q: First of all, I want to talk about what hepatitis B is and how it’s transmitted.
A: Hepatitis B is caused by a viral infection. It’s the hepatitis B virus. And when people get it, then it goes to the liver. When it gets to the liver, it can cause inflammation.
So a lot of people, when they think about hepatitis, they think about acute hepatitis, which may be asymptomatic. But if it is symptomatic, it can cause symptoms for several months — fever, inflammation of the liver.
So that can result in abdominal pain, nausea, vomiting, diarrhea, weight loss and then jaundice, where you get yellowing of the eyes and the skin. After that people can recover.
Or it could be so severe that people have liver failure and need a liver transplant. Or it can go into more of a quiescent state and cause chronic infection. And with chronic infection, then people have it for the rest of their lives and years in the future.
It may end up causing something like cirrhosis of the liver, which can cause problems of its own or liver cancer.
Q: Is it curable?
A: There are treatments for hepatitis B, antiviral treatments — and they’ve really been advanced, for many people, they may not be aware of them. And so they may not be taking advantage of those treatments that are available.
Q: Why was the vaccine originally recommended to new parents?
A: One of the reasons that we vaccinate infants is because we want to prevent chronic infection. So when infants, when newborns, get hepatitis B infection, they have a 90% chance of this going on to cause chronic infection. And that means that a quarter of them will end up dying from hepatitis B related diseases, such as cirrhosis or liver cancer.
When you get hepatitis B as an adult, there’s only a 5 to 7% chance of becoming a chronic carrier, a chronic infection.
And so really, if you want to prevent the consequences of chronic infection, you really want to prevent infection during the perinatal period. That’ll give you the best bang for your buck.
Q: That was my follow-up question. Why is it critical to be vaccinated the first day?
A: I think one of the things that is important to talk about is how hepatitis B is transmitted. So many people will have heard that hepatitis B may be transmitted by intravenous drug use or high-risk sexual activity.
But it’s transmitted in many other ways also. So it can be transmitted during the birth process or during pregnancy, and even just casual exposure in a household. Household contact is a risk factor for transmission of hepatitis B. And then it’s transmitted in ways that we just don’t fully understand.
And so even for people who we don’t think might not be at risk for hepatitis B, preventing them from getting hepatitis B during this vulnerable period for getting chronic infection is really a safety net for them, merely protecting them, to make sure that they don’t have the consequences of chronic infection.
Q: What were the original hepatitis B vaccine guidelines? And how long was that in place?
A: The original guidelines were risk-based. So just to vaccinate people who are at high risk of getting exposed. And what we found was we missed a lot of kids, we missed a lot of infections. And we did recommend screening women, all pregnant women, to see if they did have hepatitis B to see if they were carriers, and a risk of transmitting infection. That was a good program.
But again, it missed many pregnant mothers either because they weren’t screened, or they were screened and then those screening tests weren’t followed up or people misinterpreted the results.
So then the recommendation was to do universal infant hepatitis B immunization. And this recommendation turned out to be a tremendous success, decreasing infant infection by over 99%.
Q: And when were the guidelines in place? It was several decades, right?
A: Yes, these recommendations for universal infant immunization with hepatitis B came out in 1991, and it took about 10 years for them to be widely adopted. So there was a learning process for the health care system. And for physicians and communicating that to patients. But once that became routine practice, it really was tremendously successful.
So if you think about scrapping that system and returning again to the screening system and only immunizing those who you believe are at risk, that’s a real step backward. And that means that we don’t have that safety net anymore.
If we go back to our previous screening strategy alone where we don’t do universal immunization of infants, we’re going to end up missing a bunch of potential transmitting events and missing some infections.
So some of the kids are going to fall through the cracks. We’re not going to get them immunized. We’re not going to prevent infection.
And that’s going to result in about an additional 1,400 children getting infected every year in the U.S.; about 480 of them will end up dying from hepatitis B consequences.
Q: How effective is hepatitis B vaccine? What have you seen over the past three decades?
A: The vaccine is very effective. It’s about 95% effective in inducing long-term immunity when given as the three- or four-dose series. And then in addition, there’s other things that are given for known exposures to hepatitis B in addition to the vaccine. And that results in more than 96% prevention of transmission of hepatitis B.
Q: So what are the new recommendations? And how did they differ from the previous guidelines?
A: The new CDC recommendations are to delay that birth dose to 2 to 3 months of age. And also they’re recommending for parents to consult with doctors to do blood tests after every dose to see if children have formed immunity. There’s no evidence behind these recommendations.
And mainstream medical organizations such as the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, the American College of Physicians and Infectious Diseases Society of America — all of them are rejecting these recommendations from the CDC because they feel that the current program, that there’s evidence to support it, and there’s no evidence to change the program at the present time.
Q: And why were these updates made now? What changed?
A: What changed was the the makeup of the Advisory Committee on Immunization Practices to the Centers for Disease Control was changed. …
Before it was unbiased scientists who were well-qualified to make these decisions. … The information that was presented was fully transparent, was available to the public weeks to months in advance. And it was evidence-based. So it was based on actual scientific data and the implications of changing recommendations.
Q.: What about the new committee?
They’re not looking at data, they’re cherry-picking studies. The decision-making is not transparent, and they’re not sharing data with the public. So it’s really an unqualified committee currently, as it’s constituted.
Q: And what is your reaction to this?
A: Well, it’s disappointing because what this results in is a lot of confusion to parents when they read the headlines, when they see this. One thing that’s good that’s come out of this is that a lot of these professional medical organizations, mainstream organizations, have banded together and provided this evidence-based, transparent decision-making that’s an alternative to what the ACIP is doing now. And so they’re really replacing the process that was in place before. And it’s come together relatively quickly.
So if parents are confused about these recommendations, I would advise them to talk with their doctor, talk with their pediatrician or family practitioner, because they’re going to look to their professional organizations for the mainstream guidance, for what’s best for their patients.
Q: And do all hospitals have to apply the new recommendations? How does this change how UC Davis Health recommends vaccines that are given at birth?
A: UC Davis Health is really following the mainstream medical recommendations. And these are evidence-based, transparent recommendations that are really the best for our patients. And so in California, of course, we’re fortunate in that we are part of the West Coast Health Alliance.
And again, the California Department of Public Health, in association with other states, are following these really evidence-based, scientific recommendations. And so that’s different from what’s occurring in other states. So I do feel fortunate to be practicing here in California.
Q: How can families best navigate the changes overall? What would you say to parents?
A: This can be a confusing time with conflicting recommendations, specifically with vaccines. I would really recommend for parents to discuss this with their health care provider, with their pediatrician, with their family practitioner. They’re the ones who are going to know what’s best for their patients, for your child. They’re the ones that are going to have the best information.
And if you want other information, go to more mainstream sources of information. So, for example, the American Academy of Pediatrics has a website healthychildren.org. And they’ve got some really great resources both for physicians and for parents and patients, about these sorts of issues.
Q: What changes have you witnessed with parents’ views on health care or vaccines? Have you have you seen a shift?
A: I think what this has done is, it’s been confusing to parents, because we’ve got these conflicting recommendations, and some people will only see the headlines that say that the CDC has changed recommendations. And really, for so many years, the CDC has been a reliable, apolitical organization.
But, you know, unfortunately that’s changed this year. So we need to really change our focus and change who we rely on for mainstream medical information, as long as the Advisory Committee on Immunization Practices is composed the way it is.
Q: And how can the health community do more to instill trust in vaccines in general?
A: I think, you know, with vaccines, what we’ve really learned over the years, is that there are many questions about the vaccines and vaccine recommendations. And what’s really needed is clear and consistent messaging.
Unfortunately, for the next few years, I’m afraid we’re not going to have clear and consistent messaging. So that places more of a burden on parents to really look to where that information is coming from, what that information is based on.
If you really want mainstream medical information that’s based on science, that’s based on data, I would look toward those mainstream medical organizations — the American Academy of Pediatrics, the American Association of Family Practitioners, the Infectious Disease Society of America.
They’ve banded together and really have harmonized their recommendations so that they are evidence-based and scientifically-based.
Q: Is there anything else that you would like to add? Or that you want to tell parents and families about navigating these changes?
A: This hepatitis B vaccine program has been extraordinarily successful. It’s really thinking about protecting your child against future liver problems, preventing your child from getting cancer in the future. This won’t happen in the next year or two.
But, you know, when your kid is 30 or 35, has a family, they are parents of their own, you don’t want them coming down with liver cancer, and this is one way that you can protect them.
So I think about it as a safety net option. So just like you drive in a car that has seat belts, you also want your young children to be in car seats and you also want airbags in that car.
So you want everything there, everything possible, to make sure it’s the safest experience for you and your family. You don’t just want one of these components.
Tyler Bastine is a video producer for PBS KVIE, and a visual journalist for Abridged.