EXPERT Q&A

A University of Michigan health expert weighs in on a recent recommendation by a national advisory committee to drop the universal hepatitis B vaccine requirement for newborns that is raising many questions and stirring debate.

Anand Parekh, chief health policy officer at the U-M School of Public Health, said the policy, begun in 1991, is seen as one of the country’s top public health achievements after leading to a 99 percent decrease in cases among infants and children, preventing lifelong illness, liver disease and liver cancer.

Parekh spent a decade with the U.S. Department of Health and Human Service, serving as deputy assistant secretary for health in the Senior Executive Service and chief medical adviser for the Bipartisan Policy Center, among other federal public health roles.

Here are some of his insights on the Advisory Committee on Immunization Practice’s recommendations, which he said the CDC is expected to accept.

How does this differ from long-established vaccination strategy?

For several decades, the ACIP has recommended universal hepatitis B vaccination within 24 hours of birth, followed by completion of the vaccine series to prevent infant infection which can lead to chronic hepatitis B and liver disease. The birth dose prevents perinatal transmission due to a lack of testing or failures in reporting test results. It also provides protection to infants at risk from household exposure after the perinatal period.

This updated recommendation, made by a newly constituted ACIP with many members who lack a background in infectious diseases and immunization, moves away from universal vaccination and encourages individual decision-making for parents deciding whether to give the hepatitis B vaccine, including the birth dose, to infants born to women who test negative for the virus.

History has taught us that a universal vaccination strategy has been associated with dramatically reduced cases of chronic hepatitis B infections among young people. The recent ACIP recommendation did not include any new data uncovering risks of the vaccine and seemingly ignored the overwhelming amount of scientific evidence in favor of universal vaccination.

Does this fuel vaccine hesitancy, skepticism?

ACIP’s recommendation will undoubtedly create confusion amongst the public. It will also substantially increase the need for patient education about the importance of the hepatitis B vaccine series to prevent infection and chronic liver disease in children.

How does this affect physicians, healthcare providers, public health representatives?

Changes to recommendations that are not based on new scientific evidence and data place clinicians and public health officials in a difficult situation when speaking to patients and the public, respectively. The tragic irony is that while current health policy leaders have the goal of reversing the children’s chronic disease epidemic, this recommendation would increase the risk for chronic liver disease in children.

More specifically, what are your thoughts on ACIP’s recommendation that parents request antibody testing after vaccination?

ACIP’s recommendation that parents request clinicians obtain blood antibody levels after the first vaccine dose to determine whether additional shots are needed is concerning. It shifts responsibility to parents and may lead to missing the vaccine or not being fully protected. This recommendation is also not supported by evidence. Rather, data continues to demonstrate that the full three-dose vaccination series produces robust, long-term protection from hepatitis B infection. While one would hope that the CDC will reject the ACIP’s recommendation, this is unlikely to occur. The bottom line is that individuals should turn to their personal clinician if they have any questions about the hepatitis B vaccine.