Doctors, hospitals and public health departments are scrambling to ensure adequate care for pregnant women and their babies following a controversial vote by Centers for Disease Control and Prevention advisers that reversed decades of standard medical practice by giving the hepatitis B vaccine to newborns.
“We still don’t really know how hospitals and individual doctors will handle this,” said Dr. Brenna Hughes, interim chair of the department of obstetrics and gynecology at Duke University in Durham, North Carolina. “It’s creating fear and mistrust.”
Last Friday, the CDC’s vaccine panel recommended that only babies born to women who test positive for hepatitis B should receive the first dose within 24 hours of delivery. The decision rolled back decades of guidance that all newborns should be protected against a lifelong, incurable infection that can lead to liver disease and cancer.
However, many babies in the United States are born to women who never have the opportunity to be tested.
A March of Dimes report released in November found that nearly a quarter of pregnant women are not under medical care during the first trimester, when most women are tested for hepatitis B.
Dr. Steven Fleishman, president of the American College of Obstetricians and Gynecologists, said the hepatitis B vaccine given to newborns acts as a safety net.
“If someone is exposed to hepatitis B later in pregnancy or develops an infection later,” Fleishman said, “the baby is protected by that vaccine.” The virus can pass from mother to baby during childbirth.
As of Tuesday, acting CDC Director Jim O’Neill had not yet approved the committee’s recommendation. The agency is not required to follow the panel’s advice, but usually does.
The CDC does not require vaccination. Recommends a schedule so that children are protected from infectious diseases. The vaccine panel periodically reviews the data and makes changes to the schedule based on guidance from doctors or scientists with expertise in the subject.
But experts said the advisory panel, packed with members hand-picked in June by Health Sec. Robert F. Kennedy Jr, did not provide the type of scientific evidence historically associated with the CDC to support his reasoning.
The group “has not followed the standard, transparent process that had made the advisory committee a bastion of good, evidence-based decision-making,” said Dr. Jason Goldman, an internal medicine physician and president of the American College of Physicians. “Their information and decisions cannot be trusted.”
The panel recommended that women who test negative for hepatitis B can decide, in consultation with a health care provider, whether their baby should receive the birth dose.
The panel’s vote to postpone hepatitis B vaccination in infants until at least 2 months of age for the first dose if the vaccine is not given at birth was totally out of line with decades of evidence demonstrating the shot’s safety and effectiveness, experts say. The birth dose, implemented for all babies in the early 1990s, has reduced cases of acute hepatitis B infections in children by 99%.
During a call with reporters Tuesday, Dr. Aaron Milstone, a pediatrician at Johns Hopkins Medicine and a member of the American Academy of Pediatrics’ committee on infectious diseases, said the fallout is “chaos and confusion” among public health experts trying to advise doctors on best practices, as well as among doctors in exam rooms facing worried parents.
“Many physicians are working across our country with the fear that doing what is best for their patients is now at odds with information coming from previously trusted resources,” Dr. Sarah Nosal, president of the American Academy of Family Physicians, said during the same call.
“If you have to spend 20 minutes explaining that vaccines are, in fact, safe,” said Dr. Kevin Schulman, a professor of medicine at Stanford Medicine, “then we’re not going to spend 20 minutes making sure that the baby is on the growth curve, that the baby is wearing the seat belt, that the baby is using the car seats appropriately.”
Dr. Anna Lok, director of clinical hepatology and associate dean for clinical research at the University of Michigan School of Medicine, said the change in guidance adds barriers for parents, especially in a chaotic delivery room.
“It’s just telling parents that we’re going to make them climb Mount Everest to vaccinate their baby,” Lok said. “Because every step, every obstacle, is simply ensuring that something that should be done is not done.”
Dr. Rashmi Roa, an OB-GYN specializing in high-risk pregnancies at UCLA Health, said nothing has changed from a medical standpoint. “Our recommendations will remain the same.”
Some states are ignoring federal recommendations and instead joining forces to establish their own guidelines. Dr. Naima Joseph, an obstetrician and gynecologist at Beth Israel Deaconess Medical Center in Boston, said health officials from Massachusetts and other states have formed the Northeast Public Health Collaborative.
“We have already made recommendations on universal birth dosing of hepatitis B vaccine that continues to ensure access” to newborns, he said.
A measured approach is not expected nationwide, said Joe Zamboni, an attorney for the nonprofit American Families for Vaccines. “I think some states will probably do better than others,” he said.
One state that worries public health experts is Florida. The state’s surgeon general, Joseph Ladapo, said in September that Florida is working to eliminate all vaccine requirements for children to attend school.
The Florida Department of Health scheduled a meeting for this Friday, December 12 to discuss those requirements. A department spokeswoman told NBC News via email that the meeting will be held in Panama City and will not be available to the public online.
