| |  | The Lead Brief | The Advisory Committee on Immunization Practices on Friday voted to scrap a decades-old recommendation that all newborns get a hepatitis B shot within hours of birth, and endorsed another change that doctors say could complicate whether children receive the complete three-dose set of hepatitis B vaccines. Over the last two days, ACIP has debated whether it’s safe for newborns to receive the vaccine, and some on the panel emphasized that parents should be able to choose whether they want to get them. If adopted by the Centers for Disease Control and Prevention, the recommendations would mark the biggest overhaul to the childhood immunization schedule under Health Secretary Robert F. Kennedy Jr., who has spent the last two decades questioning whether vaccines are safe. Retsef Levi, an ACIP panelist who voted in favor of the recommendation change, said he believes the intention is to push parents to consider whether they want to give another vaccine to their child, my Washington Post colleagues Lena H. Sun and David Ovalle reported in their excellent story about today’s meeting. “It’s actually suggesting a fundamental change in their approach to this vaccine and maybe more broadly,” said Levi, a professor of operations management at MIT. Meanwhile, medical professionals and health officials had urged the panel of vaccine advisers not to approve the recommendations, warning they could lead to a massive step backward in public health: Since the government began recommending the universal birth dose in 1991, cases of hepatitis B — which attacks the liver and can lead to chronic conditions, cancer and even death — plummeted by 99 percent in children and young adults. Recommendations approved by the panel: - Birth dose: The panel approved, in an 8-3 vote, to recommend that shots for newborns are no longer necessary for babies born to mothers who test negative for the virus. Instead, parents should consult with their doctors regarding if or when to administer the first shot in the three-dose series — and delay the birth dose by at least two months if they decide to wait.
- Subsequent doses: ACIP approved a recommendation that, when deciding whether to get future hepatitis B shots, parents should discuss with clinicians the possibility of giving children a blood test to determine whether they are still protected against the virus by a certain level of antibodies.
PROVIDERS WORRY ABOUT IMPACTS Natasha Bagdasarian, the chief medical executive for Michigan's Department of Health & Human Services, told ACIP before the vote that the recommendation for shared clinical decision-making for the birth dose “actually creates barriers to care.” “Many health care providers interpret it as a sign that the vaccine is controversial, that additional steps are required, or that they may be exposed to additional liability,” she said Friday. Mothers in her state sometimes aren’t able to be screened for diseases if they have trouble accessing prenatal care, added Bagdasarian, making the universal birth dose essential to help fill any cracks and prevent transmission. Before the vote, ACIP panelist Cody Meissner, a professor of pediatrics at the Geisel School of Medicine at Dartmouth, derided the blood testing and specific antibody threshold as “making things up,” comparing the recommendation to “Never-Neverland.” “It's a mistake to say, because we're not seeing so much disease, we can alter the … schedule for administration,” Meissner, who voted against the change, said Friday. “Because we will see hepatitis B infections come back.” Margot Savoy, the chief medical officer at the American Academy of Family Physicians, told me that there is a concern that patients will be more confused about vaccine efficacy, and a worry that the overall process could become more complicated by potentially subjecting babies to extra blood tests — which would require multiple doctors’ visits because those tests typically have to be sent to a lab for evaluation. → Although ACIP said the antibody tests should be covered by insurance, some are questioning whether commercial plans consider them part of routine care. AHIP, which represents insurance companies that serve more than 200 million people in the U.S., said it’s reviewing the recommendation. UnitedHealth Group, the nation’s largest health insurer, and the Blue Cross Blue Shield Association didn’t immediately have a comment about coverage of these tests. | 
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