Three months after it delayed voting on a recommendation to change hepatitis B vaccine guidance, the Advisory Committee on Immunization Practices on Thursday decided to push the vote to Friday, citing continued member confusion.
"We're trying to evaluate a moving target," said committee member Joseph Hibbeln, noting panelists had received three different versions of the voting question in just 72 hours.
The recommendation presented on Thursday was to only advise a birth dose of the vaccine if a newborn's mother tested positive for hepatitis B.
If the mother tests negative for the virus or doesn't know her status, the recommendation would be to leave immunization up to "individual-based decision-making, in consultation with a health care provider" and otherwise recommend the first dose of the vaccine at two months of age.
The recommendation was not publicly disclosed prior to the meeting.
More than one ACIP member struggled to make sense of the recommendation, with one panelist questioning if it had been written by "the department of redundancy."
The recommendation mentions three times that parents should consult with their health care providers about the decision to vaccinate against hepatitis B at birth.
Panelist Cody Meissner, a professor of pediatrics at Dartmouth who spoke against changing the guidance in September, noted that parents already consult with their health care providers when deciding to immunize.
Remember: Health and Human Services Secretary Robert F. Kennedy Jr. earlier this year purged the panel's members and handpicked their replacements. The panel is now largely comprised of vaccine skeptics.
Back in September, members of the panel decided to put off voting on a recommendation to change hepatitis B vaccine guidance because members felt the evidence fell short of what was needed to make an informed recommendation.
Since 1991, the CDC has recommended that all babies receive a dose of hepatitis B vaccine within 24 hours of birth. If they are born to hepatitis B-infected mothers, the recommendation is to be vaccinated within 12 hours.
But ACIP wants to revisit that.
Why are we here? Typically, the panel evaluates new vaccines or new indications for existing vaccines if there's new evidence of harm or benefit. But hepatitis B shots have been administered in the same way for 34 years, and there was no new evidence given as to why the panel is looking to change the recommendation.
Meissner asked whether there was any evidence of harm from the universal dose.
The presenters, two anti-vaccine activists and a climate scientist who has written for an anti-vaccine publication, did not have an answer.
"This disease has gone down in the United States thanks to the effectiveness of our current immunization program," Meissner said.
Hibbeln pointed out that the near-elimination of hepatitis B in children was considered one of the top 10 greatest accomplishments in science and medicine in the United States.
As a result, "we have a high burden of proof to change this system or change our recommendations," he said.
"If there are any documents or documentation of rates of risks and rates of harm, I have not heard any," Hibbeln said.
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