CDC Approves Change to Nation’s Childhood Immunization Schedule

The Centers for Disease Control and Prevention has approved a change to the nation’s childhood immunization schedule, endorsing a recommendation from a federal advisory panel to drop the long-standing practice of giving all newborns a hepatitis B vaccine within 24 hours of birth —  intensifying a national debate over infant vaccination and drawing resistance from pediatricians, state health departments and major medical groups.

The decision followed an earlier vote by the CDC’s Advisory Committee on Immunization Practices that recommended parents of infants born to mothers who test negative for hepatitis B could, in consultation with their healthcare provider, delay the initial dose to at least 2 months of age.

However, CDC did not adopt another recommendation by the committee that drew intense objections from pediatricians. The panel voted to recommend parents and healthcare providers consider blood tests to check levels of protective antibodies to decide whether a child needs additional doses of the three-dose hepatitis B vaccine. According to the agency, it is “reviewing” that recommendation.

“Pediatricians are already reporting more parents declining to give their child this critical dose,” said Susan Kressly, MD, FAAP, president of the American Academy of Pediatrics (AAP). “As a pediatrician, this is heartbreaking when we have a vaccine that can prevent so many infections, and it is deeply disappointing to see the continued dismissal of expertise to inform recommendations that have broad implications on the health of America’s children.” AAP, joined by 66 medical organizations, said the committee’s recommendations are not based on science and “will harm children, their families and the medical professionals who care for them.”

Under the new guidance, the birth dose would still be recommended for infants whose mothers test positive for hepatitis B or whose status is unknown. Members of the committee said the universal recommendation was overbroad and unnecessary for mothers who test negative and that the risks of contracting the virus in early months of infancy were overstated. But pediatricians say the policy ignores the logistical and real-world challenges that led the United States to adopt universal newborn vaccination in 1991 — particularly the risk of missed or inaccurate maternal tests.