CDC's ACIP Revamps Infant Hep B Schedule: Frontline Nurses React

In a vote that has rocked the healthcare community, the Centers for Disease Control and Prevention vaccine advisors voted Friday to no longer recommend that all newborns receive a hepatitis B vaccine at birth. 

The Advisory Committee on Immunization Practices (ACIP) voted 8–3 to end the universal recommendation for a hepatitis B birth dose in infants born to women who test negative for the virus, while continuing to recommend a birth dose for infants whose mothers are hepatitis B positive or whose hepatitis B status is unknown. Women who test negative during pregnancy are now advised to make an individual, shared decision with their newborn’s healthcare provider about whether to receive the hepatitis B vaccine at birth or begin the series later in infancy.

According to the World Health Organization (WHO), the hepatitis B vaccine prevents more than 95% of infections when administered as recommended and protects nearly all newborns from developing chronic hepatitis B. For more than 30 years, the recommendation has been to administer the first dose within 24 hours of birth. 

Source: CDC Committee Meeting

What is the ACIP?

To understand why this vote matters, it helps to know who sits on ACIP and what they do.

The ACIP comprises 19 voting members responsible for making vaccine recommendations. The voting members are independent medical and public health individuals who are not employed by the CDC. The voting members are selected by the Secretary of the U.S. Department of Health and Human Services (DHHS). 

In addition to the 19 voting members, there are 6 ex officio members who represent other federal agencies with responsibility for immunization programs in the United States, and 30 non-voting representatives of liaison organizations that bring related immunization expertise.

The hepatitis B vaccine is a three-part vaccine series with the first dose generally administered within 24 hours of birth. Despite the CDC changing its recommendation, the WHO has not: they continue to recommend that the birth dose should be followed by 2 or 3 doses to complete the primary series, depending on different vaccine schedules.

American Nurses Association Statement

The American Nurses Association (ANA) strongly opposes the new ACIP recommendation regarding the hepatitis B vaccine. 

“The hepatitis B birth dose has long represented one of the great success stories in public health,” said ANA President Dr. Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN. “Nurses have witnessed firsthand the power of prevention. As the most trusted profession, we have both an ethical and professional obligation to advocate for evidence-based immunization practices that protect the most vulnerable. Especially newborns, who depend on us to keep them safe.”

Changes to the existing guidelines should be based on:

• Scientific evidence
• Transparent review
• Broad stakeholder engagement

“Decades of nursing leadership and public health progress have shown that vaccines save lives,” said Dr. Mensik Kennedy. “ANA stands ready to work with federal agencies, scientific experts, and our partners across health care to ensure that vaccination policies continue to reflect the best available evidence and uphold our shared responsibility to prevent disease and protect the public.”

Mass Opposition

After the announcement was made, nearly every single major healthcare organization voiced opposition to the new recommendations. These included:

• Washington State Nurses Association
• Oregon Nurses Association
• American Nurses Association/California
• Hawai’i-American Nurses Association
• West Coast Health Alliance
• American Academy of Pediatrics
• American College of Obstetrics and Gynecology
• Infectious Diseases Society of America
• American Association of Immunologists
• American Academy of Family Physicians 

Not only are major nursing and medical organizations opposing the new recommendation, but so are different cities and states’ health departments. And they are taking to social media, encouraging the CDC Director to disregard the ACIP’s recommendation. 

"Delaying the vaccine would mark a dangerous departure from decades of achievement in preventing hepatitis B infection and its complications. Recent independent analysis warns that even a modest delay could result in a substantial increase in preventable chronic infections, liver cancers, and deaths," said Dr. Ulrich von Andrian, President of the American Association of Immunologists. "Now is not the time to undermine confidence in one of the most successful vaccine-based public health interventions in modern history."

So What Now?

The final decision is in the hands of the Acting CDC Director Jim O’Neill. He must approve the recommendation before it goes to individual states.  Ultimately, each state makes the final decision regarding the recommendation, but most take those directly from the ACIP and adopt them. 

Senator and doctor Bill Cassidy (R), Louisiana, who chairs the Senate Committee on Health, Education, Labor and Pensions, wrote on social media:

Source: X.com

As debate over the birth dose continues, nurses’ voices and clinical judgment will be critical in helping parents navigate hepatitis B vaccination decisions 

 

🤔 Nurses: what do you think about this? Let us know in the discussion forum below.