Navigating Clinical Practice With The CDC Advisory Committee On Immunization Practices' Updated Hepatitis B Recommendation For Newborns

The Centers for Disease Control and Prevention ("CDC") Advisory Committee on Immunization Practices ("ACIP") develops recommendations for how vaccinations are used to control disease in the United States.Earlier this month, the ACIP voted 8-3 to narrow the CDC's guidance on newborn hepatitis B vaccination administration. Hepatitis B is an infection that causes inflammation in the liver. When chronic, the infection can lead to liver cancer, liver failure, or cirrhosis, which is the serious scarring of the liver.The ACIP's vote is being closely scrutinized and the decision will likely lead to changes in clinical practice.

Since 1991, the CDC has recommended that all newborns receive the hepatitis B vaccination at birth due to previous difficulties in targeting select populations for immunization. However, the ACIP has now decided that hepatitis B vaccinations should be given only to newborns whose mothers test positive for hepatitis B or whose mothers' hepatitis B status is unknown because most pregnant women currently receive hepatitis B testing. For mothers who test negative, the ACIP recommends that parents consult their healthcare provider to determine if and when their child should be vaccinated. If CDC Director Jim O'Neill adopts the ACIP's recommendation, as he is poised to do, the recommendation will become CDC policy.

Proponents of the ACIP's recommendation argue that it will offer greater individual choice and reduce early-life medical interventions.Opponents argue that it will weaken the protection that hepatitis B vaccinations provide to infants and children, who are more likely than adults to develop chronic hepatitis B conditions such as liver cancer, liver failure, and cirrhosis. Critics also contend the new guidance may create challenges in healthcare delivery, widen disparities in vaccination access, and leave gaps for infants whose mothers test negative but acquire hepatitis B late in pregnancy or before surface antigens are detectable.Despite the contrasting viewpoints, shifts in clinical practice appear probable.

If the CDC adopts the ACIP's recommendation and providers choose to comply or providers are enrolled in the Vaccines for Children Program, which requires adherence to the ACIP's recommendations, providers should:

• Spend additional time and resources verifying maternal hepatitis B screening results and coordinating care for newborns whose mothers test positive or whose mothers have unknown hepatitis B infection statuses, ensuring these infants receive the hepatitis B vaccination at birth;
• Devote more time and resources to counseling parents of infants whose mothers test negative for hepatitis B about the benefits, risks, and timing of hepatitis B vaccinations, since universal hepatitis B vaccination at birth would no longer be standard;
• Stay vigilant regarding the potential for false negatives or undetectable infections in maternal hepatitis B testing;
• Be careful with scheduling and managing follow-up hepatitis B vaccination doses, as variations in vaccination schedules will be more common; and
• Bolster reminder systems to ensure children receive necessary second or third hepatitis B vaccination doses once they receive their first.

Hepatitis B vaccination insurance coverage is expected to remain the same.The CDC stated that the ACIP's recommendation maintains coverage consistency for all payment mechanisms, including the Vaccines for Children Program, the Children's Health Insurance Program, Medicaid, Medicare, and insurance plans through the federal Health Insurance Marketplace. If the ACIP's recommendation becomes official CDC guidance, providers will want to be prepared for the implications on pediatric care and clinical workflows.Providers should remain alert and prioritize readiness for the impending shift.

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