It’s much worse than ridiculous. As an obstetrician, who has cared for mothers who were hepatitis B carriers and delivered their babies, before the first Hep B vaccine was available, and who has seen young adults die from liver cancer and non-alcoholic cirrhosis, I am horrified. It’s like deliberately failing to arrest a mass murderer. About half of the 400 million people who are life-long, chronic carriers of Hepatitis B are infected at birth or in early childhood by vertical transmission (infection from mother to infant). Many will unknowingly infect others, including their own partners and babies. No vaccine is perfect. Some people’s immune systems are less effective than others, but the Hep B vaccine is a very good one. If healthy newborns whose mothers are Hepatitis B carriers receive the vaccine within 12-24 hours of birth, their risk of becoming chronic carriers for life and dying from liver cancer or non-alcoholic cirrhosis is drastically reduced.
As always, your reports are invaluable as a guide in these insane times. We just got our Covid boosters today and moved the appointment up just in case the ACIP recommendations on Covid tomorrow make it difficult to get the vaccine. Trump and Kennedy are a blight on this country.
So ACIP would overrule NY executive order on Covid? Everyone is worried but nobody provides info about how it impacts a state executive order to make Covid vaccines accessible. It is very frustrating and anxiety provoking.
But that's very confusing and contradictory. The shared decision is with a healthcare provider and is not the same as an individual's own decision. Before casting his vote, a committee member asked if a provider would need to be involved and was told no. This also differs from FDA's approval for people 65+ to be eligible just by age without any other decision making.
My wife and I are in our upper 60's. I hope they do not take away the COVID shot tomorrow. It is horrible what Florida has done by removing all vaccine requirement for children.
ACIP voted to recommend the vaccines for people 65+ with individual decision-making, which also said that's the same as shared clinical decision (https://covidandvaccineupdate.substack.com/p/acip-finally-votes-on-covid-vaccines). But that's very confusing. The shared decision is with a healthcare provider and is not the same as an individual's decision. This also differs from FDA's approval for people 65+ to be eligible just by age without any other decision making.
I had some time today and was able to listen in for much of the afternoon. Listening to ALL the comments was so moving. I was so proud to belong to this group of physicians, scientists, providers, community health professionals, they were eloquent, concise and thorough. I knew it didn’t matter and that the “committee” already knew their votes, but it’s on the record. They spoke to most of the things I think about, talk about, and fear.
The voting confusion was absurd with that one guy abstaining because he couldn’t understand the implications of each vote. Shameful.
But so was the complaining about accessibility of the scientific journals and the cost!! I wish someone could explain that part to me…
I didn't see the hearings, so I am not sure what the complaints were about the accessibility and cost of scientific journals. However, I am a librarian, and this is a serious issue. Academic libraries have had to dramatically curtail their scientific journal subscriptions due to cost. The average price of health sciences journals is over $3,000, and the average for a hard sciences journal is over $8,000. There have been some changes with the Open Access movement, but the problem with that is that AUTHORS have to pay for their articles to be published, which means that it is mostly professors at the most wealthy and elite universities who are published. https://www.library.ucsf.edu/about/subscriptions/journals-costs/
Yes, understood, but shouldn’t committee members benefit from an institutional subscription? Shouldn’t their membership on the committee provide them with this information?
I certainly utilize my affiliations to access papers, so I cannot imagine being asked for such important decisions to be made without that access. That was the intent of my question, how is it they don’t have access?
One member was citing articles to support her point, but couldn't read some because she would have to buy them. And yes, my reaction was also huh, CDC can't pay for them? CDC has cancelled subscriptions, though. Maybe they had DEI language.
Just want to say thank you! Keep fighting the good fight!
Of note- I’m a pediatrician and still offering/give the mmrv at the 1y visit often because we unfortunately have a fair bit of patients lost to follow up. Measles and varicella are both very contagious and unfortunately still around (as are cases of mumps and rubella) and by me giving them in one poke at one visit I can often get families to get that vaccine plus any others. The more pokes, the less vaccines people want at one time (I get it! I wish they weren’t pokes at all and instead a magic potion I could just give kids!). So this change, while could’ve been worse, is unfortunate and just limits our ability as physicians to look at the big picture of a patients care and social situation and risks/benefits and make choices based on all that.
I got my flu and Covid vaccinations on Tuesday. RFK jr.. is an ignorant and dangerous man in the role he was appointed to. No science or medical education or training! He imposes conspiracy theories on the citizens.
Did they provide any reasoning for how delaying the HepB shot by 30 days makes any difference in anything? What could be different for the baby in 30 days? What does that achieve?
Thank you for trudging throug the slough. I forwarded it to a small circle of friends with a brief summary for those who are not accustomed to reading a measured, balanced presentation.
I added a line that is offensive, but I strongly feel needs to be said.
Vaccinating against HepB at 30 days, instead of at birth. As you might predict, this policy will predominately affect people, who do not have access to quality healthcare: poor people, blacks, minorities & isolated communities, drug users.
As a retired school nurse, this is providing fodder for nightmares.
If parents wish to stick with the previously recommended schedule will that be permitted or do physicians have to follow the recommendations of this totally unqualified committee?
All you have to do to see the impact of the hep B vaccine is to look at the incidence and mortality rates of hepatocellular carcinoma (liver cancer) in Taiwan after they implemented universal hep B vaccines in 1986. It’s nuts to expose your kid to that kind of risk by delaying the vaccine.
Heartfelt thanks to you, Katelyn and to your team for the review of today's ACIP meeting and for your invaluable work and commitment to balanced and data-backed communication.
I’m a pediatrician and I have a very small practice and yet I know two mothers who gave birth to children and the mothers had hepatitis B, but didn’t find out until after birth because the testing had a false negative. The only reason those kids don’t have hepatitis B the rest of their entire lives is because of the dose of vaccine within 24 hours of birth. I hope people continue to recommend the birth dose, even if the official recommendations changes.
YLE: "In the 1980s, before the universal birth dose was recommended in 1991, about 18,000 children under age 10 were infected with hepatitis B each year—half of them at birth."
In the 1980's there were about 4 million babies born each year. According to this sentence the chance of a baby being born then with a Hep B infection from an infected mother was about 0.225%. Or about 2.5 per thousand. Getting infected with Hep B up to the age of 10 years in a different manner was also about 0.225%. Also about 2.5 per thousand. So delaying the first shot by one month cuts one month out of 120 months of a 10 year old child. The odds of a baby getting a bit of infected blood into their system and becoming infected with Hep B during the first month of life must be extremely small. And these figures were from the 1980's when there was much less hospital screening of expectant mothers and fewer Heb B vaccines given to them or their babies.
Seems like the most dominant reason babies are given the vaccine at birth is because that's when they are in the hospital and the doctors have access to them.. One month later parents may say no, but it's harder for parents to say no with their baby under hospital care. Parents might not even know their baby got the shot.
YLE: "Not everyone gets screened. Roughly 15% of mothers are never screened for hepatitis B, despite recommendations." Are you saying the hospitals are not screening 15% of the mothers? What is the problem there and why are they not screening the expectant mothers? If the mother is discovered to have Heb B, then the parents are way more likely to get their infant vaccinated immediately.
If you factor in the screening of expectant mothers that happens today versus the 1980's, it's even more unlikely that a newborn baby up to 30 days old will get Heb B.
Or are you adding in the small percentage of births that happen outside of hospitals? Those mothers are maybe not screened. And the infant maybe gets no vaccine at birth. But this situation has no effect on babies born in hospitals who get the vaccine right at birth. And thus should not influence the decision as to when to give this vaccine.
Of course, there is a lot more to the story of Hep B vaccines that what YLE is going to write.
"In 1999, NVIC published a report that in the U.S. there were more reported cases of hepatitis B vaccine reactions than reported cases of hepatitis B disease in children under 14 years old, an infection that is primarily transmitted in the U.S. among adult high risk groups such as IV drug users and those with multiple sexual partners."
I was upset by Dr Meissner’s comment when noting that the AAP chose not to participate and was “driving itself to irrelevance “. Before RFK Jr’s confirmation hearing, AAP leadership said they would let the science play out and basically don’t want to voice its objections so that they could work with him in the future. So why aren’t they working with him now? I am extremely disappointed (and these are people I have known for years and respect)
Who are you disappointed in? RFK, Jr? Dr Meissner? I find that the AAP did have an open mind and gave RFK Jr space to show us his priorities. Then he gutted ACIP, the CDC, hired his non experienced cronies and made it clear that he was not going to present any science, evidence or reasoning for his decisions. The AAP has been clear in not compromising known facts, science, expertise or its membership.
Actually all - but this was disappointment with for it's silence during the confirmation process and now for not voicing objections to the proceedings. I have heard from the AAP explaining how it has been excluded from work groups which are the key to recommendations. I wish "my" professional organization had voiced strong objections to RFK Jr's appointment. But I am most disappointed in Senator Cassidy who chose his political career over his profession and the Hippocratic Oath when voting for RFK Jr's confirmation.
As a labor and delivery nurse I have vaccinated thousands of babies for Hep B—this is just so incredibly ridiculous.
Correct
It’s much worse than ridiculous. As an obstetrician, who has cared for mothers who were hepatitis B carriers and delivered their babies, before the first Hep B vaccine was available, and who has seen young adults die from liver cancer and non-alcoholic cirrhosis, I am horrified. It’s like deliberately failing to arrest a mass murderer. About half of the 400 million people who are life-long, chronic carriers of Hepatitis B are infected at birth or in early childhood by vertical transmission (infection from mother to infant). Many will unknowingly infect others, including their own partners and babies. No vaccine is perfect. Some people’s immune systems are less effective than others, but the Hep B vaccine is a very good one. If healthy newborns whose mothers are Hepatitis B carriers receive the vaccine within 12-24 hours of birth, their risk of becoming chronic carriers for life and dying from liver cancer or non-alcoholic cirrhosis is drastically reduced.
As always, your reports are invaluable as a guide in these insane times. We just got our Covid boosters today and moved the appointment up just in case the ACIP recommendations on Covid tomorrow make it difficult to get the vaccine. Trump and Kennedy are a blight on this country.
I think that's really smart. I'm quite worried about tomorrow.
So ACIP would overrule NY executive order on Covid? Everyone is worried but nobody provides info about how it impacts a state executive order to make Covid vaccines accessible. It is very frustrating and anxiety provoking.
This is SO state dependent. I will forward this to Marisa over at YLE NY to ensure this gets answered and it's cleared up
Thank you. I appreciate your work.
Nope. Tenth Amendment and McCarran-Ferguson Act of 1945.
Also these are recs, not approvals. Hospitals could still offer the Hep B to newborns but people might have to pay for it out of pocket.
Me too.
ACIP voted to recommend the vaccines for people 65+ with individual decision-making, but also said that's the same as shared clinical decision (https://covidandvaccineupdate.substack.com/p/acip-finally-votes-on-covid-vaccines).
But that's very confusing and contradictory. The shared decision is with a healthcare provider and is not the same as an individual's own decision. Before casting his vote, a committee member asked if a provider would need to be involved and was told no. This also differs from FDA's approval for people 65+ to be eligible just by age without any other decision making.
My wife and I are in our upper 60's. I hope they do not take away the COVID shot tomorrow. It is horrible what Florida has done by removing all vaccine requirement for children.
ACIP voted to recommend the vaccines for people 65+ with individual decision-making, which also said that's the same as shared clinical decision (https://covidandvaccineupdate.substack.com/p/acip-finally-votes-on-covid-vaccines). But that's very confusing. The shared decision is with a healthcare provider and is not the same as an individual's decision. This also differs from FDA's approval for people 65+ to be eligible just by age without any other decision making.
Thank you! I guess we'll wait for more clarity :-)
I had some time today and was able to listen in for much of the afternoon. Listening to ALL the comments was so moving. I was so proud to belong to this group of physicians, scientists, providers, community health professionals, they were eloquent, concise and thorough. I knew it didn’t matter and that the “committee” already knew their votes, but it’s on the record. They spoke to most of the things I think about, talk about, and fear.
The voting confusion was absurd with that one guy abstaining because he couldn’t understand the implications of each vote. Shameful.
But so was the complaining about accessibility of the scientific journals and the cost!! I wish someone could explain that part to me…
I didn't see the hearings, so I am not sure what the complaints were about the accessibility and cost of scientific journals. However, I am a librarian, and this is a serious issue. Academic libraries have had to dramatically curtail their scientific journal subscriptions due to cost. The average price of health sciences journals is over $3,000, and the average for a hard sciences journal is over $8,000. There have been some changes with the Open Access movement, but the problem with that is that AUTHORS have to pay for their articles to be published, which means that it is mostly professors at the most wealthy and elite universities who are published. https://www.library.ucsf.edu/about/subscriptions/journals-costs/
Yes, understood, but shouldn’t committee members benefit from an institutional subscription? Shouldn’t their membership on the committee provide them with this information?
I certainly utilize my affiliations to access papers, so I cannot imagine being asked for such important decisions to be made without that access. That was the intent of my question, how is it they don’t have access?
Yes, they should. I didn't see the hearings, so I wasn't sure what the complaints actually were.
Yep, shameful anti-vaccine performance art. There was much more of it on Day 2 (https://covidandvaccineupdate.substack.com/p/acip-finally-votes-on-covid-vaccines). The vote on Day 1 that had 2 abstentions, 1-9-2, was reversed on Friday with even more abstentions, 9-0-3. So they didn't really know how to know their votes.
One member was citing articles to support her point, but couldn't read some because she would have to buy them. And yes, my reaction was also huh, CDC can't pay for them? CDC has cancelled subscriptions, though. Maybe they had DEI language.
Appreciate this nuanced and data-driven update ♥️
Just want to say thank you! Keep fighting the good fight!
Of note- I’m a pediatrician and still offering/give the mmrv at the 1y visit often because we unfortunately have a fair bit of patients lost to follow up. Measles and varicella are both very contagious and unfortunately still around (as are cases of mumps and rubella) and by me giving them in one poke at one visit I can often get families to get that vaccine plus any others. The more pokes, the less vaccines people want at one time (I get it! I wish they weren’t pokes at all and instead a magic potion I could just give kids!). So this change, while could’ve been worse, is unfortunate and just limits our ability as physicians to look at the big picture of a patients care and social situation and risks/benefits and make choices based on all that.
I got my flu and Covid vaccinations on Tuesday. RFK jr.. is an ignorant and dangerous man in the role he was appointed to. No science or medical education or training! He imposes conspiracy theories on the citizens.
Did they provide any reasoning for how delaying the HepB shot by 30 days makes any difference in anything? What could be different for the baby in 30 days? What does that achieve?
Thank you for trudging throug the slough. I forwarded it to a small circle of friends with a brief summary for those who are not accustomed to reading a measured, balanced presentation.
I added a line that is offensive, but I strongly feel needs to be said.
Vaccinating against HepB at 30 days, instead of at birth. As you might predict, this policy will predominately affect people, who do not have access to quality healthcare: poor people, blacks, minorities & isolated communities, drug users.
This smells like ethnic warfare.
As a retired school nurse, this is providing fodder for nightmares.
If parents wish to stick with the previously recommended schedule will that be permitted or do physicians have to follow the recommendations of this totally unqualified committee?
The cruelty and confusion are continuing....
All you have to do to see the impact of the hep B vaccine is to look at the incidence and mortality rates of hepatocellular carcinoma (liver cancer) in Taiwan after they implemented universal hep B vaccines in 1986. It’s nuts to expose your kid to that kind of risk by delaying the vaccine.
Thank you for having the temerity to listen to all this foolishness and report it out. Sending you strength for the future meetings.
Heartfelt thanks to you, Katelyn and to your team for the review of today's ACIP meeting and for your invaluable work and commitment to balanced and data-backed communication.
I’m a pediatrician and I have a very small practice and yet I know two mothers who gave birth to children and the mothers had hepatitis B, but didn’t find out until after birth because the testing had a false negative. The only reason those kids don’t have hepatitis B the rest of their entire lives is because of the dose of vaccine within 24 hours of birth. I hope people continue to recommend the birth dose, even if the official recommendations changes.
YLE: "In the 1980s, before the universal birth dose was recommended in 1991, about 18,000 children under age 10 were infected with hepatitis B each year—half of them at birth."
In the 1980's there were about 4 million babies born each year. According to this sentence the chance of a baby being born then with a Hep B infection from an infected mother was about 0.225%. Or about 2.5 per thousand. Getting infected with Hep B up to the age of 10 years in a different manner was also about 0.225%. Also about 2.5 per thousand. So delaying the first shot by one month cuts one month out of 120 months of a 10 year old child. The odds of a baby getting a bit of infected blood into their system and becoming infected with Hep B during the first month of life must be extremely small. And these figures were from the 1980's when there was much less hospital screening of expectant mothers and fewer Heb B vaccines given to them or their babies.
Seems like the most dominant reason babies are given the vaccine at birth is because that's when they are in the hospital and the doctors have access to them.. One month later parents may say no, but it's harder for parents to say no with their baby under hospital care. Parents might not even know their baby got the shot.
YLE: "Not everyone gets screened. Roughly 15% of mothers are never screened for hepatitis B, despite recommendations." Are you saying the hospitals are not screening 15% of the mothers? What is the problem there and why are they not screening the expectant mothers? If the mother is discovered to have Heb B, then the parents are way more likely to get their infant vaccinated immediately.
If you factor in the screening of expectant mothers that happens today versus the 1980's, it's even more unlikely that a newborn baby up to 30 days old will get Heb B.
Or are you adding in the small percentage of births that happen outside of hospitals? Those mothers are maybe not screened. And the infant maybe gets no vaccine at birth. But this situation has no effect on babies born in hospitals who get the vaccine right at birth. And thus should not influence the decision as to when to give this vaccine.
Of course, there is a lot more to the story of Hep B vaccines that what YLE is going to write.
"In 1999, NVIC published a report that in the U.S. there were more reported cases of hepatitis B vaccine reactions than reported cases of hepatitis B disease in children under 14 years old, an infection that is primarily transmitted in the U.S. among adult high risk groups such as IV drug users and those with multiple sexual partners."
https://www.nvic.org/newsletter/mar-2008/hep-b-vaccine-discrimination
I was upset by Dr Meissner’s comment when noting that the AAP chose not to participate and was “driving itself to irrelevance “. Before RFK Jr’s confirmation hearing, AAP leadership said they would let the science play out and basically don’t want to voice its objections so that they could work with him in the future. So why aren’t they working with him now? I am extremely disappointed (and these are people I have known for years and respect)
Who are you disappointed in? RFK, Jr? Dr Meissner? I find that the AAP did have an open mind and gave RFK Jr space to show us his priorities. Then he gutted ACIP, the CDC, hired his non experienced cronies and made it clear that he was not going to present any science, evidence or reasoning for his decisions. The AAP has been clear in not compromising known facts, science, expertise or its membership.
Actually all - but this was disappointment with for it's silence during the confirmation process and now for not voicing objections to the proceedings. I have heard from the AAP explaining how it has been excluded from work groups which are the key to recommendations. I wish "my" professional organization had voiced strong objections to RFK Jr's appointment. But I am most disappointed in Senator Cassidy who chose his political career over his profession and the Hippocratic Oath when voting for RFK Jr's confirmation.