Early in her career, Dr. Kanika Cunningham cared for a pregnant patient who didn’t know she had Hepatitis B when she went into labor. When the infection was discovered during delivery, Cunningham was able to treat the newborn and prevent the infection from spreading.
“It broke my heart because she was afraid to seek care out of fear of what could happen to her and her baby,” Cunningham said, recalling the woman’s worry that the state might take her child if she admitted to a history of substance use.
Cunningham, who now serves as director of the St. Louis County Department of Public Health and oversees its perinatal Hepatitis B prevention program, said this case is an example of how a patient with Hepatitis B might fall through the cracks and accidentally spread the illness to her baby.
Hepatitis B is a viral infection that primarily attacks the liver. Those infected with chronic Hepatitis B can suffer a lifetime of negative health conditions, including cancer.
Last week, the Centers for Disease Control and Prevention’ Advisory Committee on Immunization Practice announced it no longer recommends infants receive the first of three doses of a Hepatitis B vaccine at birth.
Instead, for mothers who did not test positive for Hepatitis B in pregnancy, the CDC recommends parents wait until their child is at least 2 months old to administer the first of three doses of a vaccine that protects against Hepatitis B, if it’s given at all.
“Hearing this news that they want to undo what has been a well-researched practice … that can really set families back,” Cunningham said. “I’m really concerned about the impact on the most vulnerable, our babies, contracting it.”
While most infants with Hepatitis B were infected during delivery, Cunninghamn is among scores of medical experts warning this new guidance overlooks the risk for infection that exists outside the delivery room.
“The thing is, you don’t know who has Hepatitis B,” said Dr. Rachel Orscheln, a professor of pediatrics in the division of pediatric infectious diseases at the Washington University School of Medicine in St. Louis. “Many people are asymptomatic, and so why delay protection when the protection is safe to be administered at an early age?”
Several Missouri health care providers who spoke with The Independent, including pediatricians and obstetricians, strongly urged families to consider the risks of waiting or skipping the vaccine. All continued to align with the American Academy of Pediatrics’ recommendation that infants be vaccinated at birth.
The academy’s president, Susan Kressly, called the new CDC guidance “irresponsible and purposely misleading,” warning that it will lead to more infections.
Missouri statute requires testing for Hepatitis B, C and syphilis at the first prenatal appointment, typically in the first trimester. But it’s possible for a person to become infected at any point in pregnancy. And not everyone makes it to prenatal appointments.
About 25% of pregnant people in Missouri don’t get prenatal care until after the first trimester, according to the March of Dimes.
It’s in part why a handful of lawmakers have been pushing for additional Hepatitis B testing at 28 weeks of pregnancy and immediately after birth. The legislation, which had bipartisan support, passed this year.
Orscheln also fears that without universal newborn vaccinations, more babies will get sick.
She knows pediatricians who are increasingly hearing from parents hesitant to follow the recommended childhood vaccine schedule.
“It has not been helped by the fact that there’s been new changes to the vaccine schedule that are not supported by any data,” Orscheln said. “Our vaccine programs have been so successful that people now are more fearful of vaccines than they are for those infectious diseases … These infectious diseases still exist, and they’re ready to come back.”
Orscheln noted that while every vaccine has potential side effects including soreness at the injection site and a mild fever, serious side effects from vaccinations are “exceedingly rare.”
Dr. Bret Gordon, the OB-GYN division chair at Saint Luke’s in Kansas City, said while parents have always had the right to refuse vaccinations at the hospital, he predicts more parents will opt out of the newborn Hepatitis B vaccine as a result of the new CDC guidance.
“When patients come in with these questions, when they read things and they see things in the news, we do our best to objectively explain the data and give them good advice based on scientific data,” said Gordon, who added that clinicians increasingly have to counter opinions patients see on social media.
Since the infant Hepatitis B vaccine recommendation was announced in 1991, there has been a 99% decrease in the number of children and teens with the infection.
Martha Smith, Missouri maternal child health director with the Missouri Department of Health and Senior Services, said many people aren’t aware of the lifelong health implications of chronic Hepatitis B, the most common type of Hepatitis B to occur in babies and children if the infection isn’t discovered in time.
Not only is the liver at risk. The kidneys can also be harmed. The risk of stomach and pancreatic cancer increases, she said. Those with Hepatitis B double their chances of developing lymphoma.
“It doesn’t take much more than a microscopic amount (of body fluid) for the virus to spread,” Smith said, noting that younger infants who tend to put everything in their mouths are particularly vulnerable.
Prior to routine vaccination, about half of children who became infected with Hepatitis B got it from a source other than their mother. This was often a different caregiver, like an extended family member or a daycare provider.
“When you think that hepatitis B can be a silent, asymptomatic condition for somebody, but then they pass it to your baby who doesn’t have all the immunity built up, then they test positive for it, and now they have some significant health implications, because somebody kissed your baby. It kind of puts that age-old tradition of kissing the baby on the head in perspective, doesn’t it?”
Smith encouraged parents to consider all possible risks, and to ask their trusted health care providers about how best to manage those risks.
Dr. Edward Lyons, a pediatric board certified infectious diseases physician at Children’s Mercy in Kansas City, also encouraged parents to bring any worries or confusion to their trusted health care providers.
“I don’t know what misinformation or disinformation people have seen if they don’t tell me,” he said.
And he said while parents can’t protect their children against everything, vaccines are a known safeguard against some of the potential harm in the world.
“The goal of everybody is the same, right?” Lyons said. “Parents and families and clinicians all want these children to be healthy, to be happy, to live long, fulfilling lives.”
