Shots Snafu Puts Newborns at Risk

Hospitals urged to reinstate hepatitis B vaccine

By Jeff Kelliher
HealthScout Reporter

http://healingwell.subportal.com/

TUESDAY, Feb. 20 (HealthScout) -- A temporary change in vaccine recommendations for infants has lasted longer than intended and could be endangering newborns, the government says.

In July of 1999, the American Academy of Pediatrics and the U.S. Public Health Service recommended postponing initial doses of the hepatitis B vaccine for up to six months in infants whose mothers tested negative for the virus. Before then, the vaccine routinely had been given to infants within 12 hours of birth, regardless of whether a child's mother tested positive or negative.

But concerns over a vaccine preservative called thimerosal, known to contain mercury, prompted the change.

"The goal for any vaccine is to give it as early as possible and make sure it is given before exposure to disease occurs," says Dr. Anthony Fiore, an epidemiologist with the Centers for Disease Control and Prevention. "The change in recommendations was largely in response to studies suggesting that even small levels of mercury might be damaging to infants."

Mercury-free vaccines became available within a few months -- as early as September of 1999 -- but most hospitals haven't changed back their policies, the CDC says. And, at least one infant has died of the virus, in January of last year, the agency says.

A CDC survey finds that 67 percent of all hospitals have not reinstated standing orders to administer the hepatitis B vaccine at birth, according to a report in this week's Morbidity and Mortality Weekly Report.

"The status quo didn't snap back the way we expected it to," Fiore says. "The lesson was that we need to be very careful about vaccine policy changes because what occurs in actual practice may be somewhat different from what's intended."

A chronic infection that attacks the liver, hepatitis B is much more dangerous for children than adults, Fiore says.

"The long-term consequence of being infected with [the virus] as a young child is that 15 to 20 percent of people will die prematurely of chronic liver disease and liver cancer," he says.

Dr. Margaret Rennels, a Maryland pediatrician and member of the pediatric academy's committee on infection control, says the decision to temporarily alter recommendations for infant vaccination schedules was difficult.

"It was a very complicated decision," Rennels says. "Everyone had concerns that any change in the vaccine schedule would lead to confusion, anger and probably missed doses. So, you've always got to take that into consideration and weigh that against the need for the change and the public's need to know about it."

The pediatricians' group is working hard, she says, to see that hospitals return to previous infant immunizations recommendations, using mailings, announcements on its Web site and meetings nationwide.

But looking back, Rennels says she's not sure anything should have been done differently.

"You just can't say we're not going to do anything about mercury in vaccines," she says. "It seems that the younger the child, the more immature the child's brain and the higher the possibility of brain damage from mercury -- so it made sense to withhold the birth dose."

What To Do

If you're expecting a child, it's always a good idea to get screened for the hepatitis B virus. A vaccine will prevent your child from contracting the virus during birth or later on from people who unknowingly are infected with it.

"An important message to convey is that none of the current pediatric hepatitis B vaccines have thimerosal in them," Fiore says. "So any concerns about mercury can be put aside now."