Dr. Ryan Westergaard on Hepatitis B Vaccination for Newborns

Frederica Freyberg:
Wisconsin health officials are breaking from federal guidance on hepatitis B vaccinations for newborns, and saying babies should get the shot within 24 hours of birth. A federal panel of vaccine advisors last week voted against recommending all newborns receive it unless their mothers test positive. Those advisors were chosen by U.S. Health Secretary Robert F. Kennedy Jr., an anti-vaccine activist. State Department of Health Services Chief Medical Officer Dr. Ryan Westergaard joins us with more, and doctor, thanks very much for being here.

Ryan Westergaard:
Yes, good evening, how are you?

Frederica Freyberg:
I’m well. So, again, your guidance on hep B vaccines for newborns?

Ryan Westergaard:
Our guidance from Wisconsin Department of Health Services is unchanged actually, and it’s the same guidance that has been the standard of care in the United States for the past 30 years, and continues to be endorsed by the American Academy of Pediatrics. And that is that all children should get vaccinated with three doses of the hepatitis B vaccine, and the first dose should be given in the first 24 hours of life. This is a standard that has been going on for a very long time, and has been very successful in reducing the prevalence of hepatitis B in Americans.

Frederica Freyberg:
So, why did Wisconsin break with the new federal vaccine guidance?

Ryan Westergaard:
Well, we’re not breaking with federal guidance as much as we are reaffirming the standard of care that has been supported by solid evidence for several decades. The new recommendations that the Advisory Committee on Immunization Practice voted for, and I think it’s worth noting that it doesn’t have the force of a CDC policy until the CDC director endorses it and publishes it. That hasn’t happened yet, so really it was the committee, as you mentioned, the newly formed committee that voted to recommend something different than what has been the standard of care for many years. What they voted to recommend was to take these decisions on a case-by-case basis that people can get the vaccine at the so-called birth dose, but they didn’t support or didn’t recommend the standard practice, which is that it’s the default recommendation for everyone. And it’s that universal, that routine aspect of vaccination at birth which has allowed the public health benefit of driving hepatitis B to very low levels. We’re very concerned that if that were to change, that we would lose ground, that there would be more hepatitis B among infants, and that’s very dangerous because hepatitis B can cause lifelong chronic liver disease and result in cancer and cirrhosis and problems that we have the ability to prevent.

Frederica Freyberg:
How contagious is hep B for newborns or others?

Ryan Westergaard:
Hep B is a bloodborne virus, so it’s not contagious through casual contact or through the air or surfaces in the way that we think about colds, flu and COVID. It’s really from blood to blood. So, during the birth processes, globally and traditionally, one of the ways that babies get infected, it’s because there’s transfer of blood during the birthing process, but can also occur after birth through contact with open cuts and sores and in routine health care. In health care settings, most employers will recommend or require that people have evidence of vaccines for hepatitis B because of things like needle sticks. So, it’s very contagious if you do have an exposure like this, either through the childbirth process or a needle stick injury in health care, but not casual contact in day-to-day life.

Frederica Freyberg:
Will insurance cover the shots for newborns in Wisconsin, continue to cover it?

Ryan Westergaard:
Yes, it has been covered by insurance for many years, and our discussions from the health department with the Office of Commissioner of Health in Wisconsin, or the Commissioner of Insurance in Wisconsin, is that it should continue to be expected to be covered. Nothing should change as a result of the vote from the ACIP. Our hope and what we’re trying to affirm through the memo and through the communications that we as a health department are putting out is that the standard practice shouldn’t change because the science hasn’t changed. There’s been no new evidence that has come out as a result of this recent committee meeting that would change our conclusion that this is a strong, evidence-supported practice that will prevent infections going forward.

Frederica Freyberg:
How are patients and families to kind of make sense of childhood or even COVID vaccine schedules when the federal advisors are guiding one thing and the state is coming back in and saying, “No, maintain our current guidance.”

Ryan Westergaard:
It’s a really challenging situation. The headlines are sending mixed messages, but our recommendation as a health department and what we’ve learned through dealing with a lot of communication and miscommunication during COVID is that the best source of information, the most trusted source of information for most people in the United States when they ask them, is their personal clinician. So, our hope is that we can put the best available science out there, communicate clearly on what we think that the science says, understand that people will have questions, encourage people to ask those questions of their clinician with whom they have a relationship. And when the science is available and those conversations happen, we’re confident that people can make the right decision. In this case, the evidence is pretty clear that hepatitis B vaccination for all children is the safest approach and the most effective approach to preventing this particular virus.

Frederica Freyberg:
We leave it there. Dr. Ryan Westergaard, thanks very much.

Ryan Westergaard:
You’re welcome.