The Centers for Disease Control and Prevention's (CDC’s) newly reworked Advisory Committee on Immunization Practices (ACIP) met Thursday to finally offer its recommendations for a universal hepatitis B virus (HBV) vaccine for newborns, only to fall to the same pattern of debate and uncertainty that derailed its last attempt to vote on the matter.
Day one of the ACIP’s meeting this week was meant to pick up where the committee left off on the HBV topic during its September meeting, when it scrapped its planned vote amid confusion on specific voting language. The committee was scheduled to officially clear the air with a vote Thursday afternoon, following a morning of discussion and commentary from stakeholders, according to the final agenda.
Things didn’t quite go to plan, however. After a few hours of debate on the voting language at hand, the only vote that occurred Thursday was a 6-3 agreement on a motion to push back the HBV vote until Friday morning.
The originally planned voting questions, as presented by a representative of the ACIP’s childhood and adolescent immunization schedule work group, covered newborn HBV vaccination and additional doses for children.
The ACIP’s current guidance recommends that all babies receive a dose of the HBV vaccine within 24 hours of birth. Since the CDC made that initial recommendation in 1991, reported HBV infections among adolescents have dropped by 99%.
The committee is now weighing an individual-based decision-making process for newborn HBV vaccines, which would be a change from the existing universal recommendation. The rationale supporting this framework stems from “not well understood” vaccine safety risks, according to the work group's presentation (PDF), and the argument that most infants aren't at a high risk of HBV infection in the first few months of life.
However, the specific wording of the voting questions faced intense committee scrutiny, leading frustrated committee member Joseph Hibbeln, M.D., to suggest that one question was written by the "department of redundancy."
Eventually, Cody Meissner, M.D., the only member of the committee to have previous experience serving on the ACIP, proposed a motion to delay the vote in order to “think a little bit more” about the wording of the questions.
With the motion quickly passing, the committee will return to vote Friday morning.
The tone of Thursday’s event matched the tense atmosphere of the ACIP’s September meeting, which was marked by an air of confusion and strained debate. Thursday, the committee's newly appointed chairman Kirk Milhoan, M.D., Ph.D. was a remote participant, a situation that didn't help keep things on track.
Milhoan, who took up the chairman position earlier this week after former Chair Martin Kulldorff, Ph.D., moved on to a role at the Department of Health and Human Services, likely won’t be voting Friday, Vice Chair Robert Malone, M.D., explained, since he's “about to jump on a plane to Asia.”
A planned HBV vote Friday will further crowd the schedule for the day, which is set to include additional discussion on the childhood immunization schedule, comparisons to the Danish vaccine schedule and a presentation on “aluminum exposure” from childhood vaccines and potential implications for asthma later in life, the agenda reads.