Meidas Health: AAP President Strongly Pushes Back on Hepatitis B Vaccine Changes

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2:04Dr. Vin Gupta:Remember to pack the cooler with probiotic sodas, sparkling waters, and more. Summer savings await you at Whole Foods Market. Midas Mighty, it's great to have you back here from Midas Health. This is an emergency pod with the president of the American Academy of Pediatrics, Dr. Susan Cressley. She's been a guest on our show a few months ago. And I suspect she's going to be a frequent guest just given everything that's happening. Dr. Cressley, thanks for joining us again.

2:31Dr. Sue Kressly:Thanks so much for having me.

2:33Dr. Vin Gupta:So for our audience, if you're tuning in to the news here, it's Friday, December the 5th. Anytime today or this weekend, you're probably going to see headlines about hepatitis B vaccine guidance being recommended to change by the advisory community on immunization practices, this advisory body that advises the CDC director on what to do when it comes to the childhood dicing schedule, among other things. Dr. Crusty, why are we having this conversation about hepatitis B vaccine?

3:04Dr. Sue Kressly:So I want to start historically. I mean, hepatitis B has been a problem in this country. It's an infection that is often silent early. And when young infants and children get hepatitis B, they can go on to have chronic hepatitis. That's chronic liver disease, can lead to liver failure, need a liver transplant, and can even end up with liver cancer. And so since we've made the connection between infection with hepatitis B and all of these outcomes for children, science has really worked hard to figure out how do we protect every young infant and child from getting hepatitis B in the first place.

3:47Dr. Sue Kressly:And that is through robust vaccination. When I started in practice, hepatitis B was only recommended for what we considered high-risk individuals. We now know that it is such a ubiquitous virus and it is so contagious that we can't use a risk strategy in order to protect our young children. And so we have moved to a universal, strong recommendation saying that every infant should get the hepatitis B shot after birth before they go home from the hospital in order to make sure they have protection. That whole scientific fact-based schedule was questioned over the last two days by the Advisory Committee on Immunization Practices, which is the committee that sets public health recommendations for our entire country.

4:50Dr. Vin Gupta:Why does it matter? Just to put a really fine point on this, you raise that hepatitis B vaccine guides for infants has changed over time. And I see, especially in sort of far right information circles, that you can only get hepatitis B if you're having sex or if you're injecting drugs. And I'm hopeful you can help us understand why that's only part of the picture.

5:21Dr. Sue Kressly:Yeah, that is only part of the picture. And quite frankly, remember, if you're having a baby, somebody had sex. So that includes everybody who's ever had a baby, right? But let's talk about the contagiousness of hepatitis B. It can live on surfaces. It can be spread through touching from someone who's shedding the virus to someone else. and it's more contagious than HIV. The other problem with hepatitis B is in adults, at least half of the people in this country who have hepatitis B don't know they have it. So they are unknowingly leaving hepatitis B germs places that can put other people at risk.

6:08Dr. Sue Kressly:And so that includes, and I've seen this personally, there was a child in my practice who got hepatitis B in the first several weeks of life. And everybody tried to figure out where did this child get hepatitis B. Well, it was a grandparent that didn't know that they had hepatitis B and was helping to care for the child. And so hepatitis B is out there. You can't see it. Many people who shed the virus don't know that they do. And so when we get to these places where we can't tell 100 % who's at risk, the right answer is to protect everyone.

6:48Dr. Vin Gupta:I'm going to throw some questions at you rapid fire. Take the time that you need. But somebody might see some of the changes that have been proposed by ASIP to the CDC director and say, well, what's wrong with testing mom before birth? And if she's negative to have a conversation about immunizing baby, what's wrong with that approach, Dr. Cresley? Yeah.

7:14Dr. Sue Kressly:So let's just say that there is always a conversation before we immunize children. This is not something we do without talking to parents, answering their questions, and obtaining their consent. So this conversation, and there's been a lot of talk about that over the last couple of days, is part of normal medical care for those of us who are caring for children and realize that we need to have that conversation with the family, with the parents. The problem with testing mothers is absolutely universally recommended. There are mothers who somehow slip to the cracks and don't get tested. There are mothers who get tested and their test results are lost and can't be found.

8:01Dr. Sue Kressly:There are mothers who get tested early in pregnancy and they're negative. But then they have more months of pregnancy. and they may become infected after they were tested. And so there is no just-in-time testing as you are laboring and delivering to check if you have hepatitis B at the time of delivery. It's done earlier in pregnancy. And so there is a window that someone may get infected. There also is a window between when you get infected and when your test becomes positive. So because there are all these cracks and it's an imperfect testing system, we know that there will be some moms who are carrying the virus whose lab result says I'm negative, but that's not true at the time of delivery and that infant is at risk and vulnerable.

8:53Dr. Vin Gupta:this has been tried in the past, has it not, where test and then determine. And please improve or correct anything I say that might not be accurate. That approach didn't work. And that's where we had tens of thousands of cases of hepatitis B transmission to baby. A huge majority of those then progress on to chronic liver disease, which is devastating. And with this new shift to giving everybody a birth dose of hepatitis B vaccine, one dose, we've seen those numbers trickle down to almost unrecognizable. Is that right? Can you speak to that? Am I capturing that correctly?

9:33Dr. Sue Kressly:Yes, you are. We tried to do risk-based. Are you at risk? Are you someone who is an IV drug abuser? Are you someone who has had risky sexual behavior. And that did not capture everyone accurately. And when you can't 100 % rely on a risk-based strategy and a testing strategy, that's when we said the right strategy is protect everyone. Assume everyone. I call this like universal precautions. When you go into the hospital now, everyone wears gloves. It's because we can't tell which of the patients might be susceptible from our bacteria or what they may have. It's called universal protections with strong recommendations.

10:23Dr. Sue Kressly:And we've reduced the spread of disease because we understand that when you do the right thing for everyone, you protect those most vulnerable.

10:34Dr. Vin Gupta:Some, again, just going back to how this might be received by the public, some might say well okay i'm we're not going to get the birth dose after an informed conversation or we'll take a negative test in the first trimester whatever it may be uh as reassuring enough and wait potentially for that two month uh or to get it say at a later point maybe two months after birth what's the worry with getting exposed not knowing it if you're baby and then getting the hepatitis B dose, say at a later point, maybe two months after birth, what's the concern there?

11:15Dr. Sue Kressly:You've left your child vulnerable to an infection at their most vulnerable time in life. You can't put them in a bubble. Are you going to test everyone who comes into your house for hepatitis B and demand that they show that they're negative before they touch your child, change their diaper, help clean your dishes, feed your baby, etc. It is just not a reasonable request. But I have another problem with this. We have something that works. These people who are making the recommendations have or should have the, they should need to prove to us what is wrong with this universal birth dose that we think it's better to wait and they're showed no data there's no proof it's a whim that we think and they're going to have data that children are harmed with hepatitis b so they are taking something that is protecting children and removing the protection, the only thing I can understand why they might even be doing this is because it's a part of a larger picture to reduce confidence in vaccines in general.

12:35Dr. Sue Kressly:And they're picking away at things that seem like they're not that impactful, when in reality, it all threatens the health of our children across the nation. Every time you sow doubt, purposely erode confidence, you are putting children at risk. And there is no data and no science and no reason behind any of the hepatitis B recommendations they made today. And they couldn't even defend them when the scientific data was presented by others, non-voting members, people who actually understand and have the expertise to look at the data pushed back. But others on that committee came in, in my mind, predetermined to change the hepatitis B vaccine as part of an incremental strategy to erode access and confidence in vaccines.

13:37Dr. Vin Gupta:I want you to restate this. So there is no safety data that you're aware of as the president of the American Academy of Pediatrics that exists or no, there is no new medical information or research study that calls into question the safety of that birth dose of hepatitis B vaccine. Is that right?

13:56Dr. Sue Kressly:That is correct. This was completely without any reason, any fact, anything behind it to say, we want to change it because we think that this might be better. And there is no ongoing study. There were no studies to say that when we delayed this till two months, there were no increased cases of hepatitis B. There were less fussy periods after vaccination. And why did they arbitrarily pick two months? This is all not based in fact. It is a made up whim that without any scientific basis, but no matter what they said, it erodes the confidence that parents and families deserve to have. I want every parent in America to feel as confident in giving consent to vaccinating their child as I am in recommending it.

14:56Dr. Sue Kressly:I would never recommend for your child what I don't do for my own and my grandchildren, and I did not hesitate for one second to vaccinate them at birth.

15:07Dr. Vin Gupta:I think, Dr. Cressley, I say this as a clinician, and I think I speak for a lot of fellow clinicians and perhaps some pediatricians. When I say, how is this possible in a profession where quality and safety are paramount, do no harm, where if something were to happen, that we are bound legally in many ways, there's constraints put on us as positions to do no harm. If we do harm and it's volitional, there's repercussions. how are there no repercussions to this type of policy i'm wondering from your perspective is there anything you can share from aap's perspective on the way forward here because this feels like this can't stand but i'm wondering what we can all do what can the pediatrician

16:01Dr. Sue Kressly:listening to us right now do what can societies do so the the problem we have is that we have non-experts and not expert processes now making public health recommendations. And so when you exclude the true experts and the transparent process from all the public health recommendations, you can no longer trust the recommendations. And so we have now gotten to a place where the recommendations from the ACIP should not be trusted by anyone. And so that leaves a big void. The American Academy of Pediatrics and my colleagues and I are standing up to be that confident voice of fact-based, expert-informed recommendations.

16:55Dr. Sue Kressly:So please listen to our recommendations. They can be found on healthychildren.org. There are lots of pediatricians who are in the public space speaking up. In the meantime, we all as citizens of this country need to push back against our legislators and our policymakers. We will not stand for this. Our public health depends on them creating the space and the place for experts to inform the public what is in their best interest. And they will be accountable. History will judge them accountable for harms that are done because of the erosion of the confidence in vaccines and of these non-science-based recommendations.

17:45Dr. Vin Gupta:Dr. Susan Kressley, the president of the American Academy of Pediatrics. Dr. Kressley, we're going to be calling on you, no doubt, in the near future to join us again. But thank you for part two at Midas Health. We really are just grateful for your leadership of the country and for joining us. Thank you so much.

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