The CDC’s Advisory Committee on Immunization Practices voted unanimously, 15-0, on Wednesday to recommend hepatitis B vaccination for all adults aged 19 to 59 years.
The recommendation says adults in this age group — plus adults aged 60 years or older with risk factors — “should” be vaccinated against HBV. It says adults aged 60 years or older who do not have known risk factors for HBV infection “may” receive an HBV vaccine.
It was one of nine different recommendations made Wednesday by the ACIP, which also supported vaccinating people at occupational risk against orthopoxviruses and Ebola virus, including health care personnel and lab workers.
The votes came 1 day after the same committee unanimously endorsed Pfizer’s pediatric COVID-19 vaccine for children aged 5 to 11 years.
CDC medical officer Mark K. Weng, MD, MSc, FAAP, who leads the ACIP’s hepatitis vaccines work group, presented data on the importance of vaccinating adults against HBV.
“In the U.S. every year, there are 20,700 estimated acute hepatitis B infections, and over $1 billion dollars spent on hepatitis B-related hospitalizations,” Weng said. “There are almost two million people estimated to be living with chronic hepatitis B in the U.S., of whom there’s a [15% to 25%] risk of premature death from cirrhosis or liver cancer.”
According to Weng, a universal vaccine recommendation for adults would serve as a “natural extension” of existing routine childhood recommendations and simplify existing adult risk groups into a single recommendation.
A 2005 recommendation that all newborns should receive their first HBV vaccine dose before hospital discharge resulted in large decreases in new cases among children and adolescents, Weng said. However, adult rates have plateaued in the last decade, he said.
“The past decade has illustrated that risk-based screening among adults has got us as far as it can take us,” Weng said. “Initial decreases in new infections have stagnated. Rates of acute infections are now highest among 30- to 59-year-olds, and rates have actually increased among adults aged 40 years and older, indicating that we’re losing ground. We cannot eliminate hepatitis B in the U.S. without a new approach.”
Weng said the work group reasoned that it would be better for adults to be vaccinated before exposure, and the new recommendation would also promote health equality.
The CDC is currently drafting recommendations for all adults to be screened for HBV at least once in their lifetime, an ACIP member said. The recommendation will not be discussed or voted on until next year.
The ACIP voted unanimously on five different recommendations supporting the use of Jynneos — a vaccine approved by the FDA in 2019 to prevent smallpox and monkeypox disease in adults at a high risk for infection — as an alternative to the ACAM2000 smallpox vaccine, including for booster doses.
Two votes supporting the use of an FDA-approved Ebola vaccine as PrEP for health care personnel involved in the care and transport of suspected or confirmed Ebola cases at special treatment centers, or lab and support staff at facilities that handle Ebola specimens, were not unanimous.
Both recommendations passed 11-4, with dissenting members suggesting they would have preferred the recommendations include language on “shared clinical decision making” — that is, patients and physicians decide for themselves if it is appropriate.
PERSPECTIVE
Rita K. Kuwahara
I think that universal adult HBV vaccination is absolutely necessary in order to prevent further outbreaks of HBV, which is a vaccine-preventable disease. We have such safe and highly effective vaccines for HBV that there really shouldn’t be a single new infection in our country. However, there are certain populations that have historically been at much higher risk for contracting HBV, and then other populations that are becoming increasingly affected.
In particular, historically, the Asian American/Pacific Islander American community, as well as the African immigrant community, have seen very high levels of HBV. But we’ve also seen enormous rises in acute HBV among persons who inject drugs, particularly within the opioid epidemic.
Currently, the adult HBV vaccination rate has stood at around 25% to 30%. We currently estimate that up to 2.4 million people in the U.S. are chronically infected with HBV. To note, one in four people with unmanaged chronic HBV will develop liver cancer, liver failure or liver cirrhosis. We really do need to push for universal vaccinations to achieve elimination.Rita K. Kuwahara, MD, MIHPrimary care health policy fellow
Internal medicine physician
Georgetown University
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