With Long Island's high hepatitis B rate, local medical experts decry new vaccine recommendation

Long Island medical experts say the decision by a federal vaccine advisory committee to change the recommendations for when an infant should receive the hepatitis B vaccine will lead to more cases of the disease and is particularly concerning on Long Island, which has the highest per capita rate of new cases outside of New York City, according to state data.

"This change in recommendation is going to harm children. It's going to make children less safe," said Dr. David Fagan, the vice chairman of pediatric ambulatory administration at Cohen Children’s Medical Center in New Hyde Park. "There will be children that unfortunately contract hepatitis B and can potentially die from the complications of that infection."

Hepatitis B is a liver infection that can cause acute and chronic illness. In 2023, Nassau recorded 47.6 cases per 100,000 people — by far the highest of any county outside the city — while Suffolk recorded 17.8 per 100,000 people, according to the state health department’s latest report on hepatitis. Long Island had a combined rate of 32 cases per 100,000 people, while the Lower Hudson Valley had the next highest at 26.7.

Long Island’s relatively high hepatitis B rate makes the committee's decision even more concerning, experts said.

"The higher the risk in the population, the higher risk of it falling through the cracks and being missed," said Dr. Leonard Krilov, a pediatric infectious disease specialist and former chairman of pediatrics at NYU Langone Hospital — Long Island.

Since 1991, the CDC's Advisory Committee on Immunization Practices has recommended infants receive their first of three hepatitis B vaccine doses the day they are born. Medical experts cite immunization practice as to why childhood hepatitis B cases have dropped in the last three decades.

The committee ended that recommendation on Friday and said newborns should get the first-day dose if their mother had tested positive for hepatitis B, or in cases where the mother wasn’t tested. For other infants, the committee recommended the vaccination series for hepatitis B should begin when the child is two months old. Committee members cited the low risk of infection of the virus in newborns and said more research should be done about the vaccine's safety.

Pediatric experts told Newsday the initial dose of the vaccine close to birth is an important safety net, protecting children whose mothers experienced a false negative test or contract the virus after being tested.

"There's no data that suggests a reason to delay two months," said Krilov. The vaccine for hepatitis B is safe and effective, and its use hasn’t been questioned until recently, he said.

The committee’s decision might drive parents to delay their child’s first dose of the vaccine — or put off the immunization altogether, Krilov said. He’s worried it is "part of a precedent-setting attempt to alter the way we administer vaccines" for preventable diseases generally.

While the committee’s decision will not change New York State’s health guidance, the different recommendations will likely leave parents unsure about what to do, Fagan said.

"This is just going to lead to more confusion, more unnecessary distrust," Fagan said.

Most infants infected by hepatitis B develop a chronic infection, and roughly one in four eventually die from cirrhosis, cancer and other liver conditions, according to the New York State Department of Health.

Experts said the consequences of the committee's recommendations, if finalized by the CDC’s acting director, will emerge slowly over the next few decades, as the unvaccinated children grow into adults and contract the virus — which is typically transmitted in adulthood through sexual contact and sharing needles during drug use.

"This is going to be a silent bomb that's going to go off 20 years from now," said Dr. Sharon Nachman, the chief of the pediatric infectious disease at Stony Brook Children’s Hospital.

Nachman said the committee's recommendation is not based in vaccine science and will add to the already rising hesitancy and misinformation around vaccines.

"I think it's really important for families to talk to their child's pediatrician," Nachman said. "That person went to medical school, they did a pediatric residency and they're practicing and keeping up to date with the science. That's the expert you should rely on."