Health Wanted: Respiratory Virus Season

The Episode

In this episode of Health Wanted, host Laurel Bristow helps you gear up to avoid getting taken down by a winter virus—COVID, flu, or RSV—and chats with friend of the show Seema Lakdawala, MD, about the best ways to stop transmission.

Listen to the episode now

ACIP Update

Let’s talk about a few things that happened at the Advisory Committee on Immunization Practices (ACIP) meeting last week.

Hepatitis B Newborn Dose

The first topic discussed was the hepatitis B birth dose. We’ve talked about the reasoning behind that dose before, but here are a few important points if you missed it: 

• Prior to there being a recommendation of universal hepatitis B vaccines at birth, there were 16,000 kids a year under 10 who were infected with hepatitis B.
• Hepatitis B is highly infectious, so kids can get infected early in life simply by sharing household items like washcloths or earrings with a close contact who doesn’t know they have chronic hepatitis B (nearly half of all people with chronic Hep B don’t know they’re infected).
• Infants who get infected with hepatitis B before the age of 1 have a 90% chance of going on to develop chronic hepatitis B, which is incurable and can cause things like liver cancer and require transplants.

Centers for Disease Control and Prevention (CDC) scientists presented the body of evidence to support continuing universal hepatitis B vaccines at birth at the recent ACIP meeting. They did an extremely thorough job, not only with the amount of research presented but also in responding to questions from the committee.

During the meeting, several ACIP members seemed to want to overlook the research the CDC scientists were presenting and instead asked about a singular study that showed harm. 

In the end, the committee voted to recommend all pregnant women be tested for hepatitis B (a recommendation that’s already been in place since 1988). They tabled the vote on changing the hepatitis B recommendations, meaning that for now we still recommend the birth dose to everyone.

Measles, Mumps, Rubella, and Varicella Vaccine

The next area of discussion was the joint measles, mumps, rubella, and varicella (MMRV) vaccine.

The committee wanted to review the risk of febrile seizures in children under 4 who received this joint vaccine instead of separate measles, mumps, and rubella (MMR) and varicella vaccines. We were already aware of a slightly increased, but still small, risk of this type of seizure in young children who get MMRV. Although febrile seizures are very scary to witness, they don’t cause long-term complications and are much more common from viral illnesses than the vaccine.

Still, because of this risk, in 2009 the CDC recommended separate MMR and varicella vaccines be the preference for kids under 4 unless their parents wanted to reduce the number of injections and request MMRV.

Last week, the committee voted to remove MMRV from the schedule for kids under 4 and remove coverage from the Vaccines for Children program. Parents who use the Vaccines for Children program, which vaccinates over half of kids in the U.S., no longer even have the option to give their kid one shot instead of two.

The CDC estimates that 15% of kids under 4 receive this vaccine instead of the separate shots, which could put a strain on the supply of MMR vaccines now that it’s gone. The change also risks us losing coverage of essential vaccines like that for measles if kids now have to get more injections or go to more doctor’s visits to be fully vaccinated.

COVID-19 Vaccines

The last topic was COVID. We talked in the main episode about the voting outcome for COVID access, but there was another vote that also happened—the committee voted that the vaccine information sheet should be updated with six pieces of information using language that will undermine trust in vaccines.

One of the requests was to add language that annual mRNA COVID-19 vaccines can cause changes to the immune system that can make you more susceptible to other infections. There is no quality evidence to support this. They acknowledge that by saying “these risks are not well  understood” at the end of the recommendation but including that language in a vaccine information sheet will cause fear and distrust in these vaccines for many people. To add that language, without acknowledging the much more substantial risk of heart issues from infection, is misleading and will prevent people from being able to make an accurate risk calculation.

They talked about how the vaccine can cause post-vaccine syndrome, which has symptoms similar to long covid. This is based on the work of Dr. Akiko Iwasaki, who we had on the show, and even she said that they have not demonstrated that the vaccine is the cause of these outcomes.

The last warning that is particularly dangerous is one saying that the safety of COVID vaccines has never been properly studied in pregnant women, and that one trial found a higher level of congenital malformities in the children of women who were vaccinated.

We have a huge body of evidence that shows that COVID vaccination in pregnancy does not increase the risk of complications or birth defects. It lowers the risk of things like pre-term birth and stillbirth, which are both things a COVID infection in pregnancy can cause.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
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