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Tag: hepatitis

  • Vaccine panel’s hepatitis B vote signals further turbulence for immunization policy, public trust

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    When Dr. Su Wang was in medical school, she donated blood. That’s when she learned she was infected with hepatitis B, a virus that attacks the liver and can lead to cancer and death decades later.

    “I was 18, healthy, in college,” she said. “And suddenly I had a chronic illness I didn’t even know about.”

    Born in Florida in 1975, Wang grew up before the hepatitis B vaccine was routinely given to newborns. For years, she assumed she had been infected by her mother, only to discover later that both her parents were negative. “It turns out my grandparents, who cared for me after birth, probably passed it to me,” she said. “That’s how easy this virus spreads — not from some exotic risk factor, just family.”

    Today, Wang is the medical director for viral hepatitis programs at RWJBarnabas Health in New Jersey. Her story now sits at the center of a historic turning point in public health.

    On Dec. 5, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to end the universal U.S. recommendation for the newborn dose of the hepatitis B vaccine, instead adopting a policy urging individual-based decision-making.

    Under the new approach, only infants born to mothers who test positive for hepatitis B will automatically receive a dose of the vaccine and hepatitis B antibodies shortly after birth. For everyone else, if the parents choose to vaccinate, the birth dose can be delayed until 2 months of age.

    All the committee members were appointed by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist. In an 8-to-3 vote, the panel decided that since most pregnant women now receive hepatitis B testing, administering the vaccine at birth should be reserved for infants whose mothers test positive. They framed the shift as a way to reduce interventions deemed unnecessary, align vaccination with test results, and give parents more control over timing. Supporters of the decision described it as a move toward parental choice rather than a reflection of changing epidemiology.

    But to many clinicians and epidemiologists, the change represents a dangerous rollback that could reverse three decades of progress toward eliminating a disease that still infects as many as 2.4 million Americans and kills tens of thousands each year. They see echoes of the 1980s, when risk-based vaccination left entire generations unprotected, and worry the country is about to repeat that mistake.

    Moreover, the panel’s move on hepatitis B — in the face of overwhelming data that shows the birth dose is effective and safe — portends further upheaval for the nation’s childhood vaccine schedule, a cornerstone of public health.

    “They’re not just trying to change one vaccine,” said Angela Rasmussen, a virologist and an editor of the scientific journal Vaccine. “They’re trying to dismantle how vaccine policy is made.” 

    Department of Health and Human Services spokesperson Emily Hilliard responded: “ACIP reviews all evidence presented and issues recommendations based on evidence and sound judgment to best protect America’s children.”

    The authors of a new independent review by the Vaccine Integrity Project, which evaluated more than 400 studies and reports, warned in a public comment that delaying the birth dose “would reduce protection for infants and increase the risk of avoidable HBV infections, undermining decades of progress” toward eliminating the hepatitis B virus. The review was led by researchers at the University of Minnesota’s Center for Infectious Disease Research and Policy, which created the Vaccine Integrity Project in response to what it regards as Trump administration actions that “put the federal vaccine landscape at risk,” and it was vetted by outside experts.

    “We fought hard for that universal birth dose because targeted approaches missed too many babies,” Wang said. “We know what happens when you wait.”

    What’s unfolding now is not just a technical policy update but a fundamental test of the systems meant to protect the most vulnerable. The debate turns on a few critical questions — whether testing is reliable enough to replace universal safeguards, how infectious hepatitis B truly is, why past strategies failed, and what the CDC’s internal shake-ups mean for vaccine policy writ large.

    The limits of testing

    Hepatitis B testing sits at the center of the new ACIP recommendation, but even the CDC acknowledges that testing alone can’t guarantee protection. Pregnant women may test negative if the virus was acquired late in pregnancy or during the “window period,” before hepatitis B surface antigens become detectable. False negatives happen. No testing system, no matter how well designed, can catch every infection. That’s why universal vaccination was created in the first place.

    If a mother’s status is unknown at delivery, hospitals are supposed to give the newborn a hepatitis B vaccine within 12 hours, adding hepatitis B antibodies for premature infants or if the mother later tests positive. But in real clinical settings, these safeguards routinely break down. Results take time. Nurses miss or misread labs. Pharmacies delay deliveries. Documentation gets lost.

    “Every step you add increases the chance that something falls through the cracks,” Wang said. “Delaying the vaccine just adds another.”

    ACIP’s vote shows how that logic is being challenged.

    Some committee members suggested dropping the third hepatitis B shot if antibody levels look high after the second. 

    But Dr. Brian McMahon, a liver disease specialist who has spent decades treating hepatitis B, told the panelists that the data doesn’t support that idea. “Only maybe 20% to 30%” of infants have an adequate antibody level after the first dose, he said.

    “You need two doses to really reach a high level of protection,” he said, with the third shot giving a stronger, longer-lasting response.

    He said the overall message coming from the committee seemed designed to “discourage the birth dose.”

    “They’re making it more and more difficult,” McMahon said.

    In a second vote, ACIP also encouraged parents and clinicians to order post-vaccine serology tests — blood tests that measure protective antibody levels — after the second or third dose. The tests, ACIP said, should be covered by insurance.

    More infectious than HIV or hepatitis C

    Hepatitis B can survive on toothbrushes, razors, and household surfaces for a week. It spreads not just from mother to child but also through ordinary family contact: shared items, open sores, small blood exposures. In the 1980s, researchers found that about half of infections in American children came not from mothers but from other household members.

    That’s why state health departments continue to insist that every newborn be vaccinated within 24 hours of delivery, regardless of maternal status. “Delaying vaccination misses a crucial period of potential exposure,” a New York advisory warned this year. The vaccine, it noted, is 80% to 100% effective when given on time.

    The Vaccine Integrity Project report underscores the stakes. Since the universal birth dose was introduced in 1991, pediatric hepatitis B infections in the U.S. have dropped by more than 99%. A 2024 CDC analysis estimated that the current schedule has prevented more than 6 million hepatitis B infections and nearly 1 million hospitalizations.

    The benefits are lifelong. Infants vaccinated at birth are shielded not just from hepatitis B but also from the liver failure and cancer it can cause decades later. Yet because the disease unfolds slowly, the consequences of policy shifts may not surface for 20 or 30 years.

    Dr. Trieu Pham, a California physician, doesn’t need to imagine those consequences. Born in Vietnam in 1976, he probably contracted the virus at birth. “If the vaccine had existed then, I wouldn’t have gone through what I did,” he said. Diagnosed in his 20s, he developed cirrhosis by 40. At 47, he was coughing blood from ruptured esophageal veins. Eventually, he required a liver transplant to survive.

    “You live with this constant fatigue and fear,” he said. “And the saddest part is it was preventable.”

    His three children, all vaccinated within hours of birth, are free of hepatitis B. “That’s the difference a day can make,” Pham said.

    A lesson already learned

    In 1982, ACIP recommended the new hepatitis B vaccine only for adults at high risk: health care workers, injection drug users, and men who have sex with men. But by the late 1980s, it was clear that risk-based vaccination couldn’t contain transmission. Many newly infected adults didn’t fit any defined risk group. Identifying high-risk people proved imperfect, stigmatizing, and ultimately ineffective.

    Meanwhile, infants infected during or shortly after birth had a 90% chance of developing chronic infection, compared with less than 5% in adults. Yet public health officials repeated the same targeted strategy, this time with newborns. In 1988, the CDC recommended universal prenatal screening and linked an infant’s vaccination to the mother’s test result, again basing protection on a risk marker instead of vaccinating all infants.

    As before, it failed. Many infected mothers weren’t correctly identified. Some were never tested, some were tested too early, and others had results that were misread or never communicated. Too many infants slipped through the cracks, proof that another targeted approach couldn’t reliably protect them.

    In 1991, the CDC issued its landmark guidance recommending that all infants, regardless of their mother’s infection status, receive a hepatitis B vaccine at birth, followed by two additional doses in infancy. By 2005, the policy was fully embedded in the routine immunization schedule, then reaffirmed in 2018. This evolution was based on data showing that a universal strategy, rather than a targeted one, was the most effective in preventing infections.

    A matter of trust

    The CDC’s new hepatitis B policy rests on the premise that moving the decision to parents will strengthen trust in the vaccine system. Supporters frame it as an empowerment shift — a way to give families more control.

    In 1999, when it was last recommended to postpone the first dose of hepatitis B vaccine for infants born to uninfected mothers, vaccination rates also dropped among infants born to those who were infected.

    “Opt-in policies sound patient-centered,” Wang said, “but in practice they’re inequitable. They leave behind the very families who need protection most” — the ones most likely to miss prenatal care and testing, have infections that go undetected or arise after testing, or slip through gaps in hospital care, as well as infants who can be exposed and infected by other caregivers and household members.

    Those are often immigrant families, including from Asian and Pacific Islander communities in which hepatitis B remains endemic. “We already underdiagnose and undertreat these populations,” Wang said. “This change would deepen that gap.”

    The United States is now the only country to abandon a universal hepatitis B birth dose recommendation. Though it will take decades to gather outcomes data, some researchers predict that delaying the first dose of hepatitis B vaccine to 2 months of age could result in over 1,400 preventable infections and about 300 cases of liver cancer per year.

    “We don’t get to choose what we inherit,” Wang said. “But we do get to choose what we pass on.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

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  • What are parents to do as doctors clash with Trump administration over vaccines?

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    It’s normal for parents, or anyone, to have questions about vaccinations — but what happens if your pediatrician urges a shot that’s under attack by the Trump administration?

    That’s getting more likely: The nation’s leading doctors groups are in an unprecedented standoff with federal health officials who have attacked long-used, lifesaving vaccines.

    The revolt by pediatricians, obstetricians, family physicians, infectious disease experts and internists came to a head when an advisory panel handpicked by Health Secretary Robert F. Kennedy Jr. urged an end to routine newborn vaccination against hepatitis B, a virus that can cause liver failure or liver cancer.

    That vaccine saves lives, helped child infections plummet and has been given safely to tens of millions of children in the U.S. alone, say the American Academy of Pediatrics and other doctors groups that vowed Tuesday to keep recommending it.

    But that’s not the only difference. That Advisory Committee on Immunization Practices now is examining possible changes to the entire childhood vaccination schedule, questioning certain ingredients and how many doses youngsters receive.

    Pushing back, the American Academy of Pediatrics has issued its own recommendations for youngsters. Other medical groups — plus some city and state public health departments that have banded together — also are issuing their own advice on certain vaccines, which largely mirrors pre-2025 federal guidance.

    This article is part of AP’s Be Well coverage, focusing on wellness, fitness, diet and mental health. Read more Be Well.

    “We owe our patients a consistent message informed by evidence and lived experience, not messages biased by political imperative,” Dr. Ronald Nahass, president of the Infectious Diseases Society of America, told reporters Tuesday.

    But Nahass acknowledged the inevitable consumer confusion, recounting a relative calling him last weekend for advice about hepatitis B vaccination for her new grandbaby.

    “Most Americans don’t have a Cousin Ronnie to call. They are left alone with fear and mistrust,” he said, urging parents to talk with their doctors about vaccines.

    New guidelines without new data concern doctors

    Hepatitis B isn’t the only vaccine challenge. Kennedy’s health department recently changed a Centers for Disease Control and Prevention webpage to contradict the longtime scientific conclusion that vaccines don’t cause autism. Federal agencies also moved to restrict COVID-19 vaccinations this fall, and are planning policy changes that could restrict future flu and coronavirus shots.

    But when it comes to vaccine advice, “for decades, ACIP was the gold standard,” said Dr. Jake Scott, an infectious disease physician and Stanford University researcher.

    The panel once routinely enlisted specialists in specific diseases for long deliberations of the latest science and safety data, resulting in recommendations typically adopted not only by the CDC but by the medical field at large, he said.

    Last week’s meeting of Kennedy’s panel, which includes vaccine skeptics, marked a radical departure. CDC specialists weren’t allowed to present data on hepatitis B, the childhood vaccine schedule or questions about vaccine ingredients. Few of the committee members have public health experience, and some expressed confusion about the panel’s proposals.

    At one point, a doctor called in to say the panel was misrepresenting her study’s findings. And the panel’s chairman wondered why one dose of yellow fever vaccine protected him during a trip to Africa when U.S. children get three doses of hepatitis B vaccine. The hepatitis B vaccine is designed to protect children for life from a virus they can encounter anywhere, not just on a trip abroad. And other scientists noted it was carefully studied for years to prove the three-dose course offers decades of immunity — evidence that a single dose simply doesn’t have.

    “If they’ve got new data, I’m all for it — let’s see it and have a conversation,” said Dr. Kelly Gebo, an infectious disease specialist and public health dean at George Washington University, who watched for that. “I did not see any new data,” so she’s not changing her vaccine advice.

    Committee members argued that most babies’ risk of hepatitis B infection is very low and that earlier research on infant shot safety was inadequate.

    Especially unusual was a presentation from a lawyer who voiced doubt about studies that proved benefits of multiple childhood vaccines and promoted discredited research pointing to harms.

    “I don’t think at any point in the committee’s history, there was a 90-minute uninterrupted presentation by someone who wasn’t a physician, a scientist, or a public health expert on the topic — let alone someone who, who makes his living in vaccine litigation,” said Jason Schwartz, a vaccine policy expert at Yale University.

    By abandoning data and the consensus of front-line doctors, the ACIP is “actively burning down the credibility that made its recommendations so powerful,” added Stanford’s Scott. “Most parents will still follow their pediatricians, and AAP is holding the line here. But the mixed messages are precisely what erode confidence over time.”

    Parents already have a choice — they need solid guidance

    Trump administration health officials say it’s important to restore choice to parents and to avoid mandates. That’s how the panel’s hepatitis B recommendation was framed — that parents who really want it could get their children vaccinated later.

    Parents already have a choice, said Dr. Aaron Milstone of the American Academy of Pediatrics. The government makes population-wide recommendations while families and their doctors tailor choices to each person’s health needs.

    But many doctors don’t — or can’t — do their own lengthy scientific review of vaccines and thus had relied on the ACIP and CDC information, Yale’s Schwartz noted.

    They “rely on trusted expert voices to help navigate what is, even in the best of times, a complicated landscape regarding the evidence for vaccines and how best to use them,” he said.

    That’s a role that the pediatricians and other doctors groups, plus those multistate collaborations, aim to fill with their own guidelines — while acknowledging it will be a huge task.

    For now, “ask your questions, bring your concerns and let us talk about them,” said Dr. Sarah Nosal, of the American Academy of Family Physicians, urging anyone with vaccine questions to have an open conversation with their doctor.

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    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • Watch Live: CDC advisory panel discusses COVID-19 vaccine risks, spars with outside experts over process

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    After the tabled hep B vote, some liaison members from top medical organizations shared their agreement for holding off on making changes to the current recommendations. Some also urged more transparency in how decisions will be made on future potential recommendation changes.

    “I would urge the committee to use the methodical scientific method to weigh the risks and benefits appropriately,” said Dr. Amy Middleman, a liaison for the Society for Adolescent Health and Medicine. She added, “This is important for all vaccine decisions, and this is what I think some of us are really concerned about in terms of the absence of it.”

    ACIP member Retsef Levi said he appreciated the desire to keep scientific methods but took issue with the liaison member’s comments.

    “I have to say that one thing that puzzles me is that many of the speakers that push for the scientific approach are speaking very confidently in the absence of the gold standard evidence of robust long-term clinical trials against placebo,” Levi added, who has been pushing for more research beyond what the CDC has presented during the meetings. 

    When ACIP chair Kulldorff began to move on from the hep B discussion, Dr. Jason Goldman, president of the American College of Physicians, chimed in asking for more explanation and to call out the committee for muting him.

    “That is disrespectful. You want debate and discussion, but you’re muting people and silencing them,” Goldman said. “Please provide to the public so they can have trust, faith and confidence in vaccination as to what process we are going to be using to properly vet and discuss all future vaccines. … Tell the public how you are going to be analyzing all of these vaccine decisions so we can have confidence in this committee.”

    Kulldorff responded that he previously responded to that comment already before moving on to the next agenda matter.

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  • Kennedy’s advisory panel is expected to vote on hepatitis B and MMRV vaccines

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    ATLANTA — Health Secretary Robert F. Kennedy Jr.’s new vaccine advisory committee meets Thursday to begin a two-day session focused on shots against COVID-19, hepatitis B and chickenpox.

    Votes are expected Thursday afternoon on hepatitis B and on a combined shot against measles, mumps, rubella and chickenpox, but Department of Health and Human Services officials have not said exactly what proposals would be considered.

    Information on the meeting agenda suggests the committee may be poised to roll back — at least partly — a longstanding recommendation that all U.S. children get an initial dose of hepatitis B vaccine right after birth.

    The American Academy of Pediatrics and many public health officials support that decades-old practice.

    Dr. Mysheika Roberts, health department director in Columbus, Ohio, said rates of the liver disease among children have dropped tremendously since it was put into place.

    “I don’t understand the rationale of why we would stop providing that vaccine and that guidance to babies when we’ve seen such great progress in that area,” said Roberts, who was scheduled to join the vaccine panel but was dismissed by Kennedy. “If it’s not broken, why change it?”

    The committee’s chair, Martin Kulldorff, also has raised the idea of recommending the MMRV combination shot not be given to children younger than 4. In a June presentation to the committee, he discussed rare instances of feverish seizures that have been associated with the first dose, given to kids between ages 1 and 2.

    The ACIP last dealt with the issue in 2009, when it said either the combination shot or separate MMR and varicella shots were acceptable for the first dose. Today, most pediatricians suggest separate doses for the first round and give the combined shot for the second dose, pediatrics experts say.

    Some doctors and public health experts say they are not aware of any new safety data that would explain the revisiting of those vaccination recommendations. They worry that the panel is raising unwarranted new questions about vaccines in the minds of parents, and that it may limit the ability of families to get their children protected.

    The panel, the Advisory Committee on Immunization Practices, makes recommendations to the director of the Centers for Disease Control and Prevention on how already-approved vaccines should be used. CDC directors have almost always accepted those recommendations, which are widely heeded by doctors and guide vaccination programs.

    Kennedy, a leading antivaccine activist before becoming the nation’s top health official, fired the entire 17-member panel earlier this year and replaced it with a group that includes several anti-vaccine voices. On Monday, HHS announced the addition of five more people, some of them noted skeptics of COVID-19 vaccinations or pandemic prevention measures.

    Doctors’ groups and public health organizations have voiced alarm about Kennedy and his new panel. Concern intensified in May, when Kennedy announced he was removing COVID-19 shots from the CDC’s recommendations for healthy children and pregnant women. The move was heavily criticized by doctors’ groups and public health organizations, and prompted a lawsuit by the American Academy of Pediatrics and other groups.

    The committee is scheduled to make COVID-19 vaccine recommendations on Friday.

    The AAP and some others groups have issued their own vaccination recommendations, which disagree with recommendations put out by federal officials this year.

    In recent weeks, several states have announced policies to help residents maintain access to vaccines, in some cases signing orders that ensure COVID-19 vaccinations at pharmacies without individual prescriptions. Wisconsin this week joined a list of more than a dozen to take steps, when Gov. Tony Evers signed an executive order for state health officials to follow the guidance of national physician organizations.

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    Ungar reported from Louisville, Kentucky.

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    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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  • What happened in the UK’s infected blood scandal from the 1970s to ’90s?

    What happened in the UK’s infected blood scandal from the 1970s to ’90s?

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    LONDON — The final report of the U.K.’s infected blood inquiry was published on Monday, nearly six years after it began looking into how tens of thousands of people contracted HIV or hepatitis from transfusions of tainted blood and blood products in the 1970s and 1980s.

    The scandal is widely seen as the deadliest to afflict Britain’s state-run National Health Service since its inception in 1948, with around 3,000 people believed to have died as a result of being infected with HIV and hepatitis.

    The report criticized medical practitioners, civil servants and politicians, though many have already died given the passage of time. It’s also set to pave the way to a huge compensation bill that the British government will be under pressure to rapidly pay.

    Had it not been for the tireless campaigners, many of whom saw loved ones die decades too soon, the scale of the scandal may have remained hidden forever.

    “This whole scandal has blanketed my entire life,” said Jason Evans, who was 4 when his father died at the age of 31 in 1993 after contracting HIV and hepatitis from an infected blood plasma product.

    “My dad knew he was dying and he took many home videos, which I’ve got and replayed over and over again growing up because that’s really all I had,” he added.

    Evans was instrumental in the decision by then-Prime Minister Theresa May to establish the inquiry in 2017. He said he just “couldn’t let it go.” His hope is that on Monday, he and countless others, can.

    Here is a look at what the scandal was about and what the report’s impact may be.

    In the 1970s and 1980s, thousands of people who needed blood transfusions, for example after childbirth or surgery, became exposed to blood tainted with hepatitis, including an as yet-unknown type of the liver infection that was later named hepatitis C, and HIV.

    Those with hemophilia, a condition affecting the blood’s ability to clot, became exposed to what was sold as a revolutionary new treatment derived from blood plasma.

    In the United Kingdom, the NHS, which treats the vast majority of people, started using the new treatment in the early 1970s. It was called Factor VIII. It was more convenient when compared with an alternative treatment and was dubbed a wonder drug.

    Demand soon outstripped domestic sources of supply, so health officials began importing Factor VIII from the United States, where a high proportion of plasma donations came from prisoners and drug users who were paid to donate blood. That dramatically raised the risk of the plasma being contaminated.

    Factor VIII was made by mixing plasma from thousands of donations. In this pooling, one infected donor would compromise the whole batch.

    The inquiry heard estimates that more than 30,000 people were infected from compromised blood or blood products via transfusions or Factor VIII.

    By the mid-70s, there was evidence hemophiliacs being treated with Factor VIII were more prone to hepatitis. The World Health Organization, which had warned in 1953 of the hepatitis risks associated with the mass pooling of plasma products, urged countries not to import plasma.

    AIDS was first recognized in the early 1980s among gay men but soon started appearing among hemophiliacs and those who had received blood transfusions.

    Though HIV was not identified as the cause of AIDS until 1983, warnings had been relayed to the U.K. government the year before that the causative agent could be transmitted by blood products. The government argued there was no conclusive proof. Patients were not informed of the risk and continued to use a treatment that put them in mortal danger.

    The inquiry said lessons from as early as the 1940s had been ignored.

    Campaigners argue that since the 1940s it had been clear that heat killed hepatitis in another plasma product, Albumin. They say authorities could have made Factor VIII safe before it was sold.

    Evidence given to the inquiry suggested that authorities’ main objection was financial. Non-heated Factor VIII was prescribed by the NHS until late 1985.

    Campaigners hope the inquiry’s core finding is that Factor VIII concentrates should never have been licensed for use unless heated.

    In the late 1980s, victims and their families called for compensation on the grounds of medical negligence. Though the government set up a charity to make one-off support payments to those infected with HIV in the early 1990s, it did not admit liability or responsibility and victims were pressured to sign a waiver undertaking not to sue the Department of Health to get the money.

    Crucially, the waiver also prevented victims from suing for hepatitis, even though at that stage they only knew about their HIV infection. Years after signing, victims were told they had also been infected with hepatitis, mainly hepatitis C.

    There was no further group litigation until Evans, whose mother “crumbled” after his father’s death and who was called “AIDS boy” at school, brought a case claiming misfeasance in public office against the Department of Health.

    Combined with political and media pressure, May announced the independent inquiry. It was, she said, “an appalling tragedy which should simply never have happened.”

    The government has accepted the case for compensation, with most estimates putting the final bill in the region of 10 billion pounds ($12.7 billion). In October 2022, authorities made interim payments of 100,000 pounds to each survivor and bereaved partners.

    The government is expected to announce different payments for different infections and also address how and when bereaved families can apply for interim payments on behalf of the estates of people who have died.

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  • Experts ID Likely Cause of Mysterious Hepatitis Outbreak in Kids

    Experts ID Likely Cause of Mysterious Hepatitis Outbreak in Kids

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    April 4, 2023 – Researchers have found that co-infection by multiple common viruses may have caused a mysterious hepatitis outbreak in kids worldwide. 

    Since October 2021, these hepatitis cases in young children affected more than 1,000 kids in 35 countries. Although most children survived, of about 350 patients identified in the United States until May 2022, 22 required a liver transplant and 13 died.

    Most of these children were under 6 years old. 

    Not only are these hepatitis cases acute and severe, but what’s causing them is a mystery. They don’t fit into the common categories of liver inflammation, known as hepatitis A through E. 

    Now, researchers have zeroed in on a possible culprit. They identified a strain of virus, called adeno-associated virus type 2 (AAV2), as the central player in the outbreak. And if they are correct, AAV2 is not acting alone. 

    In fact, this virus is not strong enough to cause these severe cases without help. Instead, affected children must have at least one other “helper” virus at the same time, such as a human adenovirus (which can cause symptoms similar to the common cold or flu, according to the CDC), Epstein-Barr virus, and/or human herpesvirus 6. 

    The new study was published online March 30 in the journal Nature. 

    Pointing to the Pandemic

    The researchers say there is no evidence linking the illnesses to the virus that causes COVID-19, but the pandemic may still be a factor in these infections. Because many children were not exposed to the viruses linked to the hepatitis cases during lockdowns and social isolation, as they normally would be, they did not build up immunity to them.  

    “So it is possible once restrictions were lifted, they were suddenly exposed over a short period of time to multiple viruses,” said senior study author Charles Chiu, MD, PhD, a laboratory medicine and infectious disease specialist at the University of California San Francisco School of Medicine. 

    This setup and lack of a strong immune system to deal with these specific viruses “would have increased their risk of developing severe disease.”

    William Balistreri, MD, a pediatric hepatitis specialist who was not affiliated with the study, agreed this was possible. 

    This has been a popular theory, especially in view of the timing of the bulk of cases, peaking during the height of the COVID-19 pandemic and associated isolation procedures,” said Balistreri, who is also a professor of pediatrics and director emeritus of the Pediatric Liver Care Center at Cincinnati Children’s Hospital Medical Center. 

    What to Watch for in Kids

    As for his take-home message for parents and health care providers, “the keys are awareness and reassurance,” Balistreri said. 

    Vigilance also is warranted, he said, if a child has symptoms that often come right before hepatitis, including respiratory symptoms, nausea, vomiting, diarrhea, and belly pain. Also, If jaundice or yellowing of the eyes from jaundice, called scleral icterus, develops, then hepatitis should be suspected. 

    “Reassurance is based on the good news that most children with acute hepatitis get better. If a case arises, it is good practice to keep the child well-hydrated, offer a normal diet, and avoid medications that may be cleared by the liver,” Balistreri said, noting that COVID vaccination is “strongly suggested.”

    Working to Solve the Mystery

    Chiu and colleagues were not completely in the dark at first. They knew from previous research that adenoviruses might be involved. So they used genomic sequencing and other advanced technologies to look for the virus in 27 blood, stool, and other samples from 16 children with this severe hepatitis. They also wanted to know what other viruses might be present. 

    And for comparison, they searched for the same viruses in a group of 113 children without this severe hepatitis of unknown origin.

    Strengthening their findings were two other studies that were done at different institutions and published in the same journal at the same time. One was a genomic study confirming the presence of AAV2 and other suspected viruses, and the other was a genomic and laboratory study further supporting the results.

    Of the 16 affected children studied by Chiu and colleagues, the average age was 3. About half were boys. These children were diagnosed with severe hepatitis starting when it was first detected on Oct. 1, 2021, until May 22, 2022. 

    Key Findings

    Of the three studies published in Nature, using different diagnostic tools, there was a consistent presence of the adeno-associated virus type 2 in all or almost all of children, while the “helper” viruses of varying types were also discovered.

    Also striking in the studies: what was not found. Of 113 children in one comparison group, among those with diagnoses other than the mystery ailments — including stomach flu, hepatitis of known origin, and those admitted to a hospital for liver failure — AAV2 was much less common. 

    There was also hardly any evidence of the “helper” viruses. 

    “I am quite confident that we have identified the key viruses” because they used  comprehensive genetic sequencing “to look for potential infections from any virus or non-viral pathogen,” Chu said.

    Moving Forward

    The next steps in the research could go beyond identifying presence of these viruses and figuring out which one – or ones – are adding the most to the acute pediatric hepatitis. 

    There was also a study in the United Kingdom that identified a specific genetic factor linked to the condition, and Chiu and colleagues might look into that further. 

    They also said they might study other things linked to the COVID pandemic, including if and how long COVID fits into this and resurgence of other viruses, such as respiratory syncytial virus (RSV) and the flu.

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  • More Sleep Boosts Vaccine Effectiveness: Study

    More Sleep Boosts Vaccine Effectiveness: Study

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    March 14, 2023 – Want to get the maximum level of protection out of vaccines? Then make sure to get at least 7 hours of sleep before and after getting a shot, a new study suggests.

    Compared to people who slept at least 7 hours, people who slept less than 6 hours in the days surrounding a vaccine shot generated significantly fewer antibodies, which are what recognize and kill viruses and bacteria in the body.

    Because the effectiveness of many vaccines declines over time, the boost essentially makes the vaccine’s protection last longer – by up to 2 months, the researchers found. 

    “Good sleep not only amplifies but may also extend the duration of protection of the vaccine,” researcher Eve Van Cauter, PhD, professor emeritus at the University of Chicago, said in a statement.

    The study, published Monday in Current Biology, reanalyzed past research on the connection between sleep and the effectiveness of vaccines for flu and hepatitis. The researchers sought to understand the connection because of indications that people developed varying levels of immunity after receiving the same COVID-19 vaccines. Sleep studies specific to COVID vaccines are not yet available, so the researchers decided to evaluate existing studies and translate those findings to what’s known about COVID vaccines.

    “How we stimulate the immune system is the same whether we’re using an mRNA vaccine for COVID-19 or an influenza, hepatitis, typhoid, or pneumococcal vaccine. It’s a prototypical antibody or vaccine response, and that’s why we believe we can generalize to COVID,” researcher Michael Irwin, MD, an expert from UCLA who specializes in the relationship between psychological processes, the nervous system, and immunity, told CNN.

    When the researchers looked at vaccine response in different groups, the effects of sleep were greatest among men and in people ages 18 to 60 years old. The researchers said more research on the effects in women is needed because variations in their hormone levels impact the immune system. 

    They also found that vaccine effectiveness was not as dramatically impacted by reduced sleep in people age 65 and older. The authors suggested that this is because older people already tend to sleep less than younger people.

    The findings are important because they offer a way for people to modify their own behavior to improve their health and immunity, Van Cauter said.

    “When you see the variability in protection provided by the COVID-19 vaccines — people who have preexisting conditions are less protected, men are less protected than women, and obese people are less protected than people who don’t have obesity,” she said. “Those are all factors that an individual person has no control over, but you can modify your sleep.”

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  • How to Be Smart About Sex and Hep C

    How to Be Smart About Sex and Hep C

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    Should you tell your partner you have hep C? What do you say? And how do you have a safe love life?

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