The hepatitis B vaccine is one of Philadelphia’s oldest success stories.
The virus itself was discovered at Fox Chase Cancer Center in 1967 by Baruch Blumberg, who won a Nobel Prize for his work.
He later cocreated and developed the vaccine, which continues to be manufactured in and around the region.
A billion doses have now been administered globally, dramatically reducing cases of the disease that can do permanent damage to the liver, and for which there is no cure.
“The hepatitis B story is the original Philadelphia story,” said Chari Cohen, president of the Hepatitis B Foundation, which is also based in Philadelphia.
Now that legacy is being challenged by President Donald Trump, who last month asserted without scientific evidence that newborns should no longer universally receive the shot, saying that people should wait until age 12.
The nation’s top advisory panel on vaccines, reconstituted under the Trump administration to include several vaccine skeptics, also debated delaying the first dose of the vaccine until one month of age. Some members of the Advisory Committee on Immunization Practices (ACIP) suggested the dose for newborns should instead be given only to the populations most at risk.
Leading medical societies and infectious disease experts say there’s no scientific evidence for changing the current guidelines. Since the shot was universally recommended for all newborns within 24 hours of birth in 1991, rates of infection among children and teens have dropped by 99%.
Experts criticized Trump for incorrectly suggesting that hepatitis B is only transmitted sexually.
Hepatitis B is easily spread through contact with blood and other body fluids. In addition to being transmitted from mother to baby, the virus can be acquired from a variety of household sources, such as personal items like toothbrushes and razors that become contaminated with blood. The virus couldn’t be spread through casual contact such as hugging, touching, or sharing utensils, but it could be spread through open wounds.
Cohen said her Philadelphia-based foundation will ramp up their efforts to educate the community and nation about the disease and its vaccine. They have online tool kits complete with social media posts, videos, infographics, and audio content, available in multiple languages.
They’re also mobilizing throughout Pennsylvania and Philadelphia, bringing their materials to health fairs, cultural events, and other activities on evenings and weekends.
Their biggest priority is making sure everyone in the U.S., whether a legislator, provider, or parent, is able to make “good, informed choices” regarding the vaccine, Cohen said.
“They’ve created controversy out of where there wasn’t any,” she said.
When Su Wang went to give birth, she told her husband that his one job was to make sure their baby got the hepatitis B vaccine within 12 hours.
The New Jersey physician and mother was wary of passing on the chronic infection, which she learned she had while a freshman in college.
“It’s a silent disease, but it can completely alter people’s lives,” she said.
The disease can cause cirrhosis or severe scarring of the liver, liver failure, and liver cancer.
All four of her children received the dose at birth and remain hepatitis B-free.
Wang was born in 1975 — too early to have benefited from the hepatitis B vaccine, which was licensed only in 1981 and widely available starting in the 1990s.
She believes that if she’d gotten the vaccine at birth, she could have prevented the chronic infection. She now takes daily antiviral medication to reduce her risk of cirrhosis and liver cancer — so far, she hasn’t had symptoms.
The vaccine is particularly important for babies, since they don’t have a developed immune system, said Wang, who works as an internal medicine physician at Cooperman Barnabas Medical Center in Livingston, N.J., where she treats patients with hepatitis B.
“If they get infected, their body actually tolerates the virus. It thinks the virus is just part of it,” she explained.
That means their bodies fail to clear the virus, allowing it to develop into a lifelong infection.
Adults with healthy immune systems have a greater chance of being able to clear the virus, so that it is only a short-term, acute infection.
Prior to the universal birth dose recommendation, about half infections in children were acquired from mothers infected with the virus, the Centers for Disease Control and Prevention found.
Delaying the vaccine could impact its ability to prevent transmission of the virus from mother to baby. “If you wait longer than 24 hours, then the vaccine doesn’t work as well,” Cohen said.
The CDC’s vaccine advisory panel, ACIP, considered last month recommending doctors vaccinate only those newborns whose mothers test positive for the virus, and having the other babies wait a month for their first dose.
That’s a hard rule to implement, the foundation’s Cohen said. Universal testing for the virus has been recommended since the 1990s, but 15 to 16% of women still don’t get tested, and would be missed under that proposed rule.
The rule also doesn’t account for other exposures.
Both of Wang’s parents had tested negative for the virus.
She has traced her own exposure back to her grandparents, who both worked in healthcare in Taiwan. Her grandfather was a dentist, while her grandmother was a midwife. Back then, she said, using gloves universally as an infection precaution wasn’t a thing, allowing the virus to easily spread within healthcare facilities through direct contact with infectious bodily fluids.
Hepatitis B circulated widely in Taiwan at the time, with up to 20% of the population estimated to carry the virus. It’s likely she caught it from living with her grandparents.
“There are a lot of exposures that we aren’t testing for,” Wang said.
Hepatitis B is the most common chronic viral infection in the world.
Because there is still no cure for it, Jacki Chen, a New Jersey-based professor and founder of the Taiwan Hepatitis Information & Care Association, had few options to avoid further liver damage beyond taking antivirals.
Three decades ago, he received a phone call from a family member alerting him that his older brother had developed liver cancer and cirrhosis from a previously unknown chronic hepatitis B infection. The virus is the leading cause of liver cancer worldwide.
That prompted Chen, then in his early 30s, to get tested.
Not only did he find he had the infection, he learned it had already damaged his liver, causing a condition called advanced liver fibrosis.
“That sort of gave me a very big alarm that I have to deal with the situation,” Chen said.
His other siblings — two sisters — and their children, also tested positive.
When hepatitis B first infects someone, it travels through the bloodstream in search of the liver. This organ is one of the most energy-rich and nutrient-dense parts of the body, explained Chen, who teaches at Rutgers University’s Robert Wood Johnson Medical School.
Once in the liver, the virus infects the cells and uses their energy to replicate. Eventually, the immune system figures out where hepatitis B is hiding and tries to get rid of it by attacking the infected liver cells.
That damage to the liver causes scar tissue to form around the organ, as the body attempts to regenerate what was lost. It’s like when you get a paper cut and a scar grows around the area.
Once the liver cells get damaged and replaced with scar tissue, that leads to liver cirrhosis, and from there the liver goes into failure.
The only way to survive that would be to get a liver transplant, he said.
For the last two decades, Chen has been able to avoid progressing to cirrhosis using antiviral treatments.
At the vaccine advisory meeting last month, ACIP members ultimately voted 11 to 1 to table a vote on changing the recommendations for the hepatitis B immunization for newborns.
However, Cohen at the Hepatitis B Foundation worries the panel could return to the issue, and potentially propose more drastic changes.
Changing the recommendation could impact insurance coverage for the vaccine. If a vaccine is no longer recommended by ACIP, then private and public insurers wouldn’t have to cover it.
It could also sow seeds of doubt in the public.
“It’s leading to parents now who have concerns about safety that are not based in any science or clinical data,” Cohen said.