Confusion about the CDC's CDC guidelines may interfere with child care

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Doctors, hospitals and public health departments are scrambling to ensure proper care for pregnant women and their babies, after a controversial vote from the Centers for Disease Control and Prevention Advisers to give the Hepatitis B vaccine to newborns goes against decades of standard medical practice.

"We don't know yet how individual hospitals and physicians are going to handle this," said Dr. Brenna Hughes, interim chair of the department of obstetrics and gynecology at Duke University in Durham, North Carolina. "It's creating fear and mistrust."

Last Friday, the CDC's vaccination committee required that only newborns of women who tested positive for Hepatitis B receive the first dose within 24 hours of birth.This decision was reversed on the basis of thorough testing of all newborns, an inappropriate infection that can lead to liver disease and cancer.

However, many children in the United States are born to women who never have the opportunity to be tested.

A Dimes report published in November found that nearly a quarter of pregnant women contracted hepatitis B in the first trimester, despite their doctor's care.

Dr. Stephen Fleishman, president of the American College of Obstetricians and Gynecologists, said the hepatitis B vaccine given to newborns acts as a safety net.

"If someone is exposed to hepatitis B later in pregnancy, or gets an infection later," Fleishman said, "the baby is protected by this vaccine."The virus can pass from mother to child during childbirth.

On Tuesday, CDC Director Jim O'Malley said the commission had not yet signed the committee.

The CDC does not require immunization.It recommends schedules for children who are protected against infectious diseases.

But experts say the advisory committee, whose members were handpicked by Health Department Secretary Robert F. Kennedy Jr. in June, failed to provide the type of scientific evidence historically associated with the CDC to support its reasoning.

The panel "did not follow the standard and transparent process that makes the advisory committee a pillar of good, evidence-based decision-making," said Dr. Jason Goldman, an internal medicine physician and president of the American College of Physicians."Their information and decisions cannot be trusted.

The panel recommended that women who are hepatitis B negative should consult with their health care professional to decide whether their baby should be dosed at birth.

Experts say the panel's vote to withhold the first dose of the hepatitis B vaccine in infants until at least 2 months of age, unless the vaccine is given at birth, is completely inconsistent with decades of evidence supporting the safety and effectiveness of the shot.The birth dose, which was given to all babies in the early 1990s, reduced the incidence of acute hepatitis B infections in children by 99%.

dr.Aaron Milestone, a member of the American Academy of Pediatrics' Committee on Pediatrics and Infectious Diseases at Johns Hopkins Medicine, said in an interview with reporters Tuesday that the result is "confusion and confusion" among public health experts trying to advise doctors on best practices, as well as doctors in the exam rooms facing concerned parents.

"Many physicians across our nation are concerned that the best thing to do for their patients is now inconsistent with information from previously trusted sources," said Dr. Sarah Nosal, president of the American Academy of Family Physicians.

"If you're going to spend 20 minutes explaining the vaccine, yes, the operator makes the child, you're using a safety seat the right way."

dr.Anna Locke, director of clinical hepatology and associate dean for clinical research at the University of Michigan Medical School, said the change in guidelines adds hurdles for parents, especially in the chaotic delivery room.

"It's just saying parents, we make you climb Mount Everest to vaccination your child," Luck said."Because every step, every hurdle, everything that needs to be done does not be done."

Medically speaking, nothing has changed, said Rashmi Rao, MD, a gynecologist at UCLA Health who specializes in high-risk pregnancies."Our recommendations will remain the same."

Some states are eschewing federal recommendations and instead coming together to establish their own guidelines.OB-GYN Dr. at Beth Israel Deaconess Medical Center in Boston.Naima Joseph said health officials in Massachusetts and other states have formed the Northeast Public Health Collaborative.

"We have already made recommendations for universal birth dose hepatitis B vaccine, which continues to provide access to newborns," he said.

Joe Zamboni, an attorney for American Families for Vaccines, said the scaled approach was unexpected nationwide."I think some states will probably do it better than others," he said.

One state that worries public health experts is Florida.Surgeon General Joseph Latdopo said in September that Florida was working to eliminate all childhood vaccines.

The Florida Department has scheduled a meeting for this Friday, December 12, to discuss that policy.Henwalk, a department spokeswoman, told NBC News via email that the meeting will be held in Panama City and will not be available to the public online.

Correction: Dr.Rashmi Rao, not Roa.