New York (AP) — The U.S. government has long advised that all babies be immunized against hepatitis B right after birth. But on Friday, a federal vaccine advisory committee voted to do away with that recommendation.

The group, whose current members were all appointed by Health Secretary Robert F. Kennedy Jr., recommends a dose at birth only for babies whose mothers test positive for the virus or whose infection status is unknown.

For other babies, it will be up to the parents and their doctors to decide. The committee voted to suggest that when a family decides not to get a newborn dose, then the shots should begin when the child is 2 months old.

A loud chorus of medical and public health leaders decried the decision, saying the hepatitis B vaccine prevents thousands of illnesses.

The committee “has just condemned hundreds of children to a shorter life,” said Dr. Paul Offit, a Children’s Hospital of Philadelphia vaccine researcher and former government adviser.

Liver disease can cause lifelong health issues

Hepatitis B is a serious liver infection that for most people lasts less than six months. But for some — especially infants and children — it can become a long-lasting problem that can lead to liver failure, liver cancer and scarring called cirrhosis.

In adults, the virus is spread through sex or through sharing needles during injection-drug use.

But it can also be passed from an infected mother to a baby. Offit said babies can also get it from relatively casual contact with someone who has chronic disease, such as touching a towel or toothbrush because the virus can live on surfaces for more than seven days at room temperature. Up to 90% of infants who contract hepatitis B go on to have chronic infections, meaning their immune systems don’t completely clear the virus.

Around 2.4 million people in the U.S. are estimated to have hepatitis B, and as many as half are unaware they are infected, according to the Centers for Disease Control and Prevention.

Shots for newborns have been recommended for years 

For decades, the nation’s vaccine guidance has been influenced by a government-appointed panel of experts, the Advisory Committee on Immunization Practices. Its recommendations have usually been adopted as national guidance that is widely heeded by doctors.

In 1991, the committee recommended an initial dose of hepatitis B vaccine at birth. The guidance was modified a little over the years and currently suggests a dose within 24 hours of birth for all medically stable infants who weigh at least 4.4 pounds (2 kilograms), plus follow-up shots to be given at about 1 month and 6 months. Why a dose right at birth? Health officials used to rely on screening expectant mothers to find babies that might have been exposed to the virus. But many cases were missed, experts say, partly because some women weren’t tested or test results were incorrect.

Newborn hepatitis B vaccinations are widely considered to be a public health success story. Over about 30 years, cases among children fell from about 18,000 per year to about 2,200. A collaboration of public health researchers, the Vaccine Integrity Project, this week released its analysis of more than 400 studies and reports spanning 40 years. The group concluded the newborn dose is safe and is an important reason U.S. pediatric hepatitis B infections have fallen.

Committee revisits the newborn recommendation

Kennedy, a leading anti-vaccine activist before becoming the nation’s top health official, fired all 17 members of ACIP earlier this year and replaced them with a group that includes several anti-vaccine voices.

The panel raised concerns about giving a vaccine to a baby so early in life. Committee members also worried that in many cases, doctors and nurses don’t have full conversations with parents about the pros and cons of giving the vaccine to newborns.

Some doctors and public health experts harshly criticized the group.