A key federal vaccine advisory panel whose members were recently replaced by Health Secretary Robert F. Kennedy Jr. is expected to vote to recommend delaying, until age 4, the hepatitis B vaccine that’s currently given to newborns, according to two former senior officials at the Centers for Disease Control and Prevention.

“There is going to likely be a discussion about hepatitis B vaccine, very specifically trying to dislodge the birth dose of hepatitis B vaccine and to push it later in life,” said Demetre Daskalakis, the former director for the National Center for Immunization and Respiratory Diseases. “Apparently this is a priority of the Secretary’s.”

The vote is expected to take place Thursday during the next meeting of the CDC’s Advisory Committee on Immunization Practices, or ACIP. The meeting is scheduled for September 18-19 at a CDC office in Atlanta, Georgia.

For more than 30 years, the CDC has advised that infants get the first of three shots of the hepatitis B vaccine at birth. In that time, the potentially fatal disease has been virtually eradicated among American children. Between 1990 and 2022, case rates plummeted 99 percent among people age 19 and younger.

Pediatricians warn that waiting until age 4 to begin vaccination opens the door to more children contracting the virus.

“Age four makes zero sense,” said pediatrician Eric Ball, who practices in Orange County, California. “We recommend a universal approach to prevent those cases where a test might be incorrect or a mother might have unknowingly contracted hepatitis. It’s really the best way to keep our entire population healthy.”

In addition to the hepatitis B vaccine, the panel will also discuss and vote on recommendations for the combined measles, mumps, rubella, and varicella vaccine, and COVID vaccines.

Pediatricians worry changes to the schedules of these vaccines will limit access for many families, because ACIP’s recommendations generally determine whether insurance plans and federal programs pay for the vaccines.

Typically, ACIP would undertake an analysis of the data before recommending a change to vaccine guidelines. As of the end of August, this process had not begun for the hepatitis B vaccines, Daskalakis and another former official said.

“This is an atypical situation. There’s been no work group to discuss it,” Daskalakis said.

The second former official spoke to NPR and KFF Health News on condition of anonymity.

In an email, a Health and Human Services spokesman, Andrew Nixon, wrote, “ACIP exists to ensure that vaccine policy is guided by the best available evidence and open scientific deliberation. Any updates to recommendations will be made transparently with gold standard science.”

The draft agenda for the upcoming ACIP meeting was released to the public Sunday, only a few days before the meetings are scheduled to begin.

At the last ACIP meeting in June, chairman Martin Kulldorff, one of the new members handpicked by Kennedy, questioned the need to vaccinate every newborn, citing only two of the many ways the virus can spread.

Dr. Martin Kulldorff speaks during a June 25 meeting of the Advisory Committee in Immunization Practices at the CDC in Atlanta.

Mike Stewart/AP Photo

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Mike Stewart/AP Photo

Kulldorff is a former Harvard Medical School professor who became known for opposing some public health measures during the COVID-19 pandemic.

“Unless the mother is hepatitis B positive, an argument could be made to delay the vaccine for this infection, which is primarily spread by sexual activity and intravenous drug use,” Kulldorff said.

The infection requires direct exposure to infected bodily fluids like blood and semen. The disease has no cure and can lead to serious conditions like cirrhosis and liver cancer later in life. The CDC advisory panel may maintain the recommendation to inoculate newborns whose mothers are considered at high risk of the disease, the former officials said.

Protection From Birth

In 1991, federal health officials determined it was advisable for newborns to receive their first dose of the hepatitis B vaccine within 24 hours of birth, which blocks the virus from taking hold if transmitted during delivery.

While parents may opt out of the shots, many daycare centers and school districts require proof of hepatitis B vaccination for enrollment.

The prospect of altering the recommendation has left some people living with the virus deeply unsettled.

“I am goddamn frustrated,” said Wendy Lo, 52, who lives in the San Francisco Bay area. Lo says she has probably had hepatitis B since birth. Years of navigating the psychological, monetary, medical and social aspects of chronic hepatitis B has impacted almost every aspect of her life.

“I would not want anyone to have to experience that if it can be prevented,” she said.

Lo only learned she had the disease due to a routine screening in order to study abroad in college as a young adult.

Lo credits the vaccines with protecting all the members of her close family from infection.

“I shared with my partner, ‘if you get vaccinated, we can be together,'” she said. He got the vaccine, which protects him from infection, “so I’m grateful for that,” she said.

The CDC estimates half of people with hepatitis B do not know they are infected. It can range from an acute, mild infection to a chronic infection, often with few or no symptoms.

Most people with chronic hepatitis B were born outside of the U.S. Asians and Pacific Islanders, followed by Black people, have the highest rates of newly reported chronic infections.

When her children were born, Lo was adamant that they receive the newborn dose, a decision she says prevented them from contracting the virus.

The earlier an infection occurs, the worse the lifetime consequences, according to the CDC. When contracted in infancy or early childhood, hepatitis B is far more likely to become a chronic infection, silently damaging the liver over decades.

Those who become chronic carriers can also unknowingly spread the virus to others and face an increased risk of long-term complications including cirrhosis and liver cancer, which may not become evident until much later in life.

Treatments like the antivirals Lo now takes weren’t available until the 1990s. Decades of the virus replicating unchecked damaged her liver. Every six months she gets scared of what her blood tests may reveal.

“Now I’m in my 50s, one of my big concerns is liver cancer. The vaccine is safe and effective, it’s life-saving, and it protects you against cancer. How many vaccines do that?” Lo said.

Thirty Years of Universal Vaccination

After a vaccine was approved in the 1980s, public health officials initially focused vaccination efforts on so-called “high-risk” adults.

“I, and every other doctor, had been trained in medical school to think of hepatitis B as an infection you acquired as an adult. It was the pimps, the prostitutes, the prisoners, and the healthcare practitioners who got hepatitis B infection. But we’ve learned so much more,” said William Schaffner, professor of infectious diseases at the Vanderbilt University School of Medicine and a former voting member of ACIP.

As hepatitis B rates remained stubbornly high in the 1980s, scientists realized an entire vulnerable group was missing from the vaccination regime – newborns. The virus is often spread from an infected mother to baby in late pregnancy or during birth.

“We may soon hear ‘let’s just do a blood test on all pregnant women.’ We tried that. That doesn’t work perfectly either,” Shaffner said.

Some doctors didn’t test, he said, and some pregnant women falsely tested negative, while others acquired hepatitis B later in pregnancy, after they had already been tested. In 1991, Schaffner was a liaison member to the ACIP group that voted to recommend universal vaccination for hepatitis B before an infant leaves the hospital.

“We want no babies infected. Therefore, we’ll just vaccinate every mom and every baby at birth. Problem solved. It has been brilliantly successful in virtually eliminating hepatitis B in children,” he said.

In 1990, there were 3.03 cases of hepatitis B per 100,000 in those 19 years old and under in the U.S., according to the CDC.

Since the federal recommendation to vaccinate all infants, cases have dramatically decreased. CDC data shows that in 2022, the rate of cases among those ages 19 was less than 0.1 per 100,000.

While hepatitis B is often associated with high-risk behaviors such as injected drug use or multiple sexual partners, health experts caution that it is possible for the virus to be transmitted in ordinary situations, especially among young children.

The virus can survive for up to seven days outside the body. During that time, even microscopic traces of infected blood on a school desk or playground equipment can pose a risk.

If the virus comes into contact with an open wound or the mucous membranes of the eyes, an infection can occur. This means that unvaccinated children who are not considered “high risk” can still be exposed in everyday environments.

Future Access Uncertain

If the CDC significantly alters its recommendation, health insurers would no longer be required to cover the cost of the shot if given before the new recommended age. That could leave parents to pay out of pocket for a vaccine that has long been provided at no charge.

Children who get immunizations through the federal Vaccines for Children program would lose free access to the shot as soon as any new ACIP recommendations get approved by the acting CDC director.

The two former CDC officials said that plans were underway to push back the official recommendation for the vaccine as of August, when they both left the agency, but may have changed.

Schaffner is still a liaison member of ACIP, and hopes to express his support for universal newborn vaccination at the next meeting.

“The liaisons have now been excluded from the vaccine work groups. They are still permitted to attend the full meetings,” he said.

He intends to speak up if he can, because he’s worried about the next generation of babies and the doctors who care for them.

“We’ll see cases of hepatitis B once again occur. We’ll see transmission into the next generation,” he said. “And the next generation of people who wear white coats will have to deal with hepatitis B, when we could have cut it off at the pass.”

This story was produced in partnership with KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF.

NPR Health Correspondent Will Stone contributed to this story.

After months of slow burning controversies around his agency, from the handling of the investigation into Charlie Kirk’s murder to the bungled release of Epstein files, FBI Director Kash Patel will face Senate and House lawmakers at two highly anticipated hearings.

Lawmakers are expected to push Patel, a Donald Trump loyalist and right-wing firebrand, to explain to a questioning public whether he is truly equipped to run the nation’s top law enforcement agency and to confront doubters who worry he’s stripped the bureau of some of its credibility.

Before Kirk, a friend of Patel, was murdered last week, the FBI director had been preparing to focus at least some of his testimony on his efforts to relitigate the 2016 Russia investigation, and what Patel has said was a plot by the FBI to undermine Trump, a source familiar with the matter told CNN.

But as anger has grown against Patel’s handling of the investigation into the shooting – including in interviews this week – he’s likely to face pointed questions regarding whether he can handle the job.

On Monday, Patel took the unprecedented step of discussing evidence on air, telling Fox News the FBI had located DNA from a towel and screwdriver found near the gun they believe was used to kill Kirk and have matched the DNA to that of the alleged shooter

Some inside the Justice Department have voiced concern that Patel’s airing of evidence could hamper later prosecution of the accused shooter, two sources familiar with the matter told CNN.

Patel previously came under heavy criticism after he hastily announced Wednesday that the FBI had a “subject” in custody for Kirk’s murder, only to walk it back two hours later. The blunder infuriated officials inside the Justice Department and other law enforcement agencies assisting in the manhunt and did little to abate concerns over his leadership.

Still, Patel is touting his own role in the eventual capture of the alleged shooter by noting he had pushed for publicly releasing the images collected by law enforcement. The alleged shooter’s father subsequently recognized his son from one of the images.

“I made an executive decision on an investigative and operational need,” Patel said on Fox News on Monday, adding that “it turned out to be the right move.”

Senate Judiciary Chairman Chuck Grassley said had full confidence in Patel and downplayed his public relations errors during the investigation.

Pressed by CNN’s Maju Raju on how Patel has acted in the Kirk probe, Grassley responded, “so he announced two things that turned out to be a mistake. Everybody makes a mistake.”

Patel also received a possible vote of confidence from the president Monday, appearing with him, Attorney General Pam Bondi, Defense Secretary Pete Hegseth and others in the Oval Office.

Purge of FBI staff and the Epstein files

Democrats are expected to push Patel on his purge of senior staff inside the bureau and allegations made by three former agents who filed a lawsuit last week that accused the director of dismissing the former agents for political reasons.

That lawsuit also claimed that Patel and his senior staff were making decisions, at least in part, because of reactions on social media – an allegation that has only gained traction during the Kirk assassination investigation.

Beginning on his first day in office, Patel was a key figure in handling so-called “Epstein files.” Patel and his deputy, Dan Bongino, promised alongside Bondi to release as much evidence as possible that was gathered against accused sex-trafficker Jeffrey Epstein — a promise they reneged on several months later.

As the DOJ and the FBI faced public outrage over decision, Patel faced a second, internal crisis as Bongino threatened to quit his post. The threat came amid a clash between Patel, Bongino and Bondi over whether the two men were behind media reports that said the FBI wanted more information released but was ultimately stymied by the Department of Justice, an allegation they denied.

Bongino has so far remained on the job.

Patel has also repeatedly said the FBI is revisiting a long-held grievance from allies of the president: that the criminal probe into whether Trump’s 2016 presidential campaign colluded with Russia was a “hoax” intended to tank his campaign.

Republicans on the House and Senate committees hope to focus their questioning on Patel’s allegations that past directors and leaders in the FBI tried to hide away documents in burn bags behind locked doors at FBI headquarters.

While details of any criminal investigation into those involved in the Russia investigation are still scant, the DOJ is reportedly conducting another investigation into former FBI Director James Comey and former CIA Director John Brennan, though it is not clear what crime they are being investigated for.

CNN’s Hannah Rabinowitz and Evan Perez contributed to this report.

Israel has launched its ground incursion into Gaza City, two Israeli officials told CNN early Tuesday.

Israel in August approved a plan to take over and occupy the heavily bombarded city, which it said is one of the last remaining Hamas strongholds.

The incursion began on the outskirts of Gaza City, where the Israeli military has escalated its airstrikes and accelerated its destruction of high-rise towers over the last week. One of the officials said the ground incursion is going to be “phased and gradual” at the beginning.

The ground incursion was supposed to proceed only after the Israeli military forced the evacuation of the densely populated urban area, but only a fraction of the population has left so far.

The United Nations warned last month that Israel’s plans to invade Gaza City would put about 1 million Palestinians who live there at risk of being forcibly displaced. On Monday, an Israeli military official said an estimated 320,000 Palestinians had fled the area so far.

The incursion began with a renewed wave of Israeli strikes, which saw casualties, including children, stream into the enclave’s depleted hospitals. Dozens of injured Palestinians were brought overnight to hospitals near Gaza City, including Al-Shifa Hospital and the Baptist Hospital, according to local officials.

Videos obtained by CNN showed the bodies of multiple bloodied children arriving at hospitals in northern Gaza. Two adults can be seen in one video screaming out in pain as they grieve over the bodies of their children, covered in white shrouds.