The Brief

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.

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Mike Stewart

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AP Photo

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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. Copyright 2025 KFF Health News

An East Hollywood nursing home that nearly lost its license this year because of repeated state citations for deaths of residents at the facility was cited again last month after another person died.

The California Department of Public Health cited Brier Oak on Sunset after a 92-year-old resident bled to death on Sept. 27. Staff members had continued injecting her with blood thinners over a 40-hour period in violation of clinical guidelines.

It’s an AA citation, the most severe the department issues when violations of care standards are determined to be a substantial factor in someone’s death. The facility faces a $120,000 fine.

These kinds of citations are rare. The department has recently issued, on average, fewer than 20 AA citations yearly across more than 1,200 skilled nursing facilities in California.

Brier Oak has received three AA citations for patient deaths since late 2022.

State regulations require authorities to suspend or revoke the licenses of any facilities that get two AA citations within a period of 24 months.

The state Public Health Department began that process with Brier Oak in May based on resident deaths in 2022 and 2024. But officials dropped that effort later because they say they determined the two patient deaths had occurred 26 months apart — just outside of the two-year window.

A spokesperson for the company that owns Brier Oak told LAist it has appealed the first two citations and is considering whether to appeal the third.

Advocates for nursing home residents say the recent death could have been avoided if the state had taken action.

“There were red flags, and a lot of these red flags existed prior to the death of this poor resident,” said Tony Chicotel, senior staff attorney with  California Advocates for Nursing Home Reform.

The state said Brier Oak has until Dec. 19 to notify the department if it intends to appeal.

What led to the patient deaths?

In the recent death at Brier Oak cited by the state, multiple communication and technical failures by nursing staff led to the patient bleeding out over a period of 40 hours, according to the citation.

The 92-year-old patient was immobile and had been prescribed a blood thinner called heparin to help prevent blood clots from forming. But once a patient is bleeding, those injections make bleeding worse, and potentially fatal.

When nursing staff found bright red blood in the resident’s diaper the day before she died, Brier Oak failed to follow established processes for documenting the bleeding or communicating it to a nurse practitioner or medical doctor, according to the citation.

Nurses told state authorities they delayed informing physicians because they “get mad” when contacted in the middle of the night.

The facility’s staff also failed to fully assess the patient to determine the possible causes of the bleeding and or to properly monitor the issue during crucial periods, according to the citation.

She suffered four internal bleeding episodes over 40 hours and continued to receive blood thinner injections.

The citation says a nurse practitioner at Brier Oak told state licensing authorities later that if she’d been informed about the patient’s ongoing bleeding, she would have stopped the blood thinner and sent her to a hospital.

In 2022, Brier Oak received a AA citation after a 62-year-old woman died from respiratory failure in part because nurses hadn’t been trained to operate her breathing machine.

In 2024, the nursing home got another AA citation. This time, a 63-year-old woman with paraplegia and severe obesity fell from her bed and died while a nursing assistant was changing her. The assistant was alone, even though the woman’s care plan required two staff members.

Who owns Brier Oak?

Brier Oak on Sunset is primarily owned by Genesis Healthcare, a publicly-traded nursing home operator that filed for Chapter 11 bankruptcy in July.

Once the largest nursing home operator in the U.S., Genesis was facing billions in debt when it declared bankruptcy, according to court filings. That includes millions in potential damages from lawsuits related to patient care failures.

In a brief statement to LAist, a company spokesperson said it's still considering whether or not to appeal the recent citation at Brier Oak.

The citation should trigger a suspension or revocation of the facility's license, according to state regulations. The latter means it would have to close its doors. The two most recent deaths and citations at the facility occurred within the two-year window.

The California Department of Public Health confirmed it cited Brier Oak on Nov. 26.

The department said the facility submitted a required written response before a Dec. 6 deadline, showing how it will fix the problems and prevent them from happening again..

The department determined Brier Oak was back in compliance during an onsite visit last week, a representative told LAist.

Brier Oak on Sunset currently houses about 150 patients, according to state records.

A bankruptcy judge has stalled the proposed sale of Genesis Healthcare to an affiliate of one of its investors.

Experts say it’s unclear whether the state would revoke the license of an owner who is actively trying to sell and turn over operations to someone else.

It’s been a rough start to ski and snowboard season for California mountain towns. Snowfall is well below average, but Christmas could come with some of the white stuff. Here's where things stand:

Hmmm. Didn’t we just have a record storm?

Yes. That big atmospheric river that hit Southern California last month made it one of the wettest Novembers on records. But since then, it’s been unusually warm and dry, which is not good for mountain towns that depend on snow, and the outdoor enthusiasts that flock to them.

How bad is it?

California’s snowpack is about 20% of normal for this time of the year, according to the state’s snow-tracking website. Southern California isn’t quite as bad off — we’ve gotten about half our normal snowfall so far.

As for the resorts, only about 20% of the terrain at Bear Mountain in Big Bear is open. About 35% of Mammoth Mountain is open.

Can’t they just make snow?

They are, but the unusually warm temperatures have curbed resorts’ ability to make enough snow to open more terrain. “If you're blowing water into 40-degrees, it's going to stay water,” said Justin Kanton, a spokesperson for Big Bear Mountain Resort. “ So as much as people probably would want us to just crank the snow guns all day, every day up here and just get things moving, that's not really possible.”

But there’s a silver lining!

The dry weather has allowed Caltrans to make good progress toward opening Highway 38, said Evan Engle, who chairs the board of the Big Bear Chamber of Commerce. The road typically handles up to 40% of traffic up to the mountain town, Engle said. But it’s been closed since September when it got washed out by Tropical Storm Mario.

Getting it open as soon as possible is key to keeping visitor traffic manageable, and getting supplies to Big Bear.

What’s the snow outlook?

SoCal mountains are likely to see some precipitation around Christmas, said Kyle Wheeler, a meteorologist with the National Weather Service. But with temperatures not expected to drop much, it’s uncertain how much of it will be white, Wheeler said.

If you go to Big Bear: 

• If you plan to hit the slopes, get on it early, when the snow is at its best given the warm conditions. 
• No snow? There’s more to do than ski and snowboard. Check this list of winter fun events.  
• Worried about traffic? Consider going up earlier in the week. If you can’t do that, consider taking Highway 18 through Lucerne Valley. It’s a longer route if you’re coming from L.A., but less traveled, and less likely to make you car sick (fewer tight curves). 

The Los Angeles Police Department used more than 2,400 crowd control munitions in response to protests from June 6 to 14, according to a new report.

Officers used a total of 2,431 less-lethal projectile rounds and 35 canisters of tear gas over the nine days, according to LAPD reports. The department recorded 12 injuries officers caused with those weapons.

The LAPD released the missing report last week after LAist identified the use of crowd control weapons on four different days in June that had not been reported according to state law. Assembly Bill 48, which went into effect in 2022, limits when and how crowd control weapons can be used, and requires law enforcement agencies to publicly release reports on their use within 60 days.

A 30-day extension for these reports can be granted in some cases, but the LAPD released this report about three months late even if an extension was justified.

Officials acknowledged they were out of compliance on Dec. 10 before releasing the report, saying the delay “stems from the extraordinary volume and complexity of incidents” over that time.

This report is different from others

It is unusual for a crowd control report to include more than one day, and the report for June 9 through 14 covered six days and “45 sepearte [sic] non categorical use of force incidents.”

It does not describe any of those use of force incidents specifically, and the LAPD has not yet responded to LAist’s request for more detailed descriptions of those incidents.

The report also considered the entire six days to have been one continuous protest, though it included several anti-ICE protests over the week and the national “No Kings” protest on June 14.

Two reports released earlier this year for June 6 and 8 covered single days and provided more detailed descriptions of incidents where the LAPD used less-lethal munitions against protesters.