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CDC committee drops hep B vaccine for all newborns over objections from health officials

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CDC committee drops hep B vaccine for all newborns over objections from health officials

A key vaccine advisory panel for the Centers for Disease Control and Prevention voted Friday to drop a decades-old recommendation to vaccinate all newborns against hepatitis B, the committee’s most controversial decision since its overhaul by Health and Human Services Secretary Robert F. Kennedy Jr. in June.

The Advisory Committee on Immunization Practices voted 8 to 3 to adopt “individual-based decision making” for the newborn hep B vaccine dose for babies born to women who test negative, as are more than 99% of babies born in the U.S.

The move was met with condemnation by physicians and public health officials, including some on the committee. The CDC has recommended the shot since 1991, resulting in a 99% decline in rates of chronic hepatitis B infections in children and teens.

“‘Do no harm’ is a moral imperative. We are doing harm by changing this wording,” said Dr. Cody Meissner, an expert in pediatric infectious diseases at Dartmouth-Hitchcock Medical Center, who cast one of the few dissenting votes.

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“This has a great potential to cause harm, and I simply hope the committee will accept this responsibility when that harm is caused,” said fellow no-vote Dr. Joseph Hibbeln, a psychiatrist formerly with the National Institutes of Health.

The committee spent the rest of Friday discussing the childhood and adolescent vaccination schedule. Comments from invited speakers and some committee members suggested that further revisions to the nation’s inoculation practices could be in store.

“Cumulative risk across the entire childhood vaccine schedule [is] a risk for which we do not have adequate data,” said committee vice chair Dr. Robert Malone, who contributed to early mRNA research but has since made a number of false and discredited assertions about flu and COVID-19 shots. “The potential cumulative risk” of childhood vaccines, he said, was “the elephant in the room.”

While CDC subject-matter experts were excluded from the meeting’s agenda, its second day began with a presentation from Aaron Siri, a leading antivaccine lawyer who has previously worked as Kennedy’s personal attorney.

Following a presentation in which Siri urged the committee to “end mandates” and “de-politicize vaccines,” Meissner called the attorney’s comments “a terrible, terrible distortion of all the facts.”

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“You know how to present the facts that are favorable to you or to your client,” he added. “But for you to come here and make these absolutely outrageous statements about safety, I think it’s a big disappointment to me, and I don’t think you should have been invited.”

On X, Sen. Bill Cassidy (R-La.) criticized Siri’s presence, saying, “Siri is a trial attorney who makes his living suing vaccine manufacturers. He is presenting as if an expert on childhood vaccines. The ACIP is totally discredited. They are not protecting children.”

Changing the decades-old hep B recommendation has been a long-standing goal for vaccine opponents.

A planned vote on the issue at the committee’s meeting in September was tabled after fierce disagreement among members. When the discussion resumed Thursday, it repeatedly devolved into shouting.

“We’re trying to evaluate a moving target,” said Hibbeln, one of the move’s strongest opponents, during the meeting.

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Although a change in the current recommendation would not bar newborns from receiving the vaccine, Medicaid and other public insurance programs would no longer be required to cover it, putting a birth dose out of reach for millions of poor families and complicating access for many others.

Unlike most vaccine-preventable diseases, such as whooping cough and chickenpox, hepatitis B is typically asymptomatic, often spreading silently until midlife, when 1 in 4 infected people develop liver cancer or cirrhosis.

“It’s one of the cancers with the highest mortality in the U.S.,” said Dr. Su Wang, medical director of Viral Hepatitis Programs and the Center for Asian Health at the Cooperman Barnabas Medical Center in New Jersey, who lives with the disease. “The life expectancy we give people is six months on average.”

Opponents of the current vaccine guidance — among them, Kennedy, surgeon general nominee Casey Means and President Trump — characterize the virus as the result of high-risk “adult” behavior, including sex and IV drug use.

“Hepatitis B is sexually transmitted,” Trump said at a White House news conference in September. “There’s no reason to give a baby that’s almost just born hepatitis B.”

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But experts say that’s not how most people get the disease.

“It’s primarily transmitted mother to child,” said Dr. Chari Cohen, president of the Hepatitis B Foundation.

A majority of infected mothers are immigrants — particularly from the Philippines, China and Vietnam — making birth-dose vaccination an urgent priority for many California families.

Los Angeles County has recorded only a single case of perinatal Hep B transmission in the last five years, thanks in part to universal vaccination, the county health department said.

For some administration officials and panel members, the disease’s prevalence in immigrant communities is a talking point.

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“The elephant in the room is immigration — we have had years of illegal immigration, undocumented people coming from higher-endemicity countries,” said Dr. Evelyn Griffin, one of the panel’s most vocal proponents of the change.

“We have problems adults need to solve with our resources there, rather than asking babies to solve this problem for us,” she said.

Griffin and other opponents of the current vaccine schedule say inoculating everyone places an unfair burden on healthy newborns from nonimmigrant families whose mothers have either screened negative or have few risk factors for the disease.

But experts say the proposed alternative of universal prenatal testing and aggressive risk assessment is unrealistic in the current American healthcare system. Today, less than 85% of mothers are screened — a number experts say will fall sharply if health subsidies disappear and Medicaid enrollment is cut in coming months.

“Our previous risk-based vaccination strategy failed,” said Katrin Werner Perez of the Alliance for Aging Research. “Prior to the 1991 change to universal vaccination, nearly 20,000 babies and children were infected annually in the U.S.”

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For babies exposed to the blood-borne virus in utero or during delivery, every minute the shot is delayed heightens the risk of transmission. That reality prompted American public health officials to bump the first dose from early childhood, when it was given in the 1980s, to the first 24 hours of life, a recommendation the CDC has maintained since 1991.

“[The vaccine] saved thousands, if not millions of lives just in the U.S.,” Cohen said. “There’s more safety and efficacy data on the hepatitis B vaccine than just about anything else we put into our bodies.”

Those who catch hepatitis as infants are far more likely than those who get it as adults to develop chronic and ultimately fatal infections, data show.

Because the virus can live on surfaces for up to a week, doctors and public health experts stress that babies can contract it even from seemingly trivial exposures. Caregivers might not know they have the disease, and are unlikely to be tested, making the birth dose more urgent, they said.

“Mom is not the only person around the baby,” said Wang, who told the panel on Thursday she likely acquired the disease from her grandparents. “There’s grandparents, caregivers, other young children. You’re basically leaving that baby vulnerable.”

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Even a small cut from shared nail clippers risks infection, data show.

Kennedy and his allies on the panel counter that the vaccine is unnecessary for most infants, and that delaying it would offer parents the opportunity to participate in “shared clinical decision-making” about whether and when to vaccinate.

Still, the panel has so far struggled to coalesce around an alternative recommendation. A planned vote Thursday was tabled in part because proposed language remained in flux even as the meeting was underway.

“This is the third version of the questions that most of the ACIP have received in 72 hours,” Hibbeln said.

Hibbeln and Meissner were vocal opponents of a change to the birth-dose recommendation when it was first debated in September.

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“We will be creating new doubts in the mind of the public that are not justified,” Meissner said.

Others said the move would not go far enough.

“I don’t see even where is the argument to vaccinate younger children at all that live in a normal environment,” panelist Dr. Retsef Levi said in September.

In addition to limiting public coverage for the vaccine, a change to the recommendation could also force privately insured parents to navigate layers of complex authorizations in order to access a birth dose, experts warned.

Many feared the decision could further stigmatize the shot in a moment when many parents are refusing it simply because the recommendation is under review.

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“States and hospitals are reporting declines in hepatitis B vaccination,” said Kayla Inthabandith of the Center for Advancing Health Equity in Rural and Underserved Communities. “Even some mothers living with hepatitis B are refusing the birth dose, putting their own infants at the highest risk of infection.”

Moving the recommendation from the first day of life to the second month could lead to 1,400 new infections a year, experts warned.

“Any child who gets a hepatitis B infection because we change policy is one too many,” said Dr. Judith Shlay. “I want us to make sure we never have any child get hepatitis B infection.”

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Can fire-resistant homes be sexy? ‘You be the judge,’ says this Palisades architect

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Can fire-resistant homes be sexy? ‘You be the judge,’ says this Palisades architect

At first glance, it looks like nothing more than a charming Spanish-revival, quintessentially Californian home — but this Pacific Palisades rebuild is constructed like a tank.

Every exterior wall of the steel-framed home is a foot-thick, fire-resistant barricade. The home is connected to a satellite fire monitoring service. Should a fire start in town, sturdy metal shutters descend to cover every window. An exterior sprinkler system can pump 40,000 gallons of water from giant tanks hidden behind the shrubs in the property’s yard. If the cameras and heat sensors around the house detect danger, the system can envelop the home in over 1,000 gallons of fire retardant and hundreds of gallons of fire-suppressing foam.

Palisades resident and architect Ardie Tavangarian is so confident in his design that he even asked the fire department if they could start a controlled fire on the property to test it all out. (They said no.)

Tavangarian built a career designing multimillion-dollar luxury homes in Los Angeles, but after the Palisades fire destroyed 13 of his works — including his family’s home — he found another calling: how to design a house that can handle what the Santa Monica Mountains throw at it. And how to do it quickly and affordably.

Water tanks form part of a backup water supply in a newly built fire-resistant home in Pacific Palisades.

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“Nature is so powerful,” he said, sitting on a couch in the new house, which he built for his adult twin daughters. “We are guests living in that environment and expecting, ‘Oh, nature is going to be really kind to me.’ No, it’s not. It does what it’s supposed to do.”

Tavangarian watched the Jan. 1 Lachman fire from his property not far from here; a week later that fire rekindled, grew into the Palisades fire, and burned through his house. But the painful details of the fire — the missteps of the fire department, the empty reservoir — didn’t matter when it came to deciding how to rebuild, he said. The reality is, many fires have burned in these mountains. Many more will.

A sprinkler on a roof.

A sprinkler on the roof is part of a house-wide sprinkler system.

For the architect, who has spent much of his 45-year career designing for luxury, hardening a home against wildfire has brought a new kind of luxury to his homes: peace of mind.

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It’s a sentiment that resonates with fire survivors: Tavangarian says he’s received considerable interest from other property owners in the Palisades looking to rebuild their houses.

The metal shutters and advanced outdoor sprinkler system are the flashiest parts of Tavangarian’s home hardening project, and the efficacy of these adaptations is still up for debate. Because the measures have not yet been widely adopted, there are few studies exploring how much or little they protect homes in real-world fires.

Ardie Tavangarian stands inside a house.

Architect Ardie Tavangarian inside the house he designed.

Anecdotal evidence has indicated the effectiveness of sprinklers can vary significantly based on the setup and the conditions during the fire. Extreme wind, for example, can make them less effective. Lab studies have generally found shutters can reduce the risk of windows shattering.

These measures aren’t cheap, either. Sprinkler systems can cost north of $100,000, for example. However, Tavangarian said when all was said and done, the home he built for his daughters cost around $700 per square foot — less than what Palisades residents said they expected to pay, but more than what Altadena residents expected for their rebuilds.

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Tavangarian also hopes to see insurers increasingly consider the home-hardening measures property owners take when writing policies, which he said could potentially offset the extra cost in a decade or less. As he explored getting insurance for the new home, one insurer quoted him $80,000 a year. After he convinced the company to visit the property, it lowered the quote to just $13,000, he said.

A living room inside a fire-resistant house, with metal heat shields drawn over the windows.

The house includes metal heat shields that can drop down if a fire approaches.

The home also has essentially all of the other less flashy — but much cheaper and well-proven — home hardening measures recommended by fire professionals: The underside of the roof’s overhang is closed off — a common place embers enter a home. The roof, where burning embers can accumulate, is made of fire-resistant material. The windows, vulnerable to shattering in extreme heat, are made of a toughened glass. There is virtually no vegetation within the first five feet of the home.

When asked if he felt he had compromised on design, comfort or aesthetics for the extra protection — one of the many concerns Californians have with the state’s draft “Zone Zero” requirements that may significantly limit vegetation within five feet of a home — Tavangarian simply said, “You be the judge.”

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Commentary: My toothache led to a painful discovery: The dental care system is full of cavities as you age

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Commentary: My toothache led to a painful discovery: The dental care system is full of cavities as you age

I had a nagging toothache recently, and it led to an even more painful revelation.

If you X-rayed the state of oral health care in the United States, particularly for people 65 and older, the picture would be full of cavities.

“It’s probably worse than you can even imagine,” said Elizabeth Mertz, a UC San Francisco professor and Healthforce Center researcher who studies barriers to dental care for seniors.

Mertz once referred to the snaggletoothed, gap-filled oral health care system — which isn’t really a system at all — as “a mess.”

But let me get back to my toothache, while I reach for some painkiller. It had been bothering me for a couple of weeks, so I went to see my dentist, hoping for the best and preparing for the worst, having had two extractions in less than two years.

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Let’s make it a trifecta.

My dentist said a molar needed to be yanked because of a cellular breakdown called resorption, and a periodontist in his office recommended a bone graft and probably an implant. The whole process would take several months and cost roughly the price of a swell vacation.

I’m lucky to have a great dentist and dental coverage through my employer, but as anyone with a private plan knows, dental insurance can barely be called insurance. It’s fine for cleanings and basic preventive routines. But for more complicated and expensive procedures — which multiply as you age — you can be on the hook for half the cost, if you’re covered at all, with annual payout caps in the $1,500 range.

“The No. 1 reason for delayed dental care,” said Mertz, “is out-of-pocket costs.”

So I wondered if cost-wise, it would be better to dump my medical and dental coverage and switch to a Medicare plan that costs extra — Medicare Advantage — but includes dental care options. Almost in unison, my two dentists advised against that because Medicare supplemental plans can be so limited.

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Sorting it all out can be confusing and time-consuming, and nobody warns you in advance that aging itself is a job, the benefits are lousy, and the specialty care you’ll need most — dental, vision, hearing and long-term care — are not covered in the basic package. It’s as if Medicare was designed by pranksters, and we’re paying the price now as the percentage of the 65-and-up population explodes.

So what are people supposed to do as they get older and their teeth get looser?

A retired friend told me that she and her husband don’t have dental insurance because it costs too much and covers too little, and it turns out they’re not alone. By some estimates, half of U.S. residents 65 and older have no dental insurance.

That’s actually not a bad option, said Mertz, given the cost of insurance premiums and co-pays, along with the caps. And even if you’ve got insurance, a lot of dentists don’t accept it because the reimbursements have stagnated as their costs have spiked.

But without insurance, a lot of people simply don’t go to the dentist until they have to, and that can be dangerous.

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“Dental problems are very clearly associated with diabetes,” as well as heart problems and other health issues, said Paul Glassman, associate dean of the California Northstate University dentistry school.

There is one other option, and Mertz referred to it as dental tourism, saying that Mexico and Costa Rica are popular destinations for U.S. residents.

“You can get a week’s vacation and dental work and still come out ahead of what you’d be paying in the U.S.,” she said.

Tijuana dentist Dr. Oscar Ceballos told me that roughly 80% of his patients are from north of the border, and come from as far away as Florida, Wisconsin and Alaska. He has patients in their 80s and 90s who have been returning for years because in the U.S. their insurance was expensive, the coverage was limited and out-of-pocket expenses were unaffordable.

“For example, a dental implant in California is around $3,000-$5,000,” Ceballos said. At his office, depending on the specifics, the same service “is like $1,500 to $2,500.” The cost is lower because personnel, office rent and other overhead costs are cheaper than in the U.S., Ceballos said.

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As we spoke by phone, Ceballos peeked into his waiting room and said three patients were from the U.S. He handed his cellphone to one of them, San Diegan John Lane, who said he’s been going south of the border for nine years.

“The primary reason is the quality of the care,” said Lane, who told me he refers to himself as 39, “with almost 40 years of additional” time on the clock.

Ceballos is “conscientious and he has facilities that are as clean and sterile and as medically up to date as anything you’d find in the U.S.,” said Lane, who had driven his wife down from San Diego for a new crown.

“The cost is 50% less than what it would be in the U.S.,” said Lane, and sometimes the savings is even greater than that.

Come this summer, Lane may be seeing even more Californians in Ceballos’ waiting room.

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“Proposed funding cuts to the Medi-Cal Dental program would have devastating impacts on our state’s most vulnerable residents,” said dentist Robert Hanlon, president of the California Dental Assn.

Dental student Somkene Okwuego smiles after completing her work on patient Jimmy Stewart, 83, who receives affordable dental work at the Ostrow School of Dentistry of USC on the USC campus in Los Angeles on February 26, 2026.

(Genaro Molina / Los Angeles Times)

Under Proposition 56’s tobacco tax in 2016, supplemental reimbursements to dentists have been in place, but those increases could be wiped out under a budget-cutting proposal. Only about 40% of the state’s dentists accept Medi-Cal payments as it is, and Hanlon told me a CDA survey indicates that half would stop accepting Medi-Cal patients and many others will accept fewer patients.

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“It’s appalling that when the cost of providing healthcare is at an all-time high, the state is considering cutting program funding back to 1990s levels,” Hanlon said. “These cuts … will force patients to forgo or delay basic dental care, driving completely preventable emergencies into already overcrowded emergency departments.”

Somkene Okwuego, who as a child in South L.A. was occasionally a patient at USC’s Herman Ostrow School of Dentistry clinic, will graduate from the school in just a few months.

I first wrote about Okwuego three years ago, after she got an undergrad degree in gerontology, and she told me a few days ago that many of her dental patients are elderly and have Medi-Cal or no insurance at all. She has also worked at a Skid Row dental clinic, and plans after graduation to work at a clinic where dental care is free or discounted.

Okwuego said “fixing the smiles” of her patients is a privilege and boosts their self-image, which can help “when they’re trying to get jobs.” When I dropped by to see her Thursday, she was with 83-year-old patient Jimmy Stewart.

Stewart, an Army veteran, told me he had trouble getting dental care at the VA and had gone years without seeing a dentist before a friend recommended the Ostrow clinic. He said he’s had extractions and top-quality restorative care at USC, with the work covered by his Medi-Cal insurance.

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I told Stewart there could be some Medi-Cal cuts in the works this summer.

“I’d be screwed,” he said.

Him and a lot of other people.

steve.lopez@latimes.com

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Diablo Canyon clears last California permit hurdle to keep running

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Diablo Canyon clears last California permit hurdle to keep running

Central Coast Water authorities approved waste discharge permits for Diablo Canyon nuclear plant Thursday, making it nearly certain it will remain running through 2030, and potentially through 2045.

The Pacific Gas & Electric-owned plant was originally supposed to shut down in 2025, but lawmakers extended that deadline by five years in 2022, fearing power shortages if a plant that provides about 9 percent the state’s electricity were to shut off.

In December, Diablo Canyon received a key permit from the California Coastal Commission through an agreement that involved PG&E giving up about 12,000 acres of nearby land for conservation in exchange for the loss of marine life caused by the plant’s operations.

Today’s 6-0 vote by the Central Coast Regional Water Board approved PG&E’s plans to limit discharges of pollutants into the water and continue to run its “once-through cooling system.” The cooling technology flushes ocean water through the plant to absorb heat and discharges it, killing what the Coastal Commission estimated to be two billion fish each year.

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The board also granted the plant a certification under the Clean Water Act, the last state regulatory hurdle the facility needed to clear before the federal Nuclear Regulatory Commission (NRC) is allowed to renew its permit through 2045.

The new regional water board permit made several changes since the last one was issued in 1990. One was a first-time limit on the chemical tributyltin-10, a toxic, internationally-banned compound added to paint to prevent organisms from growing on ship hulls.

Additional changes stemmed from a 2025 Supreme Court ruling that said if pollutant permits like this one impose specific water quality requirements, they must also specify how to meet them.

The plant’s biggest water quality impact is the heated water it discharges into the ocean, and that part of the permit remains unchanged. Radioactive waste from the plant is regulated not by the state but by the NRC.

California state law only allows the plant to remain open to 2030, but some lawmakers and regulators have already expressed interest in another extension given growing electricity demand and the plant’s role in providing carbon-free power to the grid.

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Some board members raised concerns about granting a certification that would allow the NRC to reauthorize the plant’s permits through 2045.

“There’s every reason to think the California entities responsible for making the decision about continuing operation, namely the California [Independent System Operator] and the Energy Commission, all of them are sort of leaning toward continuing to operate this facility,” said boardmember Dominic Roques. “I’d like us to be consistent with state law at least, and imply that we are consistent with ending operation at five years.”

Other board members noted that regulators could revisit the permits in five years or sooner if state and federal laws changes, and the board ultimately approved the permit.

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