How Much Do You Know About Colorectal Cancer? Take the Quiz

Updated on Mar 4, 2026 | Cancer, Featured, Gastroenterology, Your Health

Colorectal cancer is now the leading cause of cancer deaths in the United States for both men and women under the age of 50. There are many misconceptions about the disease, and knowing the facts can help you fight it. Can you separate myth from fact? Take the quiz below, then click “Done” to see your score and correct answers.

This quiz was developed with Pascale White, MD, MBA, MS, FACG, Director of Health Equity in Action for Liver and Digestive Diseases and Associate Professor of Medicine (Gastroenterology and Liver Disease) at the Icahn School of Medicine at Mount Sinai.

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Colorectal Cancer Is Rising Among Younger People. Here’s What We Know.

Updated on Feb 18, 2026 | Featured, Gastroenterology, Your Health

Colorectal cancer (cancers of the colon and rectum) is now the leading cause of cancer death in the United States for both men and women under the age of 50. In 2018, the American Cancer Society changed their screening recommendation from age 50 to 45 because of the alarming increase in early-onset colorectal cancer (affecting those under 50 years old).

A recent study published in the Journal of the American Medical Association (JAMA) reported that colorectal cancer mortality has risen 1 percent annually since 2005, an increase that has now placed colorectal cancer as the No. 1 cause of cancer mortality in young adults. Experts don’t know why more younger people are getting colorectal cancer, but it’s clear that early-onset colorectal cancer is an important public health issue.

Pascale White, MD, MBA, MS, FACG

In this Q&A, Pascale White, MD, MBA, MS, FACG, Director of Health Equity in Action for Liver and Digestive Diseases (HEALD), and Associate Professor of Medicine (Gastroenterology and Liver Disease), Icahn School of Medicine at Mount Sinai, discusses warning signs younger people should look out for and when to see a doctor.

Why are many people in their 20s and 30s going undiagnosed with colorectal cancer?

Many young people may not have primary care doctors or are ignoring their symptoms. They may go to an urgent care center for strep throat or the flu but may be too embarrassed to discuss symptoms like rectal bleeding and may not be thinking they could have colorectal cancer. Regardless of how old you are, you should never ignore symptoms and should seek medical attention. Having a primary care doctor who could start a timely workup of the symptoms and make a referral to a gastroenterologist is critical to making the diagnosis early. The earlier colorectal cancer is diagnosed, the greater your chances are for survival.

Unfortunately, we are seeing that younger patients are being diagnosed with advanced stage colorectal cancer (stages III and IV). A majority of cases are occurring in the rectum and the distal (left) colon, which can present as rectal bleeding. That is why it is important not to delay seeing the doctor.

What increases my risks as a younger person?

While scientists do not have the exact answers, lifestyle and environmental factors are being investigated. Some studies have linked risk factors for early-onset colorectal cancer to obesity and alcohol intake. Note that these are similar risk factors for older adults too. Other risk factors include having a family history of colorectal cancer or having a hereditary condition like Lynch syndrome; not getting enough physical activity; using tobacco and eating a low-fiber diet high in processed foods.

A Colorectal Cancer Health and Screening Fair will be held at The Mount Sinai Hospital Friday, March 6, from 9 am to 3 pm. Click here to learn more.

Are certain groups more at risk than others?

Early-onset colorectal cancer is increasing in both men and women, but racial disparities exist. Although incidence among non-Hispanic white patients has shown a consistent increase, Black patients still have the highest overall incidence and lowest survival rates.

What type of family history puts me at risk?

The majority of young people who are getting early-onset colorectal cancer don’t have a family history of cancer. That said, any family history of colorectal cancer could be relevant. Knowing first-degree family history (mom/dad/brother/sister) helps your doctor determine if there is a higher risk. However, second-degree family history (aunts/uncles/grandparents/grandchildren/half siblings/nieces and nephews) can help spot potential patterns that might put you at risk. Mount Sinai has genetic counselors that can help identify these patterns.

What symptoms indicate that younger people should see a doctor?

A majority of younger people who are coming to see the doctor with early-onset colorectal cancer are symptomatic, and the most common symptoms are blood in stool and abdominal pain. Other symptoms include iron deficiency anemia, unintentional weight loss, and a change in bowel habits. Young people need to understand seeing blood in the stool (whether it is bright red blood or black stool) should not be ignored. Bleeding could be caused by something benign like hemorrhoids or something malignant like colorectal cancer. If you experience these symptoms, see a doctor as soon as possible. If colorectal cancer is caught early, your chances of survival are higher.

Should I Be Worried About Changes in My Stool?

How can I reduce my risk?

Some things may not be in your complete control. For example, we are investigating whether there are certain environmental exposures that put younger people at risk. That said, there are actions you can take regardless of age that reduce overall risk for colorectal cancer. These include eating a well-balanced diet of high-fiber foods (fruits, vegetables, nuts, legumes, and whole grains); reducing your intake of processed foods, especially processed meat; reducing alcohol intake; getting regular exercise; and monitoring any health conditions you have, such as diabetes and obesity​.

What is a colonoscopy?

A colonoscopy is a safe and effective procedure where a doctor uses a camera to examine the lining of the colon and rectum for growths called polyps and/or other abnormalities, including colorectal cancer. During the examination, you are given some sedation to keep you comfortable. If polyps are found, they are removed and sent to a pathologist for evaluation. Some polyps are benign while others could be precancerous. The type of polyps removed will determine when the colonoscopy should be repeated in the future.

Will my insurance cover it?

Insurance companies cover colonoscopies for people who are 45 years and older for screening colonoscopies. A screening colonoscopy is what the procedure is called when it is being done on a patient who has no symptoms. If you are under age 45 but are experiencing symptoms, you would be sent for a diagnostic colonoscopy because the procedure is being done to find the diagnosis that would explain the symptoms. In either case, we encourage patients to communicate with their insurance company prior to procedures to ensure they will cover the cost.

How can I get a colonoscopy if I don’t have insurance?

Call your health provider to see what resources may be available for free or low-cost colonoscopies. They can help navigate patients to centers that accommodate people who do not have insurance.

Learn more about Digestive Diseases and Gastroenterology at Mount Sinai
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How An Interest in Cardiothoracic Surgery Is Shaping Caroline Tavolacci’s Path as a Surgeon-Scientist at Mount Sinai

Updated on Feb 17, 2026 | Featured, Research, School

Sooyun Caroline Tavolacci, MD, MSCR, with her mentor, Anelechi Anyanwu, MD

Sooyun Caroline Tavolacci, MD, MSCR, is a third-year PhD student in the Clinical Research Program at the Icahn School of Medicine at Mount Sinai and a surgeon-scientist in training. Her dissertation research focuses on heart transplantation outcomes, specifically evaluating beating heart transplantation using ex-vivo heart perfusion and its impact on donor pool expansion, under the mentorship of Anelechi Anyanwu, MD, Professor and Vice Chair, Department of Cardiovascular Surgery, and Natalia Egorova, PhD, Professor, Department of Population Health and Science.

In parallel with her doctoral training, Dr. Tavolacci works as a clinical research coordinator in the Department of Cardiovascular Surgery at The Mount Sinai Hospital, Clinical Research Office, which is led by Julie Swain, MD, Professor and Vice Chair of the Department.

Having progressed from an international master’s student to a PhD candidate and hospital employee, she reflects on five years of training marked by perseverance, balance, and growth across research, work, and life.

Her interest in medicine began early, sparked by seeing the Jarvik-7 artificial heart in a school textbook. She was fascinated by the idea of replacing a vital organ, the multidisciplinary care behind it, and the trust required between patients and surgeons.

“What I liked most during my two years of research training at the Icahn School of Medicine was that I could apply what I learned in the classroom right away in real-world settings.” -Sooyun Caroline Tavolacci, MD, MSCR

 

Cardiothoracic surgery has since become her lifelong passion. She completed six years of medical school in South Korea, followed by a cardiovascular surgery sub-internship in Brescia, Italy. After graduating from medical school, and realizing that she lacked experience in clinical research, she sought a program that bridged scientific research and clinical practice, leading her to Mount Sinai’s Graduate School of Biomedical Sciences.

“The Icahn School of Medicine is unique as a pioneering model for a medical school grown directly from a hospital, not a university” she says. “The rich clinical environment, combined with strong multidisciplinary faculty, makes it ideal for studying clinical research.”

In 2021, in the middle of the COVID-19 pandemic, she entered the Master of Science in Clinical Research (MSCR) program at the Icahn School of Medicine while working on an NIH-funded study examining the serological response to the SARS-CoV-2 vaccine in lung cancer patients led by Fred Hirsch, MD, PhD, Professor and Director, Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute. She described this experience as firsthand exposure to bench-to-bedside translational research. Her days began in the lung cancer clinic at the Institute and ended in the Biorepository and Pathology CoRE laboratories.

“Weekly meetings involved thoracic oncologists, thoracic surgeons, pathologists, virologists, immunologists, biostatisticians, and radiologists. This multidisciplinary collaboration and exposure to different perspectives taught me how to approach team science in research,” she says.

Dr. Tavolacci completed her master’s thesis, in which she investigated the mechanisms underlying sex-based differences in immunotherapy response in lung cancer, with Dr. Hirsch and co-mentor Rajwanth Veluswamy, MD, MSCR, a former faculty member of the Icahn School of Medicine and a graduate of the MSCR program. She presented her work at national and international meetings and published her several peer-reviewed articles during her master’s program.

“What I liked most during my two years of research training at the Icahn School of Medicine was that I could apply what I learned in the classroom right away in real-world settings,” she says. “I was extremely satisfied with the coursework and the quality of education I received.”

After completing her MSCR in June 2023, she decided to continue her research education and was accepted into the PhD in Clinical Research program.

“I developed a strong interest in biostatistics during my master’s program,” she says. “My experience was primarily in thoracic oncology, with a focus on lung cancer; however, I wanted dedicated time to learn outcomes research in cardiovascular surgery.”

After her acceptance into the PhD program, she faced significant financial hardship due to a loss in her family and visa restrictions that limited her ability to secure a job at The Mount Sinai Hospital at that time.

She considered returning to South Korea or continuing her academic journey in the United States, but instead reached out for help. In recognition of her academic excellence, she received Emergency Fund support from the Office of Postdoctoral and Student Affairs at the Graduate School of Biomedical Sciences and continued her work-study program through Westchester Medical Center in New York State. During this time, she completed her PhD coursework and conducted heart failure and transplant outcomes research under the mentorship of Suguru Ohira, MD, PhD, Cardiac Surgeon at Hartford HealthCare. This included large database analyses using the United Network for Organ Sharing registry.

Now Dr. Tavolacci balances her dissertation research with her role as a research coordinator in the Department of Cardiovascular Surgery at Mount Sinai. She credits the Icahn School of Medicine’s hospital-based model for naturally generating research questions through close interaction with surgeons, fellows, and residents.

“The clinical exposure I gain every day as a research coordinator helps me understand why these variables scientifically matter in clinical trials and studies, and it directly shapes my academic research,” she says. “With my master’s and PhD training in clinical research, I have a strong understanding of research methodology, such as study design, logistics, objectives and hypotheses, and analysis planning. This foundation is incredibly helpful in performing my role. It is a humbling experience to care for patients and to advocate for advancements in clinical research.”

Dr. Tavolacci frequently mentors prospective international applicants, particularly those navigating funding challenges in the PhD in Clinical Research program. She receives emails and LinkedIn messages from many people interested in clinical research asking how to find a mentor, identify research topics, and secure funding.

“It is challenging, and sometimes being equivalent as an international student is not enough—you have to be better to get noticed. However, people who have been through similar processes recognize your strengths.” She strives to do the same for prospective applicants by sharing her honest journey as an international student.

Dr. Tavolacci recalls what her PhD mentor, Dr. Anyanwu, said during their first meeting: “See how far you have come.” She carries this message with her whenever she faces difficulties or setbacks, using it as a reminder to keep moving forward.

In 2026, Dr. Tavolacci will present her doctoral research at various national meetings within the cardiothoracic surgery community. Throughout her academic journey, she has learned that research comes with many practical challenges. What has been most helpful to her is maintaining concentration and focus to push projects forward and see them through to completion. What she learned the hard way is that everything takes time and effort, and that there are many failures behind every achievement in academia.

Dr. Tavolacci will complete her PhD in two years and plans to enter cardiothoracic surgery residency. Her training will allow her to practice surgery while designing and conducting clinical studies and trials. Her ultimate goal is to become a surgeon-scientist.

Learn more about the Clinical Research Education Program at the Icahn School of Medicine at Mount Sinai

Mount Sinai AIHH Grand Rounds: A Thoughtful Way to Adopt AI in Health Care

Feb 10, 2026 | Artificial Intelligence, Featured, Research, School

Isaac Kohane, MD, PhD, Chair of the Department of Biomedical Informatics, Harvard Medical School, was keynote speaker of the Icahn School of Medicine at Mount Sinai’s Windreich Department of AI and Human Health (AIHH) December 2025 session of AIHH Grand Rounds.

Health care systems across the country have been increasingly using artificial intelligence (AI) systems to assist and augment what clinicians and researchers can achieve. As adoption of machine learning accelerates, thought leaders have been scrutinizing how AI is being embraced.

“Many doctors are already using these tools, such as OpenEvidence, but without visibility or oversight by health care systems,” says Isaac Kohane, MD, PhD, Chair of the Department of Biomedical Informatics, Harvard Medical School. OpenEvidence is an AI-powered clinical decision support and medical search engine.

Dr. Kohane is a prominent researcher in biomedical informatics and AI whose nearly 400 papers have been cited more than 95,000 times, according to Google Scholar. He was the keynote speaker of the Icahn School of Medicine at Mount Sinai’s Windreich Department of AI and Human Health (AIHH) December 2025 session of AIHH Grand Rounds. Dr. Kohane wants to see not just more use of AI, but more responsible use—a theme of his lecture, which was titled “A Tipping Point for Clinicians’ Influence Upon AI-Driven Clinical Decisions.”

Dr. Kohane gave a lecture, titled “A Tipping Point for Clinicians’ Influence Upon AI-Driven Clinical Decisions,” which focused on where the opportunities lie for the health care industry to use AI more, but in a thoughtful way that accounted for human values and ethics.
The AIHH Grand Rounds is a monthly seminar series hosted by Mount Sinai’s Windreich Department of AI and Human Health (AIHH). Clinicians and researchers who work extensively with AI, including Girish N. Nadkarni, MD, MPH, CPH, Chair of AIHH (left) and David L. Reich, MD, President of The Mount Sinai Hospital (right), attend to learn and discuss the latest developments in the field.
AI is transforming the health care and scientific publishing industries, with its potential to save time and effort for individuals and institutions. However, as long as there are incentives for perverse behaviors regarding AI, there will be bad actors abusing the technology, says Dr. Kohane. These fields need to collectively reset such cultures and behaviors.
A theme Dr. Kohane discussed in his lecture is the need to build in human values within AI models. There will be occasions when a broad, normative model will fail to account for the needs of an individual patient. He proposes that the responsibility for building human values in AI lies with the clinicians and researchers who use it.
A highlight of the AIHH Grand Rounds is not merely the lectures presented, but the discussions that occur after. These discussions help foster collaboration between researchers as they share ideas.

“I chose these topics for Grand Rounds because I view the Icahn School of Medicine and its leadership as among the most forward-looking in the country,” says Dr. Kohane, “and therefore they should be truly focused on setting an example in terms of accelerating adoption options that are both safe, and also enabling patients and clinicians to benefit from the complementarity of AI to human expertise, as well as changing the promotion process to reflect greater engagement with reproducibility and robust research.”

The AIHH Grand Rounds is a monthly seminar series that showcases developments in how AI, science, and medicine intersect, and features an open discussion to foster collaboration. The inaugural session launched in September 2025.

How should health systems think about engaging with AI as it pertains to patients, clinicians, and researchers in a way that is beneficial to all parties? Dr. Kohane discussed the following themes during the seminar.

Transforming the institution with AI

By their nature, large health care systems in the United States are high-revenue, low-margin businesses, and because of that, they face challenges in moving rapidly with change to avoid disruptions.

Institutionally, AI adoption has found more comfort and scalability on the administrative side of operations, including reimbursement and corporate functions. AI is a critical lever, but not a priority for health care system spending presently, according to Dr. Kohane.

However, the application of AI on the clinical side, including continuity of care, clinical operations, and quality and safety, remains nascent or in pilot stages.

“It’s actually the doctors who are leading [with AI adoption], even when their own institutions are not supporting them directly,” says Dr. Kohane.

That landscape is slowly changing as health care leaders begin to engage their clinicians with AI support where it is needed now, but it should not be at the cost of extended, effortful multi-year governance conversations, Dr. Kohane pointed out. The incentives for using AI in the practice of medicine must be focused on improving care rather than maximizing revenue.

“And so, I anticipate that the future first adoptions will happen in specialized high-end services like concierge services, primary care, or cancer care,” he says. “But eventually, it would become a requisite for the safe practice of medicine, and for meeting the expectation of our patients, that ultimately our health care systems will be propelled into more significant engagement [with AI].”

Transforming publishing and literature review with AI

“Every part of the scientific publication process—that is, the generation of manuscripts and review of manuscripts—is going to be augmented by AI,” says Dr. Kohane. “That is going to present, or is already presenting, challenges that the whole peer-review publishing industry is not well equipped to handle.”

Dr. Kohane discussed a case study in which he created a hypothesis that was incorrect, and with AI tools was ultimately able to generate data that were not only fictional, but designed by AI to avoid detection by the majority of fake-data-generation detectors.

“We’re going to really have to address, first and foremost, the incentives that drive perverse behaviors,” he says. An industry that prizes publication volume, or publishing in high-profile publications over producing work with actual scientific impact—such as important but unglamorous replication studies—is only going to drive bad actors.

In the right hands, AI will increase the efficiency and quality of scholarly scientific review. AI can serve as a prism that allows clinical and laboratory experience to be distilled into new knowledge, forming a substrate for truly lifelong medical education. “However, we have to reset the culture and incentives,” Dr. Kohane says.

Transforming AI with human values

In an industry where urgency and time matters, AI presents a strong value proposition with its capability to process large datasets and execute large volumes of actions in a blink of an eye. Time-consuming tasks can be automated by AI, but when decisions that pertain to the care of individuals with unique needs are left to a normative model that adheres to overarching policies, the individual’s needs might not be met.

The solution is not to turn away from AI, but to develop personal models that account for the needs of not just the patient at hand, but also their caretakers, doctors, or any other relevant stakeholders, says Dr. Kohane. It is about building human values within an AI model, which can flag when an individual case does not align with the normative model.

That work to develop such projects falls on the health care system, says Dr. Kohane. He introduced the Human Values Project, an international initiative led by Harvard Medical School’s Department of Biomedical Informatics, which aims to characterize how AI models respond to ethical dilemmas in medicine, measuring both their default behaviors and their capacity for alignment. And he proposed that researchers at the Icahn School of Medicine have that potential to develop their own human values-based AI models.

“My takeaway from presenting and participating in the AIHH Grand Rounds really stemmed not from the presentation itself, but from discussions I had afterwards with various leaders of the AI efforts,” says Dr. Kohane. “My sense was that more than most institutions, [Mount Sinai’s] leadership was willing to invest and take a chance on pilots of deployments of these technologies to learn fast and adapt fast. And at the same time, everybody recognized that this is very challenging, given our current regulatory environments and incentives.”

Dr. Kohane ended his presentation with a line of wisdom for participants to consider: “There is no one to lead this in the direction we want, other than us.”

Learn more about the Windreich Department of Artificial Intelligence and Human Health and AIHH Grand Rounds

An Early Interest in Immunology Set the Stage for Building a Scientific Career at Mount Sinai

Updated on Feb 8, 2026 | Featured, School

Ananya Parthasarathy, MSBS

Ananya Parthasarathy, MSBS, a first-year student in the PhD in Biomedical Sciences program at the Icahn School of Medicine at Mount Sinai, recalls developing an interest in immunology while growing up in India, including becoming involved in a project to investigate bacterial contents in Indian street foods.

She completed her Master of Science in Biomedical Science at the Icahn School of Medicine in June 2025, and is now continuing to work in the Immunology Multidisciplinary Training Area in the lab of Karen Edelblum, PhD, studying intraepithelial lymphocytes. Before this, she completed her bachelor of science, with honors, in biology at Azim Premji University in Bengaluru, India, where she gained research experience working with bacterial and cnidarian model organisms.

In this Q&A, she discusses why she chose Mount Sinai, the focus of her research in the immune system, and her career aspirations.

Why did you choose to study at Mount Sinai?

I chose to study at Mount Sinai because of the strong research focus of the MSBS program, particularly the wide array of research opportunities in studying immune functioning at barrier sites. Through the MSBS program, I gained not only theoretical knowledge from immunology elective courses, but also invaluable research experience in working with mouse models and using a variety of experimental techniques to study immune functioning in the small intestine.

What were some of your accomplishments during your time in the Master of Science in Biomedical Science (MSBS) program?

During my time in the MSBS program, I had multiple opportunities to present my research to faculty and my peers to receive feedback on my project. In doing so, I received awards such as best presentation at the MSBS Research Symposium in June 2024, and best poster presentation at the Pathology Research Day in May 2025. Outside of Mount Sinai, I attended the American Physiology Society Summit in April 2025, where I was awarded a Research Recognition Award and a Distinguished Abstract Award. Towards the end of my MSBS journey and the start of my PhD, I applied for and received the Society for Mucosal Immunology Technique-Sharing Travel Grant, which will contribute to my PhD project in 2026.

How did the MSBS program prepare you to apply for a PhD program?

The research and academic experience I gained during the MSBS program prepared me for PhD applications. Being part of PhD-level courses delving into fundamental concepts of biomedical science and immunology ensured I had a strong foundation of theoretical knowledge to conduct research. The exposure to multiple research techniques and the resources available at Mount Sinai allowed me to perform independent research and write a thesis for my MSBS degree, which ultimately prepared me for research as a graduate student.

Why continue your education at Mount Sinai with a PhD in Biomedical Sciences?

I enjoyed working in the Edelblum Lab, which is the primary reason I chose to continue my education at Mount Sinai. During the MSBS program, I completed all the academic requirements for the PhD in Biomedical Sciences, which allowed me to jump straight into full time research as a first-year PhD student. Additionally, the multitude of opportunities at Mount Sinai to present one’s research, as well as the accessibility and availability of resources to answer a wide array of research questions, encouraged me to continue my education at Mount Sinai. I also appreciate the collaborative nature of the immunology and graduate student departments at Mount Sinai, and was keen to continue working in such a supportive environment.

What made you interested in the immunology training area?

I have always been interested in understanding how bacteria influence the human body, particularly the immune system. Growing up in India, I was no stranger to conversations about the hygiene hypothesis and the importance of probiotics to the gut microbiome; these conversations made me interested in understanding how microbes in the human body can influence immune functioning at steady state, as well as how this can change in the context of disease. I interned at a microbiology lab in high school to investigate bacterial contents in Indian street foods, and conducted research for my undergraduate thesis on how skincare products affect the human skin microbiome.

What is the focus of your research?

My research in the Edelblum lab explores the role of gd intraepithelial lymphocytes (IEL) in intestinal homeostasis and inflammatory bowel disease (IBD). As an MSBS student, I studied the role of CD47 in gd IEL migration, and am finishing up this project to publish soon. For my PhD, I am investigating regulators of gd IEL activation and migration at steady state, focusing on the role of CD103 in signal transduction.

What are your plans after you complete your PhD?

After my PhD, I intend to continue conducting research in immune functioning at barrier sites, whether that be in industry or academia. As a first-year student, I look forward to gaining more experience in academic research, as well as in teaching and mentoring, to better understand the trajectory of my scientific career post graduate school.

Learn more about the PhD in Biomedical Sciences Program

Here’s What You Should Know About the New Hepatitis B Vaccine Recommendation

Jan 5, 2026 | Children's Health, Family Medicine, Featured, Infectious Diseases, Pediatrics

For several decades, federal guidelines regarding hepatitis B vaccination for infants in the United States had been unchanged and consisted of a first shot given at birth, a second at 1-2 months, and a third at 6-18 months.

In December 2025, the Centers for Disease Control and Prevention (CDC) announced new recommendations for hepatitis B vaccinations. For infants born to mothers who test negative for hepatitis B, the agency recommended the initial shot only at two months or after, and for infants to undergo antibody testing to determine whether the second and third shots are needed.

“The medical community hasn’t changed its stance on hepatitis B vaccinations, however,” says Daniel Caplivski, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine, and Director of the Icahn School of Medicine Travel Medicine Program.

Daniel Caplivski, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai (left), and Roberto Posada, MD, Professor of Pediatrics (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai (right).

“Hepatitis B is a virus that, for many people, once they get the infection, they have it for the rest of their lives,” says Roberto Posada, MD, Professor of Pediatrics (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai. “It can lead to cirrhosis of the liver and liver cancer, both of which are very preventable through childhood vaccination.”

Why are medical experts recommending that infants receive hepatitis B vaccinations at birth and to receive all shots? Drs. Caplivski and Posada explain the rationale behind the schedule and other facts about the virus.

Why should babies be vaccinated for hepatitis B at birth?
Dr. Posada: This recommendation had been in place since 1991. There are a few reasons why medical experts had pushed for hepatitis B vaccination for infants at birth. Usually, we check pregnant women for hepatitis B. But some people might not have access to full prenatal care, or the check sometimes gets missed. A mother in that situation can unknowingly pass hepatitis B on to the child. Vaccination at birth can prevent that.

Another reason is that the opportunity to protect the child is highest at the moment of childbirth. Once a child and mother are discharged, they might not return for follow-up appointments, or do so at the appropriate times. Thus, giving the hepatitis B vaccination right at childbirth at least provides that initial protection.

What’s the risk of waiting to vaccinate infants for hepatitis B?
Dr. Posada: For infants, other than hepatitis B being passed from the mother, the virus can be transmitted to some degree through household exposure to someone who has hepatitis B. For example, sharing utensils, an infant putting a parent’s toothbrush in the mouth—these are not the main ways of contracting the disease, but they can happen. We want to vaccinate the kids in the event there is someone in the household with hepatitis B.

Other than for infants, the main way hepatitis B is transmitted is through sexual transmission or contact with contaminated blood, such as via needles. That’s another reason to vaccinate children before they become sexually active.

Is the hepatitis B vaccine effective at preventing transmission?
Dr. Caplivski: Ever since we adopted the practice of vaccinating infants at birth, the rate of infants and children contracting hepatitis B has dropped to practically zero.

And the success of vaccinating at childbirth has been replicated around the world. In China, after they adopted a three-dose vaccination schedule from birth, the prevalence of hepatitis B carriers under 5 years old fell from 10 percent to around 0.3 percent in 10 years. That’s a lot of lives saved from chronic complications of the disease.

What could be the consequences of contracting hepatitis B?
Dr. Posada: If a baby gets it at birth, they’re very likely to have it for the rest of their life. And because the infection is lifelong, the more chances for cirrhosis, liver failure, or liver cancer to develop in the lifetime. Someone who contracts it at an older age has a higher chance of clearing the infection from the body.

Dr. Caplivski: The long-term consequences of liver failure and cancer are incredibly difficult for a patient. It is a medically intensive disease, but it also has a huge impact on health care expenditures. All of these could be avoided through vaccinations at childbirth.

According to statistics from the CDC, about 9 in 10 infants who become infected go on to develop lifelong chronic infection. The risk goes down as a child gets older. About 1 in 3 children who get infected before age 6 will develop chronic hepatitis B. Approximately 15–25 percent of people with chronic infection develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.
Is it safe for infants to be vaccinated at childbirth?
Dr. Posada: The vaccine is a recombinant vaccine—meaning it is not a live virus; it is only protein from the virus synthesized in the lab. It cannot cause infection. Other than discomfort at the time of injection, we have had decades of data showing that hepatitis B vaccination at childbirth is safe.
Would the new recommendation by CDC create any access changes?

Dr. Caplivski: Historically, insurers have used CDC recommendations to base their coverage of vaccinations. While the federal entity is retreating from actively recommending hepatitis B vaccinations at childbirth, don’t forget that state departments of health can have their own recommendations and intervene if needed. In the case of New York State, there has been no change in guidelines, and we are still actively recommending hepatitis B vaccinations at childbirth.

What the new CDC action might have caused is a worsening of vaccine skepticism. Even in that situation, it is worth speaking with your pediatrician and health provider to learn more about what is the right course of action for you and your child.

Dr. Posada: Besides talking to your pediatrician, there are other sources of information that are well trusted, such as the American Academy of Pediatrics. It has very good information about childhood vaccines. At the end of the day, as doctors, we want your children to be healthy too.

 

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