Justin Cooper , 2025-04-25 15:18:00
April 25, 2025
3 min read
Key takeaways:
- West Virginia could end a mandate that newborns receive prophylactic ointment against potentially blinding eye infections.
- Experts said the intervention’s benefits outweigh its costs.
A bill recently passed by the West Virginia legislature would undo the state’s mandate for newborns to receive prophylaxis against ophthalmia neonatorum, a potentially blindness-causing eye infection.
As of April 23, House Bill 3444 was headed to Gov. Patrick Morrisey’s desk, with the possibility of being signed into law.
A bill recently passed by the West Virginia legislature would undo the state’s mandate for newborns to receive prophylaxis against ophthalmia neonatorum, a potentially blindness-causing eye infection. Image: Adobe Stock
According to Prevent Blindness, most U.S. states currently require that all newborns have an antibiotic ointment — typically erythromycin — applied to their eyes to prevent infection, known as ophthalmia neonatorum, passed from mother to child during birth. If untreated, the most serious of these infections, caused by Neisseria gonorrhoeae, could rapidly lead to corneal scarring and perforation and blindness.
Valerie M. Kattouf, OD, FAAO, associate professor of optometry at Illinois College of Optometry, told Healio that the cost of potential eye infections in infants not given prophylaxis “far outweighs the cost of the use of the ointment.
“It is clear and understandable that the public’s trust has diminished in regard to public health officials and mandates, but this particular issue seems quite futile,” Kattouf said, noting that erythromycin “has minimal to zero risk profile, is effective and inexpensive, and prevents mild non-sight-threatening and sight-threatening infections.
“I believe it will be used quite routinely even if the mandate is taken away,” she added.
Preventing ophthalmia neonatorum was a driving force behind the founding of Prevent Blindness in 1908. In an interview, Jeff Todd, the group’s president and CEO, defended the concept of mandatory prophylaxis.
“A mandate ensures that all infants, regardless of socioeconomic background or parental awareness, receive the same evidence-based care,” Todd said. “This isn’t about government overreach; it’s about safeguarding children from avoidable harm, particularly when the intervention is a noninvasive, proven one.
“Our concern is that a policy shift in one state — especially related to a long-standing and successful public health intervention — could prompt similar, unwarranted changes in others,” he added.
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A, emeritus professor at Illinois College of Optometry/Illinois Eye Institute, described the proposal to remove West Virginia’s mandate as “sheer folly.”
He told Healio, “Of all the medical procedures, this has to be one of the most cost-effective interventions we have. The efficacy has been shown time and again, and there’s just no medical reason not to do it for the benefit gained.”
Republican West Virginia state delegate Evan Worrell, who introduced the bill, did not respond to a request for comment.
The CDC recommends the application of erythromycin as soon as possible after both vaginal and cesarean deliveries.
In 2019, the U.S. Preventive Services Task Force reaffirmed its recommendation for universal prophylaxis against gonococcal ophthalmia neonatorum, the most serious form of infection. The organization said that erythromycin was effective in preventing the infection and was not associated with serious harm, adding that cost was not a factor in its assessment.
On the other hand, the Canadian Paediatric Society said prophylaxis “should not be routinely recommended” in a position statement it reaffirmed in January 2024.
The organization noted that topical prophylaxis is not effective against the chlamydial form of ophthalmia neonatorum, which is currently the most common form in the U.S. It added that ophthalmia neonatorum caused by either gonorrhea or chlamydia has significantly declined in North America, coinciding with decreases of both infections in the general population and the institution of routine screening and treatment during pregnancy.
The United Kingdom and other high-income countries have also done away with mandatory prophylaxis, the organization added.
In March, Idaho enacted a law that modifies the state’s existing mandate, including by using the term “ocular antibiotic prophylaxis” in place of “germicide.”
“As we understand it, the bill does not substantively change their mandate but simply updates the language,” Todd said.
References:
For more information:
Valerie M. Kattouf, OD, FAAO, can be reached at vkattouf@ico.edu.
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A, can be reached at dmaino@ico.edu.
Jeff Todd can be reached at jtodd@preventblindness.org.
