The federal government has sharply reduced the number of recommended childhood vaccinations, eliminating six routine vaccines that have protected millions of people from serious illness, long-term disability and death.
Just three of the six vaccines the CDC says it will no longer routinely recommend—hepatitis A, hepatitis B and rotavirus—have prevented nearly 2 million hospitalizations and more than 90,000 deaths over the past 30 years, according to the Centers for Disease Control and Prevention. CDC's own publications.
Vaccines against these three diseases, as well as respiratory syncytial virus, meningococcal disease, influenza and Covid, are now only recommended for children at high risk of serious illness or after “shared clinical decision-making” or consultation between doctors and parents.
The Centers for Disease Control and Prevention (CDC) maintained its recommendations for 11 childhood vaccines: measles, mumps, and rubella; whooping cough, tetanus and diphtheria; a bacterial disease known as Hib; pneumonia; polio; chicken pox; and human papillomavirus, or HPV.
Federal and private insurance will continue to cover vaccines for diseases that the CDC no longer universally recommends, according to the Department of Health and Human Services. newsletter; Parents who want to vaccinate their children against these diseases will not have to pay out of pocket.
Pediatric disease experts were puzzled by the change in recommendations. HHS said the changes followed a “scientific review of the underlying scientific evidence” and are consistent with vaccination programs in other developed countries.
HHS Secretary Robert F. Kennedy Jr., an anti-vaccination activist, pointed to Denmark as a model. But most European countries' schedules are closer to the US standard, as modified by the new recommendations.
For example, in Denmark, which does not vaccinate against rotavirus, there are approximately 1,200 hospitalizations in infants and young children each year. The rate in the country of 6 million people is about the same as the United States before vaccinations.
“They're fine with 1,200 or 1,300 children hospitalized, which is the tip of the iceberg in terms of childhood suffering,” said Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia and co-inventor of the licensed rotavirus vaccine. “We weren't. They should be trying to imitate us, not the other way around.”
Public health officials say the new guidance puts the onus on parents to research and understand each childhood vaccine and why it's important.
Here is a summary of the diseases that delayed vaccines prevent:
RSV. Respiratory syncytial virus is the most common cause of hospitalization in infants in the United States.
The respiratory virus usually spreads in the fall and winter and causes cold-like symptoms, although it can be deadly in young children, causing tens of thousands of hospitalizations and hundreds of deaths a year. According to the National Foundation for Infectious Diseases, approximately 80% of children under 2 years of age hospitalized with RSV have no identifiable risk factors. The long-awaited vaccines against the disease were introduced in 2023.
Hepatitis A. Hepatitis A vaccination, which was phased in in the late 1990s and recommended for all babies since 2006, has led to a more than 90% reduction in incidence since 1996. total In 2023, there were 1,648 cases and 85 deaths.
Hepatitis B. The disease causes liver cancer, cirrhosis and other serious diseases. especially dangerous when infecting infants and young children. The hepatitis B virus is transmitted through blood and other body fluids, even in microscopic quantities, and can survive on surfaces for up to a week. From 1990 to 2019, vaccination led to a 99% reduction in reported cases of acute hepatitis B among children and adolescents. Liver cancer among American children has also dropped sharply as a result of universal childhood vaccinations. But the hepatitis B virus still exists, with 2,000 to 3,000 acute cases of the disease reported annually among unvaccinated adults. There were more than 17,000 diagnoses of chronic hepatitis B in 2023. The CDC estimates that about half of infected people do not know they have it.
Rotavirus. Before routine administration of current rotavirus vaccines began in 2006, about 70,000 young children were hospitalized and 50 died each year from the virus. This phenomenon was known as “winter vomiting syndrome,” said Sean O'Leary, a pediatrician at the University of Colorado. “It was a terrible disease that we hardly see anymore.”
However, the virus is still prevalent on surfaces touched by infants, and “if you lower immunization rates, children will be hospitalized again,” Offit said.
Meningococcal vaccines. They were needed mainly by teenagers and college students, who are especially vulnerable to critical illnesses caused by bacteria. Every year in the United States, from 600 to 1000 cases of meningococcal infection are registered, but more than 10% of those affected die from it, and every fifth survivor becomes disabled.
Flu and Covid. Each of the two respiratory viruses has killed hundreds of children in recent years, although both tend to be much more severe in older people. Flu is currently on the rise in the United States, and the virus killed 289 children last flu season.
What is shared clinical decision making?
Under the changes, decisions about vaccinating children against influenza, Covid, rotavirus, meningococcal disease and hepatitis A and B will now be based on what officials call “shared clinical decision making,” meaning families will have to consult with a health care provider to determine whether the vaccine is appropriate.
“That means the provider has to talk to the patient to lay out the risks and benefits and make the decision for that particular person,” he said. Laurie Handypediatric infectious disease specialist at Children's Hospital of Philadelphia.
In the past, the CDC used the term only to refer to narrow circumstances, such as whether a person in a monogamous relationship needed the HPV vaccine, which prevents sexually transmitted infections and some types of cancer.
Handy said the CDC's new approach falls short of the science because of the proven protective benefits that vaccines have for the vast majority of the population.
In their report justifying the changes, HHS officials Tracy Beth Hoeg and Martin Kulldorff said the U.S. vaccination system requires more safety research and more parental choice. They say eroding trust in public health, caused in part by an overscheduled vaccination schedule, has led more parents to avoid vaccinations against serious threats such as measles.
The vaccines on the schedule that the CDC changed were supported by extensive safety studies when they were evaluated and approved by the FDA.
“They are held to a higher standard of safety than any other medical intervention we have,” Handy said. “The value of routine guidelines is that they really help the public understand that everything has been checked topsy-turvy and vice versa.”
Eric Balla pediatrician in Orange County, California, said the change in recommendations will cause more confusion among parents who believe it means the vaccine's safety is in question.
“It is critical for public health that vaccine recommendations be very clear and concise,” Ball said. “Anything that can muddy the waters will lead to more children getting sick.”
Ball said that instead of focusing on a child's individual health needs, he often has to spend limited time in the clinic reassuring parents that vaccines are safe. The vaccine's “shared clinical decision making” status has nothing to do with safety concerns, but parents may think it does.
The HHS changes do not affect state vaccination laws and therefore should allow reasonable practitioners to continue operating as usual, he said. Richard Hughes IVlawyer and George Washington University professor who is suing Kennedy over vaccine changes.
“You would expect any pediatrician to follow the compelling evidence and recommend that their patients get vaccinated,” he said. The law protects health care providers who follow professional care guidelines, he said, and “RSV, meningococcus and hepatitis remain serious threats to the health of children in this country.”
