When the Centers for Disease Control and Prevention overhauled the United States’ childhood vaccine schedule on Monday, it stopped recommending routine vaccination against six diseases that can be serious or even deadly.
The agency no longer recommends vaccination against hepatitis A, hepatitis B, influenza, meningitis, respiratory syncytial virus and rotavirus except for “high risk” children or under a framework called shared clinical decision making, which allows parents to get their child a shot after consulting with a medical provider. The C.D.C. said the decision was intended to align the U.S. schedule with those of other wealthy countries, especially Denmark.
However, outside organizations, including the American Academy of Pediatrics, continue to recommend the shots for all children. Pediatricians, epidemiologists and public health experts have pointed out that Denmark is not an appropriate model for the United States, and said that the changes were likely to reduce vaccine uptake and lead to more cases of preventable diseases.
The previous vaccine schedule was developed over decades, under presidential administrations of both parties, by a panel of experts who examined evidence, determined that the vaccines’ benefits outweighed any risks and recommended the timing of each dose based on when children’s immune systems could best benefit from it.
“This is death by a thousand cuts, and they are cumulative,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. “More and more cuts like this are causing parents — young parents — to question, well, how safe are these vaccines?”
The C.D.C. also changed its guidance for vaccination against human papillomavirus, which causes most cases of cervical cancer; it now recommends that all children receive one dose rather than the two or three previously recommended. Studies have shown comparable protection from a single dose.
Here is a look at the vaccines that the agency has removed from the routine schedule, and the diseases they prevent.
Hepatitis A
Hepatitis A is a highly contagious virus that can in rare cases cause liver failure and death. The virus lives in the stool and blood of infected people and often spreads through contaminated food or close contact.
The vaccine is largely responsible for driving down cases in the United States. Between the vaccine’s introduction in 1996 and 2011, the number of cases decreased by more than 95 percent. Previously, the C.D.C. had recommended the vaccine for all children.
This week, federal officials changed the guidelines to recommend the shot only for “high-risk groups.” Otherwise, they encouraged physicians and parents to decide whether to give the vaccine “based on individual characteristics.”
The vaccine is typically given in two doses, or three if it’s paired with the hepatitis B shot, and is extremely effective at preventing infections. Before the hepatitis A vaccine was routinely given, children played a major role in spreading the virus: Most kids who become infected experience no symptoms and can shed it in their feces for months.
Hepatitis B
Hepatitis B is another extremely contagious virus that can lead to lifelong liver disease or injury. The disease can spread through sex or shared needles — but also through contact with household objects and from mother to child during birth. It can be up to 100 times as infectious as H.I.V.
Rates of the disease have fallen since the C.D.C. began widely recommending the vaccine for all newborns in 1991. Acute infections reported among children and teens dropped by 99 percent between 1990 and 2019. But in December, an influential C.D.C. vaccine panel reversed its recommendation that all newborns receive the shot. The panel now recommends delaying the shot by two months for infants born to mothers who test negative for the virus.
Influenza
Flu is surging in the United States, fueled by a concerning new variant. Early data suggests this year’s shot still offers some protection against getting seriously ill, especially for children, even though it is not an ideal match against the new variant.
The 2024-25 flu season was one of the deadliest on record for children, with the vast majority of deaths occurring among the unvaccinated. The flu can be particularly dangerous for children under 5 because they are susceptible to potentially fatal complications like pneumonia, brain issues and severe dehydration.
While the flu shot may not stop people from contracting the virus, it does help prevent people from getting very ill and dying.
Meningitis
Vaccines are available against five groups of meningococcal bacteria that can cause meningitis, a potentially fatal inflammation of membranes around the brain and spinal cord.
This inflammation creates pressure and causes fever, neck stiffness, headaches, vomiting and cognitive changes. With prompt treatment, many people recover fully, regardless of their vaccination status. But about one in six people who get sick with bacterial meningitis die from it, while one in five survivors have serious complications like long-term hearing loss, muscle weakness, speech difficulties or memory problems, according to the World Health Organization and the National Foundation for Infectious Diseases.
Previously, the C.D.C. recommended that all children receive a combination vaccine against the A, C, W and Y groups of meningococcal bacteria over two doses, the first at 11 or 12 and the second at 16. Now, it recommends these shots only for those it considers at high risk, such as those with H.I.V. and first-year college students living in dormitories, because the infection can spread quickly and easily in communal spaces via coughing and sneezing.
A separate vaccine protects against the B group, but it has long been recommended only for some children — including those who lack a functioning spleen or who live in a place with an outbreak. That recommendation didn’t change.
Respiratory syncytial virus
R.S.V. is the leading cause of infant hospitalization in the United States, sending between 58,000 and 80,000 children younger than 5 to the hospital every year. The virus is more likely to cause serious complications in children with compromised immune systems or chronic lung disease. However, healthy babies may also develop a severe case of R.S.V.
Early infections have also been linked to long-term complications. One study found that infants who avoided contracting R.S.V. before age 1 had a 26 percent lower risk of developing asthma by 5.
Previously, C.D.C. guidance explained that if a mother was vaccinated during pregnancy, her infant may not need a dose at birth. The new recommendations are more prescriptive, recommending the dose only for children whose mother did not receive the vaccine. Experts said this may leave out children born to women whose vaccination status is unknown or who may need additional protection.
Rotavirus
Rotavirus is a diarrheal illness that most commonly affects children under 5, and killed hundreds of thousands per year worldwide before vaccines were available. While deaths are much less common in countries like the United States, which has access to quick treatment for dehydration, the virus used to cause tens of thousands of hospitalizations in American children.
Infection rates began to plummet after a vaccine’s introduction in the late 2000s, and the National Foundation for Infectious Diseases estimates that vaccination prevents 40,000 to 50,000 rotavirus-related hospitalizations in the United States every year. An earlier vaccine was withdrawn from the market in 1999 after it was linked to a serious type of intestinal blockage, but the current versions have not been associated with serious side effects.
Until this week, the C.D.C. advised all children to receive doses at 2 months and 4 months. (Depending on the brand of vaccine administered, some children were advised to get a third dose at 6 months.) The agency has removed the recommendation, though parents can still seek the vaccine for their children from a doctor.
Maggie Astor covers the intersection of health and politics for The Times.
The post What to Know About the Vaccines Cut From C.D.C. Recommendations appeared first on New York Times.
