CDC Changes Childhood Vaccination Schedule: What Parents Need to Know

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More than 2,000 Americans have contracted measles in the largest outbreak in decades, including three children who died—the first measles deaths in more than a decade. Last year’s flu season killed 280 children, the deadliest toll since child flu deaths became nationally tracked in 2004, excluding the 2009 H1N1 pandemic. Eighty-nine percent of those children hadn’t been fully vaccinated.

The Centers for Disease Control and Prevention announced on January 5, 2026, that it was cutting the number of vaccines all children should get from 17 to 11. Six vaccines that pediatricians have routinely administered for years—against rotavirus, influenza, respiratory syncytial virus, hepatitis A, hepatitis B, and meningococcal disease—were either moved to categories for only children with certain health conditions or moved to a category called “shared clinical decision-making.”

In practice, these shots will no longer be standard preventive care. Instead, they require decisions made together by parents and doctors.

More than 2,000 Americans have contracted the illness in the largest outbreak in decades, including three children who died—the first deaths in more than a decade. Last year’s flu season killed 280 children, the deadliest toll since child flu deaths became nationally tracked in 2004, excluding the 2009 H1N1 pandemic. Eighty-nine percent of those children hadn’t been fully vaccinated.

On the same day federal health officials said they would no longer recommend flu shots for all kids, they also reported that nine more had already died from influenza this season.

Changes to Universal Recommendations

The new schedule divides childhood vaccines into three tiers. The first tier—vaccines recommended for all children—now includes only measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B, pneumococcal disease, human papillomavirus, and varicella (chickenpox). That’s 11 diseases.

The second tier covers vaccines recommended only for children at higher risk: respiratory syncytial virus, hepatitis A, hepatitis B, dengue, and meningococcal disease. Federal officials didn’t clearly define what “higher risk” means in the guidance, and that ambiguity will create confusion in pediatricians’ offices across the country.

The third category—”shared clinical decision-making”—includes rotavirus, COVID-19, influenza, and overlaps with hepatitis A, hepatitis B, and meningococcal disease depending on the child’s circumstances. In this category, parents and doctors discuss whether vaccination makes sense, rather than simply administering the shots as routine preventive care.

The CDC now recommends only a single dose of the HPV vaccine instead of the previous two or three doses, depending on when vaccination started. Officials haven’t publicly explained why they made this change.

How This Decision Was Made

President Trump issued a memorandum on December 5, 2025, directing federal health officials to examine how other developed nations structure their childhood vaccination schedules. The memo noted that the U.S. recommended vaccines for 17 diseases, compared to Denmark’s 10, Japan’s 14, and Germany’s 15, saying the U.S. recommends more vaccines than other countries.

What followed was a one-month assessment authored by Tracy Beth Høeg, Acting Director of the FDA’s Center for Drug Evaluation and Research, and Martin Kulldorff, a researcher now serving as chief science and data officer for HHS’s Assistant Secretary for Planning and Evaluation. Both have publicly opposed vaccine mandates and advocated for reducing childhood vaccination schedules before assuming their government positions.

The group that normally reviews vaccine science—called ACIP—wasn’t consulted for this overhaul. ACIP met once in December 2025 to discuss childhood vaccines, and its only formal action was voting to remove the universal recommendation for hepatitis B vaccination at birth for infants born to mothers who test negative for the virus. That limited action doesn’t explain or justify the sweeping changes made on January 5.

Dr. Demetre Daskalakis, former director of the CDC’s National Center for Immunization and Respiratory Diseases, said that altering the schedule without consulting U.S. experts in pediatrics, infectious diseases, and public health “skips the scientific process and keeps decisions hidden.” Kate O’Brien, the World Health Organization’s director of immunization, vaccination, and biologics, said she had never encountered another country that dramatically changed its immunization program without serious safety concerns and transparent public process.

The assessment document itself acknowledged that vaccines on the previous schedule have well-established safety profiles and that no new safety signals or adverse events data had emerged that would warrant removing universal recommendations. The argument for change rested instead on the premise that some vaccines could be selectively recommended based on individual risk factors and that the sheer number of recommended vaccines had become a barrier to public trust.

Shared Clinical Decision-Making and Vaccine Acceptance

The term “shared clinical decision-making” emerged in vaccine policy around 2015 to address situations where the medical evidence doesn’t clearly point one way or the other—situations where a person’s specific health needs change whether a vaccine makes sense. It was designed for vaccines like meningococcal B in adolescents, where individual risk factors could legitimately influence vaccination decisions.

Using this approach for vaccines against highly contagious diseases with significant serious illness and death in children represents something different. Research demonstrates that when doctors routinely recommend vaccines without asking—this is the single strongest driver of vaccine acceptance among parents.

Shared decision-making requires providers to present information about vaccine risks and benefits and engage in open-ended negotiation with parents about whether vaccination is appropriate. In busy clinical practices with limited appointment time, this slows things down. Providers may be less likely to promote vaccines in shared decision-making categories. Parents may not think to ask about them if they’re not actively recommended.

The effect is predictable: fewer kids will get vaccines that are no longer routinely recommended, even though insurance coverage technically remains available. Moving a vaccine from routine recommendation to shared decision-making signals uncertainty to parents, undermining confidence in a way that “you can still get it if you want” doesn’t fix.

What Parents Need to Do Now

If your child hasn’t started vaccinations yet, the new recommendations will form the template for their immunization plan. They’ll be offered the 11 vaccines in the universal recommendation category as standard preventive care. For rotavirus, influenza, RSV, hepatitis A, or hepatitis B, you’ll need to have explicit conversations with your pediatrician.

For infants in particular, the change to hepatitis B vaccination represents a significant shift. Doctors used to give the vaccine within 24 hours of birth as standard preventive care for all newborns. The new guidance allows parents and providers to discuss timing for infants born to hepatitis B-negative mothers, with the suggestion that vaccination could be deferred until age 2 months.

The U.S. attempted targeted hepatitis B screening in the 1980s, and it failed because 35 to 65 percent of infected mothers had no identifiable risk factors and therefore weren’t identified through screening. Universal newborn hepatitis B vaccination was adopted in 1991 precisely because selective screening was unreliable and couldn’t protect all infants at risk. Going back to vaccinating only some babies based on mother’s test results brings back the same problems that happened before.

If your child has already started vaccinations under the previous schedule, you’ll need to consult with your pediatrician to determine whether they should continue on the original vaccination schedule to complete series initiated under prior guidance or transition to the new system. Federal officials haven’t published clear guidance on how kids with partially completed vaccine series should be managed during this transition.

Schedule an appointment with your pediatrician specifically to discuss your child’s vaccination plan. Ask which guidelines they’re following—the new recommendations or the American Academy of Pediatrics recommendations, which continue to recommend the previous schedule covering 17 diseases. Many pediatricians plan to follow AAP recommendations rather than the new guidance, meaning different doctors might recommend different vaccines to families.

Ask specific questions about rotavirus, influenza, RSV, hepatitis A, and hepatitis B vaccination. Don’t assume these shots will be offered because they’re technically still available and covered by insurance. In the new system, you may need to request them explicitly.

Disease Outbreaks and Current Risks

Rotavirus caused between 55,000 and 70,000 hospitalizations annually before the vaccine’s introduction and still kills kids in developing nations where vaccination rates remain low. The vaccine works. Moving it to “shared decision-making” status will reduce how many children actually get vaccinated, and that will mean more hospitalizations of infants with severe dehydration from rotavirus gastroenteritis.

Respiratory syncytial virus remains the leading cause of hospitalization among infants in the United States. The RSV vaccine for infants was only recently introduced, and early data showed measurable impact across the whole population in reducing hospitalizations. Moving RSV vaccination to recommendation-only-for-high-risk status came amid RSV spreading during fall and winter, precisely when infants are most vulnerable.

Last year’s flu season killed 280 kids—the highest toll for any non-pandemic flu season since child deaths became nationally notifiable in 2004. Among those with available vaccine information, 89 percent of those who died from influenza had not been fully vaccinated. As of January 5, 2026, when the vaccination schedule changes were made, nine had already died from influenza in the current season.

Federal officials chose that moment to move influenza vaccination to “shared decision-making” status.

The outbreak shows the same virus strain spreading from person to person, meaning cases aren’t isolated incidents but rather show the virus is still spreading because not enough kids are vaccinated. A six-year-old girl in Lubbock, Texas, died in late February 2025 after three weeks of illness, becoming the first American child to die of the illness since 2015.

Pertussis infected nearly 28,000 Americans last year, with 13 deaths reported. Infants too young for full vaccination are at highest risk.

Healthcare Provider Challenges

Pediatricians, family medicine doctors, nurses, and pharmacists now face the challenge of putting a completely new vaccination system into practice with minimal guidance and in the midst of multiple ongoing outbreaks affecting kids. They must update how they treat patients, their computer systems, and their vaccine inventory, as well as parent communication materials to reflect the new three-tiered category system.

For providers who serve diverse patient populations with varying risk profiles, implementing “shared decision-making” recommendations requires additional clinical time per patient, potentially creating bottlenecks in busy practices. Some healthcare providers have indicated they will continue following AAP recommendations rather than the new guidance, effectively operating under two different vaccination schedules and forcing doctors to keep track of which rules apply to each patient.

The concern among pediatricians is that in busy clinical practices, vaccines in the “shared decision-making” category will simply fall off the radar. When a provider has 15 minutes for a routine checkup for a healthy child and needs to address growth, development, nutrition, safety, and multiple other preventive care topics, adding extended discussions about whether to vaccinate against rotavirus or influenza becomes logistically challenging. Busy doctors will simply skip those conversations, which means fewer kids get vaccinated.

Political Context and Leadership

Health and Human Services Secretary Robert F. Kennedy Jr. co-founded an organization that spreads vaccine misinformation before resigning to run for president and subsequently endorsing Donald Trump. His appointment as HHS Secretary provided him with the authority to fundamentally reshape federal vaccine policy.

Throughout 2025, Kennedy overhauled federal vaccine policy by firing all ACIP members and replacing them with new individuals, some with ties to groups that oppose vaccines or groups that oppose vaccine mandates. In May 2025, federal officials revised COVID-19 vaccination guidance, removing recommendations for routine immunization for healthy children and pregnant women.

Kennedy framed the January 5 statement as a positive step toward restoring public trust in health institutions and letting families make choices with full information about vaccines. “President Trump directed us to examine how other developed nations protect their children and to take action if they are doing better,” Kennedy stated. “After reviewing the evidence, we are matching the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent.”

The assessment document itself acknowledged that no new safety signals or adverse events data had emerged that would warrant removing universal recommendations. The argument for change wasn’t based on new scientific evidence about vaccine safety or efficacy. It was based on the premise that other countries recommend fewer vaccines and that aligning with them would restore public trust.

Medical Organization Responses

The American Academy of Pediatrics called the changes “dangerous and unnecessary” and stated that the new recommendations are not supported by scientific evidence. AAP President Andrew Racine emphasized that the changes represent ignoring decades of careful, transparent safety testing.

The American College of Physicians stated that “abandoning the U.S. evidence-based process is a dangerous and potentially deadly decision for Americans.” The Infectious Diseases Society of America called the changes a “reckless step” and warned that “overturning old vaccine recommendations without public input and engagement with external experts will undermine confidence in vaccines with the likely outcome of decreasing vaccination rates and increasing disease.”

Jesse Goodman, a professor of medicine and infectious diseases at Georgetown University and former FDA chief scientist, said the statement would destroy vaccination policy, warning that “there will be more diseases, more infection, more hospitalization.”

Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases, stated: “This is a dark day for children and for their parents and for our country generally.” He questioned why the administration wanted to “bring the diseases back,” asking: “With RSV we’ve already seen measurable impact across the whole population. Why do they want more hospitalizations?”

U.S. Senator Bill Cassidy of Louisiana, a physician and chair of the Senate Health Committee, stated that “changing the pediatric vaccine schedule based on no scientific input on safety risks and little transparency will cause fear for patients and doctors, and will make America sicker.”

State-Level Implementation

Although the federal government doesn’t mandate childhood vaccinations, CDC recommendations shape what vaccines states require for school. All 50 states currently require that kids entering schools be immunized against certain diseases, with requirements varying by state.

Following the January 5 statement, state health departments and schools must decide whether to change their vaccination requirements to align with the new guidance or to maintain existing requirements. Several states have already indicated they will maintain stricter vaccination requirements than the new guidance.

The Maryland Department of Health said that Maryland’s vaccine schedule will continue to follow American Academy of Pediatrics recommendations, which maintain universal recommendations for 17 diseases. Los Angeles County stated that it would continue to follow existing California Department of Public Health vaccination guidelines.

The potential for state variation in vaccination requirements raises concerns about leaving some kids less protected depending on where they live, with some states potentially adopting the new guidance while others maintain stricter requirements. This could create disparities in vaccination coverage and more diseases will spread in areas with fewer kids who are vaccinated.

Florida has said it plans to eliminate all school vaccination requirements entirely, making it the first state without any vaccination mandates for school entry. Idaho, already the state with the lowest vaccination rates and highest exemption rates during the 2024-2025 school year, let lawmakers decide which vaccines to require instead of doctors, likely weakening enforcement of school vaccination requirements.

Legal Challenges

The American Academy of Pediatrics and other medical organizations are already suing to block the vaccine policy changes. In January 2026, the U.S. District Court for the District of Massachusetts affirmed that medical professional societies, led by the American Academy of Pediatrics, have the right to bring this lawsuit to court concerning recent vaccine policy changes.

Plaintiffs are trying to stop the Secretary from canceling vaccine recommendations and seeking a court ruling that says the changes are illegal, as well as asking the court to force the Secretary to rebuild ACIP properly. The court’s decision to deny the government’s motion to dismiss represents a significant step forward for litigation challenging vaccine policy changes.

Legal experts have suggested that lawsuits might fail because federal law requires officials to make decisions carefully and publicly, not randomly. However, courts might give the HHS Secretary broad power to make recommendations about vaccine schedules, and it’s unclear how courts will handle these challenges.

Insurance Coverage and Access

The government says all vaccines will stay free, but fewer kids will get vaccines if they are no longer routinely recommended. Research is clear on this point: when vaccines move from routine recommendations to shared decision-making categories, how many children actually get vaccinated drops dramatically.

The 2026 deadline for keeping measles elimination—something the U.S. achieved after decades of vaccination—is now at risk because fewer kids are vaccinated and the illness continues to circulate. The U.S. could lose its status, which it achieved in 2000 after years of sustained high vaccination coverage.

For parents, the new situation means parents need to talk to doctors to make sure kids get vaccinated against all vaccine-preventable diseases, not those remaining in the universal recommendation category. For healthcare providers, doctors need to completely change how they handle vaccines and parent communication strategies. For state health departments and school systems, schools may change their vaccine requirements.

The changes made on January 5, 2026, are the biggest change to childhood vaccine policy in modern U.S. history. The process by which these changes were made—without public input, expert review, or consulting the normal vaccine committee—raises serious questions about whether the government followed good science.

The timing, amid record-breaking outbreaks, the deadliest influenza season for kids in more than a decade, ongoing pertussis transmission, and continued RSV-related hospitalizations of infants, has prompted urgent warnings from medical and public health organizations that these policy changes will result in preventable illness, hospitalization, and death among American kids.

The diseases discussed—rotavirus, influenza, RSV, hepatitis—are circulating now. They’re hospitalizing kids now. They’re killing kids now, in numbers not seen in years or decades.

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