CDC updates childhood immunization schedule; routine list narrowed to 11 diseases

The Centers for Disease Control and Prevention (CDC) has updated its childhood immunization schedule to recommend routine vaccination against 11 diseases, down from 17 at the end of 2024, after Jim O’Neill, acting director of the CDC, signed a decision memorandum accepting recommendations from a federal scientific assessment ordered by President Donald Trump in December 2025.

The change is effective immediately.

The CDC will continue to universally recommend vaccines for 10 diseases the Department of Health and Human Services (HHS) says have “international consensus,” as well as for varicella (chickenpox).

Immunizations for respiratory syncytial virus (RSV), hepatitis A, hepatitis B, dengue, meningococcal ACWY and meningococcal B are now recommended for high-risk groups or populations.

In addition, immunizations for rotavirus, COVID-19, influenza, meningococcal disease, hepatitis A and hepatitis B are now categorized as requiring clinical decision-making. These vaccinations now require physician-parent consultation rather than standing, universal guidance.

“President Trump directed us to examine how other developed nations protect their children and to take action if they are doing better,” said HHS Secretary Robert F. Kennedy Jr., who has long challenged the size and cadence of the U.S. immunization schedule. He said the changes reflect a push toward international consensus.

“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent. This decision protects children, respects families and rebuilds trust in public health,” Kennedy said.

The scientific assessment compared U.S. childhood immunization recommendations with those of 20 “peer, developed nations," evaluated clinical and epidemiological evidence and documented what the department described as knowledge gaps.

Notably, among those 20 nations was Denmark, which also immunizes children against 10 diseases.

HHS said the review included consultations with health ministries abroad and an internal review by National Institutes of Health (NIH) Director Jay Bhattacharya, M.D., Ph.D.; Food and Drug Administration (FDA) Commissioner Marty Makary, M.D.; and Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, M.D.

HHS noted that some vaccines may fall into more than one nonuniversal category, depending on patient risk and clinician consultation.

What’s changing

Under the updated schedule, the CDC will continue to organize recommendations into three categories, as follows:

1. Vaccines recommended for all children.
2. Vaccines recommended for certain high-risk groups or populations.
3. Vaccines based on shared clinical decision-making.

The “recommended for all children” category will include vaccines for measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B, pneumococcal disease, human papillomavirus and varicella, according to the HHS.

“After reviewing the evidence, I signed a decision memorandum accepting the assessment’s recommendations,” O’Neill said. “The data support a more focused schedule that protects children from the most serious infectious diseases while improving clarity, adherence and public confidence.”

Coverage unchanged, officials say

Oz emphasized that coverage policy will not change.

“All vaccines currently recommended by CDC will remain covered by insurance without cost sharing,” he said. “No family will lose access. This framework empowers parents and physicians to make individualized decisions based on risk, while maintaining strong protection against serious disease.”

That assurance is likely to be central for practices that manage vaccine counseling, stocking and billing, especially those with large Medicaid and Children’s Health Insurance Plan (CHIP) panels.

Reaction from physician groups

The update drew swift, public responses from major physician organizations, underscoring how sharply the revision clashes with longstanding clinical guidance.

The American Medical Association

The American Medical Association (AMA) voiced concern over how the decision was made and the potential consequences of altering routine recommendations without broader expert input.

“Changes of this magnitude require careful review, expert and public input, and clear scientific justification. That level of rigor and transparency was not part of this decision,” said Sandra Adamson Fryhofer, M.D., AMA trustee. “When longstanding recommendations are altered without a robust, evidence-based process, it undermines public trust and puts children at unnecessary risk of preventable disease.”

She added that the AMA “supports continued access to childhood immunizations recommended by national medical specialty societies” and urged federal health leaders to return to “a transparent, evidence-based process that puts children’s health and safety first and reflects the realities of our nation’s disease burden.”

The American Academy of Family Physicians

The American Academy of Family Physicians (AAFP) utilized its social media platform to reaffirm its support for its existing immunization guidance, emphasizing continuity in its own evidence-based review process.

In a LinkedIn post, the organization wrote that it “rigorously reviews the science so we can support family physicians in protecting patients through safe, effective vaccination."

Sharing a link to the organization's own childhood immunization recommendations, they wrote: "Vaccines remain our single best defense against preventable disease. The evidence hasn’t changed, so the AAFP’s recommendations haven’t changed. Vaccines save lives.”

The American Academy of Pediatrics

The American Academy of Pediatrics (AAP) responded in a statement shared to their website, rejecting both the process and the premise of aligning the U.S. schedule to a smaller routine list.

"Today's announcement by federal health officials to arbitrarily stop recommending numerous routine childhood immunizations is dangerous and unnecessary," said AAP President Andrew D. Racine, M.D., Ph.D., FAAP. "The longstanding, evidence-based approach that has guided the U.S. immunization review and recommendation process remains the best way to keep children healthy and protect against health complications and hospitalizations."

Racine continued, criticizing the CDC’s decision to no longer recommend immunization for hepatitis A and B, rotavirus, respiratory syncytial virus, flu, and meningococcal disease, decisions made by the CDC and modeled after the immunization schedules of peer-developed nations, including Denmark.

"The United States is not Denmark, and there is no reason to impose the Danish immunization schedule on America’s families. America is a unique country, and Denmark’s population, public health infrastructure and disease risk differ greatly from our own," Racine said. "At a time when parents, pediatricians and the public are looking for clear guidance and accurate information, this ill-considered decision will sow further chaos and confusion and erode confidence in immunizations. This is no way to make our country healthier."

Like the AAFP, the AAP will continue to publish its own childhood vaccine recommendations, separate from the CDC.

Growing skepticism of vaccines

HHS framed the decision as part of an effort to address a decline in public trust and falling vaccination rates since the COVID-19 pandemic, warning that drops in adherence can increase the risk of outbreaks of vaccine-preventable disease.

“Public health works only when people trust it,” Makary said. “That trust depends on transparency, rigorous science and respect for families. This decision recommits to all three.”

The assessment also calls for “gold standard” research, including placebo-controlled randomized trials and long-term observational studies to better characterize vaccine benefits, risks and outcomes.

“Science demands continuous evaluation,” Bhattacharya said. “This decision commits NIH, CDC and FDA to gold standard science, greater transparency and ongoing reassessment as new data emerge.”

Reporting and measurement changes

Last week, CMS informed states that it will no longer require them to report childhood vaccination levels for Medicaid and CHIP quality measurement, although states may still submit the data voluntarily while the agency explores “alternative immunization measures,” according to a Dec. 30 letter from CMS to state health officials.

Together, the CDC schedule change and the CMS reporting shift are likely to intensify scrutiny from public health leaders, pediatric clinicians and state health officials, particularly because federal recommendations often influence school-entry requirements set by states.

HHS said it will work with state health agencies, physician groups and other partners on implementation and will educate parents and clinicians on the updated schedule.