The federal government has drastically reduced the number of recommended childhood immunizations, excluding six routine vaccines that have protected millions of people from serious illness, long-term disability and death.
The U.S. Centers for Disease Control and Prevention (CDC) found that of the six vaccinations no longer routinely recommended, only three (vaccinations against hepatitis A, hepatitis B, and rotavirus) prevented nearly 2 million hospitalizations and more than 90,000 deaths over the past 30 years. CDC’s own publications.
Vaccines for the three diseases, as well as respiratory syncytial virus, meningococcal disease, influenza and COVID-19, are now only recommended for children at high risk for serious illness or after “shared clinical decision-making” or consultation between doctors and parents.
CDC maintained recommendations for 11 childhood vaccines, including measles, mumps, and rubella. whooping cough, tetanus, diphtheria; A bacterial disease known as Hib; pneumonia; polio; varicella; 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. fact sheet; Parents who want their children vaccinated against these diseases do not have to pay out-of-pocket.
Pediatric disease experts were perplexed by the change in guidelines. HHS said the changes followed a “scientific review of the basic science” and are consistent with immunization programs in other developed countries.
Secretary of Health and Human Services Robert F. Kennedy Jr., an anti-vaccination activist, cited Denmark as a model. However, most European countries’ schedules are closer to the U.S. standard, which has changed due to the new guidelines.
For example, in Denmark, where rotavirus vaccination is not available, approximately 1,200 infant rotavirus hospitalizations are registered annually. This rate in a country of 6 million people is roughly the same as the rate in the U.S. before vaccination.
“It’s OK to have 1,200 to 1,300 children admitted to the hospital. That’s the tip of the iceberg in terms of childhood suffering,” said Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and co-inventor of the licensed rotavirus vaccine. “We didn’t. They should try to imitate us, not the other way around.”
Public health officials said the new guidelines place the onus on parents to research and understand each childhood vaccine and why it is important.
Below is a summary of the diseases that sideline vaccines prevent.
RSV. Respiratory syncytial virus is the most common cause of hospitalization in infants and young children in the United States.
The respiratory virus usually spreads in the fall and winter and causes cold-like symptoms, but can be fatal in young children, causing tens of thousands of hospitalizations and hundreds of deaths each year. According to the National Foundation for Infectious Diseases, about 80% of children under 2 years of age hospitalized with RSV have no identifiable risk factors. A long-awaited vaccine against this disease will be released in 2023.
Hepatitis A. Hepatitis A vaccination, which was phased in starting in the late 1990s and recommended for all infants since 2006, has reduced the disease by more than 90% since 1996. Foodborne viruses that cause devastating illnesses continue to plague adults, especially those who are homeless or who abuse drugs or alcohol. total In 2023, 1,648 cases and 85 deaths were reported.
Hepatitis B The disease causes liver cancer, cirrhosis, and other serious illnesses, and is especially dangerous for infants and young children. Hepatitis B virus is transmitted in minute amounts through blood and other body fluids and can survive on surfaces for up to a week. From 1990 to 2019, vaccination reduced reported cases of acute hepatitis B among children and adolescents by 99%. Liver cancer among American children has also plummeted as a result of universal childhood vaccinations. However, hepatitis B virus still exists, with 2,000 to 3,000 acute cases reported each year among unvaccinated adults. More than 17,000 chronic hepatitis B diagnoses were reported in 2023. The CDC estimates that about half of infected people do not know they have hepatitis B.
rotavirus. Before routine administration of the current rotavirus vaccine began in 2006, approximately 70,000 children were hospitalized and 50 died from the virus each year. It’s known as “winter vomiting syndrome,” said Sean O’Leary, a pediatrician at the University of Colorado. “It was a miserable disease that is no longer seen.”
But the virus is still common on surfaces babies touch, Offit said, and “lowering immunity will put children back in the hospital.”
Meningococcal vaccine. This was primarily needed for adolescents and college students, who are particularly vulnerable to serious illness caused by bacteria. Approximately 600 to 1,000 cases of meningococcal disease are reported each year in the United States, but more than 10% of those affected die and one in five survivors suffers permanent disability.
Flu and Corona. Two respiratory viruses have each killed hundreds of children in recent years. But both tend to be much more serious in older people. Flu is currently on the rise in the United States, and last flu season the virus killed 289 children.
What is shared clinical decision making?
Under the changes, decisions about vaccinating children against influenza, COVID-19, rotavirus, meningococcal disease and hepatitis A and B will now depend on what officials call “shared clinical decision-making.” That means families should talk to their health care provider to determine whether a vaccine is appropriate for them.
“This means that health care providers must have conversations with patients to explain the risks and benefits and make decisions for the individual,” he said. Lori HandyHe is a pediatric infectious disease specialist at the Children’s Hospital of Philadelphia.
In the past, the CDC used the term only in relation to narrow situations, such as whether people in monogamous relationships needed the HPV vaccine, which prevents sexually transmitted diseases and certain cancers.
The CDC’s new approach is inconsistent with the science because of the proven protective benefits vaccines have for the majority of the population, Handy said.
In a report justifying the changes, HHS officials Tracy Beth Høeg and Martin Kulldorff said the U.S. vaccination system needs more safety studies and more parental choice. They said overcrowded vaccine schedules have eroded trust in public health, causing more parents to avoid vaccinations against major threats such as measles.
The vaccines on the CDC’s revised schedule were supported by extensive safety studies when they were evaluated and approved by the FDA.
“They are held to a higher safety standard than any other medical intervention we perform,” Handy said. “The value of routine recommendations is that it really helps the public understand that this has been looked at backwards in every way.”
Eric BallA pediatrician in Orange County, California, said the guideline change will cause more confusion among parents who believe there are issues with the safety of the vaccine.
“It is very important for public health that recommendations on vaccines are very clear and concise,” Ball said. “If we muddy the waters, more children could get sick.”
Ball said limited clinic time is often spent trying to convince parents that vaccines are safe, rather than focusing on the individual health needs of children. “Shared clinical decision-making” status for vaccines is not related to safety concerns, but parents may think it is.
HHS’s changes do not affect state vaccination laws, he said, so prudent health care workers should be able to continue to proceed as before. Richard Hughes IVHe is a lawyer and lecturer at George Washington University who is leading the lawsuit against Kennedy over the vaccine changes.
“You can expect every pediatrician to follow solid evidence and recommend that their patients get vaccinated,” he said. He said the law protects health care providers who follow professional practice guidelines and that “RSV, meningococcus and hepatitis remain serious health threats to children in this country.”
