Analyzing the Impact of Removing Long-Standing Childhood Recommendations for 6 Vaccine-Preventable Diseases

On Jan. 5, Health and Human Services Secretary Robert F. Kennedy Jr. and the CDC announced the largest rollback of the U.S. childhood immunization recommendations in decades, cutting the number of vaccines routinely recommended for all children from 17 to 11. The new policy moves several longstanding shots into a category where use is left to “shared clinical decision-making” or reserved for children judged to be at high risk.

In practice, that means these vaccines are no longer treated as standard preventive care, making them easier for insurers not to cover, harder for pediatricians to offer routinely, and more likely to be missed by families navigating busy, fragmented health care systems

The dramatic change came without any evidence of children facing less risk of illness, without any issues with vaccine safety, and without opportunity for public comment or engagement with independent experts. The childhood vaccines affected protect against rotavirus, hepatitis A and B, meningococcal ACWY and B, RSV, Covid-19, and influenza.

More than 230 clinical, pediatric, and public health organizations and medical societies criticized the overhaul as an unprecedented experiment that doesn’t meet U.S.-specific health care needs. In a letter to Congress, they warned that this shift will sow confusion, make access more difficult for parents who want to vaccinate their children, weaken population level protection, reverse hard-won gains against once common childhood infections, and widen health inequities for children whose families face the greatest barriers to care.

Here's a deeper dive into the successes and safety of each vaccine affected and the toll of illnesses they help prevent.

Rotavirus

Before rotavirus vaccines were introduced in 2006, about 95% of U.S. children had at least one rotavirus infection by age 5, causing hundreds of thousands of clinic visits and tens of thousands of hospitalizations each year. Rotavirus diarrhea often struck suddenly and could lead to severe dehydration, requiring IV fluids and hospital care, especially for infants and toddlers.

CDC analyses estimate that between 2007-11, the routine infant rotavirus vaccination program prevented roughly 280,000 clinic visits, 62,000 emergency department visits, and 45,000 hospitalizations for rotavirus disease every year among U.S. children under 5. As vaccination rates climbed, winter “rotavirus seasons” nearly disappeared in many pediatric wards.

Infectious disease experts warn the removal of a universal recommendation for rotavirus vaccination will allow the virus to regain a foothold, particularly in communities with limited access to clean water, rehydration therapy, or consistent pediatric follow up.​

Hepatitis A and B

Before widespread hepatitis B vaccination (HBV), an estimated 18,000 U.S. children a year developed chronic HBV infection before age 10, often from mothers or other family members who did not know they were infected. Since the universal birth dose recommendation in 1991, infections in children and teens declined 99%. Chronic hepatitis B can silently damage the liver for decades, leading to cirrhosis and liver cancer in adulthood.

The hepatitis A vaccine, introduced in the late 1990s, helped turn a disease that regularly caused foodborne and communitywide outbreaks into a largely preventable infection, with steep declines in symptomatic cases among vaccinated children and surrounding communities. Together, universal childhood vaccination against hepatitis A and B pushed U.S. rates of these infections to historic lows and became part of broader efforts to eliminate viral hepatitis as a public health threat.​

In late 2025, federal advisers dropped the recommendation for all newborns to receive a hepatitis B vaccine at birth, and the January 2026 overhaul moved both hepatitis A and B into shared clinical decision-making or high-risk categories rather than routine use. Clinicians caution that shifting responsibility to individual families will almost certainly create gaps in coverage, missed birth dose opportunities, and new clusters of hepatitis infections and preventable liver disease and cancer in the decades ahead.

Meningitis

Meningococcal vaccines protect against a fast-moving bacterial infection that can cause life threatening swelling around the brain and spinal cord or severe blood infection in otherwise healthy kids and teens. Bacterial meningitis is rare, but when it strikes it is extremely serious: About 1 in 10 people with this infection die, often within a day of getting very sick, and many survivors live with amputations, hearing loss, or permanent brain damage.

Since experts began recommending a routine meningococcal ACWY shot for all 11-12 year olds, with a booster at 16, meningitis caused by those strains has dropped sharply in teens, and researchers estimate the vaccine program has already prevented hundreds of cases. On college campuses, strong uptake of this vaccine helped push most outbreaks toward a different strain (group B), which later led to a separate meningococcal B vaccine for older teens, especially those moving into dorms. If these shots are given only to kids labeled “high risk,” more teens and young adults will go without protection in places like schools, dorms, and military barracks, where close contact makes it easier for meningitis to spread.

Covid-19

Covid-19 has caused waves of serious illness in kids, especially during big surges, leading to thousands of hospitalizations and deaths among children, particularly those with chronic health conditions or disabilities. Even in otherwise healthy kids, Covid-19 can trigger complications such as pneumonia, multisystem inflammatory syndrome (MIS-C), and lingering symptoms that interfere with school and daily life.

Age-appropriate Covid-19 vaccination for everyone 6 months and older became a standard pediatric recommendation after large studies showed strong protection against severe disease, hospitalization, and death in children and teens. Pediatric data also show that vaccinated kids are less likely to miss school or need emergency or inpatient care for Covid-19 than their unvaccinated peers.

Influenza

Seasonal influenza has long been a leading cause of serious viral respiratory illness in children, sending tens of thousands to U.S. hospitals in a typical year and contributing to hundreds of pediatric deaths in severe flu seasons. CDC surveillance reports track pediatric flu hospitalizations and deaths every winter and consistently find that flu strikes the hardest among young children and those with underlying medical problems.

Because of this risk, annual flu vaccination for everyone 6 months and older has been recommended for years, with multiple studies showing that flu shots reduce children’s chances of hospitalization and death from flu related complications. High vaccination coverage in schools helps slow the spread of flu, which in turn protects infants too young to be fully vaccinated, as well as immunocompromised people.

RSV

Respiratory syncytial virus (RSV) is a common winter virus that usually causes cold-like symptoms but can lead to dangerous breathing problems, pneumonia, and hospital stays in infants and young children. In recent years, new tools to prevent RSV have become available: vaccines for pregnant people and older adults and long acting antibody shots, such as nirsevimab, that act like a “temporary shield” for babies during RSV season. These products have been shown to significantly cut the risk of severe RSV disease and hospitalization in the first months of life.​

The updated federal schedule moves routine RSV prevention out of the default column and toward use mainly in infants and toddlers judged at higher risk or whose families can navigate shared decision-making visits. Pediatric and public health organizations warn that this shift could leave more babies, particularly those in lower income or medically underserved communities, without timely protection, even as RSV remains one of the leading causes of infant hospitalizations each winter.