FACTBOX-How four US childhood vaccine recommendations have changed

By Puyaan Singh and Sneha S K Jan 22 (Reuters) - The Trump administration has rolled back decades-old guidance recommending routine childhood vaccination against influenza and three other infectious diseases, saying their use should instead be decided between parents and healthcare providers. The changes, part of Health Secretary Robert F. Kennedy Jr.’s push to recast U.S. vaccine policy over objections of major medical groups and despite a lack of scientific evidence for the moves, follow last year’s removal of universal COVID-19 and hepatitis B recommendations for children. Leading medical organizations and more than 20 state health departments have said they will continue to recommend these vaccines for U.S. children, warning that a shift from their widespread use will lead to more infections, hospitalizations and deaths. Here is how the Centers for Disease Control and Prevention vaccine recommendations have changed: ROTAVIRUS Old schedule: Recommended universal vaccination with oral liquid vaccines including Merck’s (MRK.N) RotaTeq at 2, 4 and 6 months, or GSK’s (GSK.L) Rotarix at 2 and 4 months, with the first dose due by 15 weeks. The series was to be completed by 8 months. New schedule: Recommends shared clinical-decision-making in which parents consult healthcare providers on whether the child should be inoculated. When and why adopted: In 1998, the first U.S. rotavirus vaccine called RotaShield from Wyeth, later acquired by Pfizer (PFE.N) , was recommended but soon withdrawn due to a potentially deadly gastrointestinal side effect. The U.S. began recommending RotaTeq in 2006 and Rotarix in 2008 after studies showed strong safety and efficacy at preventing severe gastroenteritis. At the time of the recommendations, there were 55,000 to 70,000 hospitalizations of children annually, making prevention a public-health priority. The U.S. said it was shifting to shared clinical-decision-making to align with other similar wealthy countries. In Europe, 17 countries including France and Germany recommend the shot routinely. INFLUENZA Old schedule: Recommended universal vaccination at ages six months and older, with one or two doses for young children depending on prior vaccination and age-appropriate formulations. New schedule: Recommends shared clinical-decision-making for the general population and strongly recommends for high-risk groups. When and why adopted: CDC adopted universal annual vaccination in 2010 to simplify messaging and expand protection following the 2009 H1N1 flu pandemic, replacing complex risk-based recommendations. Latest disease burden: The CDC estimates at least 15 million flu illnesses, 180,000 hospitalizations and 7,400 deaths through January 3 for the 2025–26 season among adults and children. Low vaccination rates, holiday travel, and misinformation are contributing to the spike, public health experts said. The U.S. said the change was warranted, claiming it needed stronger evidence for its universal use and a lack of broad agreement internationally on the inoculations. In Europe, it is recommended in 16 countries. MENINGOCOCCAL DISEASE Old schedule: Recommended routine MCV4 vaccination - sold under various brand names by GSK (GSK.L) and Sanofi (SASY.PA) among others - to protect against meningococcal disease caused by related bacteria at ages 11 to 12 with a booster at 16. Recommended MenB for meningococcal disease related to serogroup B under shared decision-making to healthy 16- to 23-year-olds and routinely to high-risk groups, such as college students and others living in communal settings. Meningococcal disease is caused by the Neisseria meningitidis bacterium and most often presents as meningitis, an inflammation of the membranes covering the brain and spinal cord, or as a bloodstream infection. It spreads through respiratory secretions during close contact and has a fatality rate of 10% to 15% even with antibiotic treatment. New schedule: Recommends based on shared clinical-decision-making and for those in high-risk groups. When and why adopted: In 1985, the CDC gave its first recommendation for vaccination for high-risk groups and in outbreak control. It recommended routine adolescent MenACWY vaccination in 2005, expanding it in 2007, due to the disease’s rapid progression, outbreak risk in settings such as college dorms, and high fatality rates. Latest disease burden: The CDC estimates 415 U.S. cases in 2025, down from 523 cases in 2024. The incidence of meningococcal disease fell from around 0.92 cases per 100,000 people in 1998 to about 0.33 cases per 100,000 in 2007, according to a study published in an Infectious Diseases Society of America journal. The CDC cited those low rates and lack of consensus internationally as the reason for dropping routine vaccination with MCV4. In Europe, 20 countries recommend either or both shots. HEPATITIS A Old schedule: Recommended two doses for all children aged 12 months to 23 months; and targeted catch-up vaccination for at-risk groups including travelers to regions of endemic disease, people who use drugs and those with chronic liver disease. New schedule: Recommends shared clinical-decision-making except for groups at high-risk. When and why adopted: The CDC began recommending the hep A shot in 2006 after studies showed children often transmit the virus despite mild or no symptoms, and that vaccination reduced community outbreaks. Hepatitis A spreads through contaminated food or water or close contact and can cause weeks to months of fatigue, nausea, jaundice, fever, and abdominal pain. Routine childhood vaccination cut U.S. incidence by around 90% by 2006. Latest disease burden: The CDC said there were 0.5 cases per 100,000 people reported in the U.S. in 2023. Prior to the vaccine’s adoption, hepatitis A cases numbered around 21,000 annually, and infections were common among children, CDC said. The U.S. said the shift reflects very low domestic incidence and limited peer-nation consensus for universal vaccination. Few European countries recommend it universally, while Mexico, where the disease is endemic, does. A retrospective analysis estimated an average 14.7 U.S. cases per 100,000 from 2000–2019.