The American Academy of Pediatrics on Monday released updated recommendations for which vaccines children should receive. It’s a routine review, little different from last year’s recommendations, but it has more meaning this year: More states and doctors are relying on it instead of a controversial new program from the US Centers for Disease Control and Prevention.
The AAP’s newest recommendations include a new respiratory syncytial virus (RSV) immunization and several other minor tweaks — a sharp departure from the sweeping changes to the CDC’s vaccine schedule this month.
Although the CDC schedule has long been the default guideline for vaccination across the country, many doctors say they now choose the AAP’s guidelines instead.
“The science hasn’t changed,” said Dr. Claudia Hoyen, a pediatric infectious disease specialist and director of pediatric innovation at UH Rainbow Babies and Children’s Hospital in Cleveland. “We will continue to follow the science.”
The AAP continues to widely recommend routine immunization against RSV, hepatitis A, hepatitis B, rotavirus, influenza, and meningococcal disease. Twelve major medical and health care organizations have formally endorsed its recommendations, including the American Medical Association, the National Medical Association, and the American Academy of Family Physicians.
Instead, the CDC’s updated program narrowed the recommendations for protection against meningococcal disease, hepatitis B, and hepatitis A for children who are at higher risk of infection. It also recommends that choices about flu, Covid-19 and rotavirus vaccinations be based on “shared clinical decision making”, meaning that people who want to consult with a healthcare provider.
“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccination schedule with international consensus while strengthening transparency and informed consent,” said U.S. Health and Human Services Secretary Robert F. Kennedy Jr. after the vaccination schedule update. “This decision protects children, respects families, and rebuilds trust in public health.”
There were no safety concerns or new research to suggest that the vaccines in the previous CDC program were unnecessary.
“For now, unfortunately, we have to ignore everything about vaccines that comes from our federal government,” said Dr. Sean O’Leary, chairman of the AAP Committee on Infectious Diseases. “Parents should trust their pediatrician, professional societies like the American Academy of Pediatrics.”
The half-dozen pediatricians who spoke to CNN said they would follow the AAP’s guidelines.
Dr. Sarah Elizabeth DeRoo, a pediatrician at Children’s National in Washington, DC, says she will continue to be “very honest” with families about vaccines and that “we know they are safe and effective.”
When the CDC’s vaccination schedule changed this month, she said, it undermined some parents’ confidence.
“We have families come into our clinic who have traditionally been very accepting of vaccines and they want to know, ‘is this recommendation new, is it evidence-based, or do I need to think differently about these vaccines’ that they previously accepted?” DeRoo said. “We have sent messages to our patients that we continue to follow the program recommended by the American Academy of Pediatrics, which is an evidence-based program.”
The disconnect between the CDC’s advice and that of doctors has confused and even scared some parents.
“We’re seeing the vaccine conversation come up more and more frequently because of the fear of it and the general misinformation that’s spreading online,” said Dr. Nina Alfieri, director of the Continuity Clinic at Lurie Children’s Pediatrics in Uptown Chicago. “We always want families to feel welcome coming to the clinic with their questions.”
Dr. Adam Ratner, a pediatric infectious disease specialist at NYU, said he understands why parents are asking more questions.
“We’ve had so many years of the CDC being a trusted source of information,” he said. “It’s understandable why families are confused.”
Historically, states have followed CDC recommendations, but most say they will now follow AAP recommendations, according to KFF, a health policy organization.
As of Jan. 20, KFF found, 28 states were giving advice that deviated from federal guidelines for some or all childhood vaccines. While it’s not clear how states will handle school vaccination requirements, what is clear is that there is a real blue/red divide on which vaccine advice to follow, according to Jen Kates, co-author of the analysis.
All states with Democratic governors have announced they will not follow the federal guidelines. Only four Republican-led states did the same.
“For the first time in our country, we’re going to have very different laws, policies and attitudes about vaccines depending on where people live,” Kates said. “It’s a sea change in public health policy.”
Hoyen, at UH Rainbow Babies and Children’s, has been practicing medicine for 30 years and said she doesn’t want to go back to the pre-vaccine days. He remembers a classmate who was deaf in one ear due to a childhood case of mumps and another in the same class who was deaf in one ear due to meningitis.
Meningitis was so common before the Haemophilus influenzae type b (Hib) vaccine came into use in 1987, she recalls, that pediatricians routinely kept tap equipment on hand.
“They would do taps in the office, give them a shot of penicillin or whatever, and send them straight to the hospital,” Hoyen said. “There’s a reason these vaccines were created. It’s to help children thrive and not have to worry about the complications of these childhood diseases.”
O’Leary also doesn’t want to go back to the pre-vaccine era. He trained to be a doctor in the 1990s, before there was a rotavirus vaccine.
“We had three seasons. In the winter, we had flu season, we had RSV season and we had rotavirus season. Heaven forbid they all hit at the same time because we would be overwhelmed. Now, we don’t have rotavirus season and we’re seeing a very big impact on RSV season with the new product,” O’Leary said.
DeRoo, who only cared for children during what she called the “vaccine era,” says she tried to brush up on what vaccine-preventable diseases look like.
“We need to rethink how we approach people who come in and are sick in the clinic to make sure we’re taking all the appropriate precautions if they’re not fully immunized,” she said.
Ratner said a measles outbreak in New York a few years ago was the first time many of his colleagues had ever seen a case.
“I think with the way things are going in this country, it’s possible that will change,” he said.
“The idea of going backwards is terrifying because you don’t want to lose your hard-earned progress, but also because we’re not talking about something abstract,” Ratner said. “We’re talking about real children and families.”
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