Childhood Immunization Schedule in Transition: Experts Break Down Significant Policy Shifts

This roundtable series, Clinical Insights: Childhood Vaccine Schedule Changes, discusses ongoing changes to the pediatric vaccine schedule, the inner workings of the CDC’s Advisory Committee on Immunization Practices (ACIP), and how these changes are impacting US public health.

Recent revisions to the childhood immunization schedule have generated substantial discussion among clinicians, public health experts, and professional societies. Some updates involve shifts in recommendation status for several long-standing vaccines, including changes affecting routine use of hepatitis B vaccination at birth, meningococcal vaccination strategies in adolescents, and preventive approaches to respiratory syncytial virus (RSV) in infancy. Such modifications represent more than incremental adjustments; they may alter the long-standing framework through which pediatric infectious diseases have been prevented in the US.

Vaccination schedules are traditionally developed through rigorous evaluation of clinical trial evidence, epidemiologic data, and population-level risk–benefit assessments. Historically, these recommendations have been guided by structured frameworks that assess vaccine effectiveness, safety, disease burden, cost-effectiveness, and equity considerations. Changes to these schedules therefore carry implications not only for individual patient protection but also for broader herd immunity and public health infrastructure.

During a recent roundtable discussion, Jacinda Abdul-Mutakabbir, PharmD, MPH, of the University of California San Diego; Sharon Nachman, MD, of Stony Brook Children’s Hospital; Mary Koslap-Petraco, DNP, PNP-BC, CPNP, of Stony Brook University School of Nursing; and William Schaffner, MD, of Vanderbilt University School of Medicine reviewed these updates and their potential consequences. The experts emphasized that changes involving RSV prevention strategies, hepatitis B vaccination at birth, and broader reliance on shared clinical decision-making represent some of the most consequential developments for pediatric clinicians in recent years.

Disclosures include Shionogi, GSK, NovaVax, CSL Sequiris, Innoviva Specialty Therapeutics, and Abbvie for Abdul-Mutakabbir.

References:

1. CDC adopts individual-based decision-making for hepatitis B immunization for infants born to women who test negative for hepatitis B virus. News release. US Centers for Disease Control and Prevention. Published December 16, 2025. Accessed March 10, 2026. https://www.cdc.gov/media/releases/2025/2025-hepatitis-b-immunization.html
2. Halsey G. ACIP votes to modify decades-long hepatitis B birth dose recommendation. Patient Care Online. December 5, 2025. Accessed March 10, 2026. https://www.patientcareonline.com/view/acip-votes-to-modify-decades-long-hepatitis-b-birth-dose-recommendation