Doctors ignore new federal vaccine recommendations to stick with science

By Jen Christensen, CNN

(CNN) — The American Academy of Pediatrics on Monday released its updated recommendations for what vaccines children should get. It’s a routine revision, hardly different from last year’s recommendations, but it carries more significance this year: More states and doctors are relying on it instead of a controversial new schedule from the US Centers for Disease Control and Prevention.

The AAP’s newest recommendations include a new immunization against respiratory syncytial virus (RSV) and a few other minor adjustments — a stark difference from the sweeping changes abruptly made to the CDC vaccine schedule this month.

Although the CDC schedule has long been the default guide to vaccination across the country, many doctors say they’re now choosing 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 broadly recommend routine immunization against RSV, hepatitis A, hepatitis B, rotavirus, flu 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.

In contrast, the updated CDC schedule narrowed recommendations for protection against meningococcal disease, hepatitis B and hepatitis A to children who are at higher risk for infections. It also recommends that choices on vaccinations against flu, Covid-19 and rotavirus be based on “shared clinical decision-making,” which means people who want one must consult with a health care provider.

“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” US Health and Human Services Secretary Robert F. Kennedy Jr. said after the vaccine schedule update. “This decision protects children, respects families, and rebuilds trust in public health.”

There were no safety issues or new research to suggest that the vaccines on the CDC’s previous schedule weren’t necessary.

“For now, unfortunately, we have to ignore everything about vaccines that is coming from our federal government,” said Dr. Sean O’Leary, chair of the AAP’s Committee on Infectious Diseases. “Parents should trust their pediatrician, trust the professional societies like the American Academy of Pediatrics.”

The half-dozen pediatricians who spoke with CNN they said they’ll stick with the AAP’s guidance.

Dr. Sarah Elizabeth DeRoo, a pediatrician at Children’s National in Washington, DC, says that she will continue to share “very candidly” with families about vaccines and that “we know they’re safe and effective.”

When the CDC’s vaccine schedule changed this month, she said, it undermined some parents’ confidence.

“We have families that come into our clinic that traditionally have been very accepting of vaccines and they want to know, ‘is this new recommendation, is this evidence-based, or do I need to think differently about these vaccines’ that they’ve accepted previously?” DeRoo said. “We’ve been giving messaging to our patients that we’re continuing to follow the recommended schedule by the American Academy of Pediatrics, which is an evidence- based schedule.”

The disconnect between advice from the CDC and from doctors has confused and even scared some parents.

“We are seeing the vaccine conversation come up more and more frequently because of fear of this and general misinformation spreading online,” said Dr. Nina Alfieri, Continuity Clinic director with Lurie Children’s Pediatrics at Uptown in Chicago. “We always want families to feel welcome coming to clinic with their questions.”

Dr. Adam Ratner, a pediatric infectious disease specialist at NYU, said he gets why parents are asking more questions.

“We’ve had so many years of the CDC being a reliable 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 instead, according to KFF, a health policy organization.

As of January 20, KFF found, 28 states were giving advice that deviates from federal guidelines for some or all childhood vaccines. Although it’s not clear how states will handle vaccine requirements for schools, what is clear is that there is a real blue/red divide on which vaccine advice to follow, according to Jen Kates, a co-author of the analysis.

All states with Democratic governors have announced that they won’t follow federal guidelines. Only four states led by Republicans have done the same.

“For the first time in our country, we’re going to have really varying laws, policies and attitudes about vaccines based on where people live,” Kates said. “It’s a major sea change in public health policy.”

Hoyen, of 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. She remembers a colleague who was deaf in one ear because of a childhood case of mumps and another in the same class who was deaf in one ear because of meningitis.

Meningitis was so common before the Haemophilus influenzae type b (Hib) vaccine came into use in 1987, she remembers, that pediatricians routinely kept spinal tap equipment on hand.

“They’d do the taps in the office, give them a dose of penicillin or whatever and send them straight to the hospital,” Hoyen said. “There’s a reason why these vaccines were created. It’s to help kids thrive and not to have to worry about complications from these childhood illnesses.”

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 vaccine against rotavirus.

“We had three seasons. In the winter, we had influenza season, we had RSV season, and we had rotavirus season. Heaven forbid if they all hit at the same time, because we’d be overwhelmed. Now, we don’t have a rotavirus season, and we’re seeing a very big impact on RSV season with the new product,” O’Leary said.

DeRoo, who has only been caring for children during what she called “the vaccine era,” says she’s been trying to refresh her knowledge of what vaccine-preventable diseases look like.

“We have to rethink how we’re approaching people who walk in and are sick in the clinic, to make sure that we take all the appropriate precautions in the event that they may not be 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, given the way that things are going in this country, that is likely to change,” he said.

“The idea of going backwards is horrifying because you don’t want to lose hard-won progress, but also because we’re not talking about something abstract,” Ratner said. “We’re talking about actual children and families.”

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