On January 5, 2026, the U.S. Centers for Disease Control and Prevention (CDC) announced changes to its recommended schedule of vaccines for children and adolescents. Previously, the CDC recommended that all children be vaccinated against 18 illnesses.1 A recommendation that all children be vaccinated is known as a “universal” recommendation.
The new recommendations that were published on January 5 call for universal vaccination of all children against 11 illnesses. Additional vaccines are recommended for certain children who are considered to be high-risk. For other childhood vaccinations that had been recommended universally, the CDC now recommends “shared clinical decision-making,” which means that the decision whether to vaccinate a particular child is made on an individualized basis following a consultation with a health care provider.
The CDC’s recommendations are not requirements or mandates. All U.S. states do require certain vaccines for children, but those requirements are established at the state level and do not have to exactly match the federal recommendations. The shift in federal recommendations therefore does not change North Carolina’s childhood immunization schedule, which is set by state law and presently requires vaccination against 12 illnesses. Read on for more information about what has and has not changed as a result of the new federal recommendations.
What are CDC’s vaccine recommendations and how have they changed?
The CDC vaccine schedule that was in place at the beginning of 2025 recommended universal vaccination against 18 illnesses. Federal policy began changing last spring when U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. announced that routine covid-19 vaccination for healthy children and pregnant women would no longer be universally recommended.
Subsequently, Secretary Kennedy replaced all the members of the Advisory Committee on Immunization Practices (ACIP), a federal advisory panel that makes vaccine recommendations to the director of the CDC. In December, the reconstituted panel voted to drop its recommendation for universal hepatitis B vaccination at birth and replaced it with a recommendation for shared clinical decision-making for most infants. (The committee continued to recommend the hepatitis B vaccine at birth for newborns whose mothers are known to be positive for hepatitis B.)
On December 5, President Trump issued a memorandum directing Secretary Kennedy to align the United States’ childhood vaccine recommendations with those of “peer, developed countries.” The memo did not define peer developed country but noted that Denmark, Germany, and Japan recommended fewer childhood vaccines than the U.S. A January 5, 2026 press release stated that the new federal recommendations are intended to be responsive to the president’s memorandum.
The new recommendations are divided into three categories: vaccines that are recommended for all children (universal recommendations), vaccines that are recommended for children who are at high risk, and vaccines that may be administered based on shared clinical decision-making, as follows:
- Universally recommended: diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type b (Hib), pneumococcal conjugate, polio, measles, mumps, rubella, human papillomavirus (HPV), and varicella (chickenpox).
- Recommended for high-risk children: respiratory syncytial virus (RSV), hepatitis A, hepatitis B, dengue, meningococcal ACWY, and meningococcal B.
- Recommended for shared clinical decision-making for children not at high-risk: rotavirus, covid-19, influenza, meningococcal disease, hepatitis A, and hepatitis B.
The CDC’s vaccine recommendations are not legal mandates. They are influential, however, and may be consulted by individual states when they establish their vaccine requirements.
What are North Carolina’s immunization requirements?
Like all other states, North Carolina requires children to be immunized against certain illnesses before attending day care or school. G.S. 130A-152; -155. Exemptions to the requirements are allowed for children who have a medical contraindication to a vaccine or whose parents have a bona fide religious objection to immunization. G.S. 130A-156; -157.
G.S. 130A-152 specifies six diseases that children must be immunized against and authorizes the Commission for Public Health, an appointed rulemaking body, to require additional immunizations in the interest of the public health. The Commission also adopts the immunization schedule, which specifies the ages at which a child should receive each of the required immunizations. 10A N.C.A.C. 41A .0401.
In creating the list and schedule of required immunizations, the Commission considers the recommendations of the CDC but it does not automatically adopt those recommendations as requirements. Changes to the federal vaccine schedule therefore have no immediate impact on North Carolina’s immunization requirements.
At present, the following vaccines are required in North Carolina: diphtheria, tetanus, pertussis (whooping cough), polio, measles, rubella, mumps, Haemophilus influenzae b (Hib), hepatitis B, varicella (chickenpox), pneumococcal conjugate, and meningococcal conjugate. The North Carolina requirements are very similar to the new federal recommendations, with two differences. First, the North Carolina schedule does not include HPV, which CDC universally recommends. Second, the North Carolina schedule includes hepatitis B and meningococcal conjugate, two vaccines that the CDC is no longer recommending universally but is continuing to recommend for children at high risk or based on shared clinical decision-making.
What is the effect of the federal changes?
What will the changes to CDC’s vaccine recommendations mean for patients, providers, and parents? At this point, there are more questions than answers, but one thing is certain: North Carolina’s immunization requirements have not changed as a result of the revised federal recommendations. The state’s schedule is pretty closely aligned with the changed federal recommendations already, and it requires children to be immunized against a total of 12diseases.
In addition, to date there have been no changes to mechanisms for paying for vaccines for children. In a fact sheet accompanying its January 5 press release announcing the new recommendations, the U.S. Department of Health and Human Services stated, “All immunizations recommended by the CDC as of December 31, 2025, will continue to be fully covered by Affordable Care Act insurance plans and federal insurance programs, including Medicaid, the Children’s Health Insurance Program, and the Vaccines for Children program. Families will not have to purchase them out of pocket.”
- I am aware that the CDC’s press release and most news sources have stated that the previous schedule addressed 17 illnesses. The number 18 comes from the CDC vaccination schedule that was in effect on January 1, 2025, which is no longer available online but is on file with the author. The 18 illnesses addressed by that schedule were RSV, hepatitis B, rotavirus, diphtheria, tetanus, pertussis, Hib, pneumococcal disease, polio, covid-19, seasonal flu, measles, mumps, rubella, varicella, hepatitis A, HPV, and meningococcal disease. ↩︎
