The Centers for Disease Control and Prevention (CDC) and U.S. Department of Health and Human Services (HHS) have released a significantly revised childhood vaccination schedule for 2026 — one that represents a structural overhaul rather than an incremental update.
The new schedule reduces the number of immunizations recommended universally for all children from 17 to 11, introduces a three-tier recommendation framework, and changes the guidelines for several widely used vaccines, including HPV, influenza, rotavirus, and COVID-19.
Here is a clear breakdown of what changed, which vaccines moved categories, and what it means for families and clinicians.
A NEW THREE-TIER RECOMMENDATION SYSTEM For the first time, childhood vaccines are now grouped into three categories: 1) Vaccines recommended for all children (universal schedule) 2) Vaccines recommended only for children in specific high-risk categories 3) Vaccines offered through shared clinical decision-making (discussion between family and provider rather than a default universal recommendation) This replaces the long-standing system in which most vaccines were presented as universally recommended unless medically contraindicated.
VACCINES STILL RECOMMENDED FOR ALL CHILDREN
The following vaccines remain on the routine universal schedule, meaning they are still recommended for all children unless medically exempt:
• DTaP (diphtheria, tetanus, pertussis) • Hib (Haemophilus influenzae type b)
• Pneumococcal conjugate vaccine • Polio (IPV)
• Measles
• Mumps
• Rubella
• Varicella (chickenpox)
• HPV (with new dosing guidance — detailed below) These vaccines are still administered on the familiar milestone schedule through infancy, early childhood, and adolescence.
HPV VACCINE: NOW RECOMMENDED AS A ONEDOSE SCHEDULE The 2026 update reflects new outcome data showing that a single dose of HPV vaccine provides protection comparable to the prior two-dose protocol in most children and adolescents.
Key changes include:
• One dose is now recommended for routine vaccination when started on schedule.
• Catch-up vaccination remains available for adolescents and young adults who begin the series later.
• The acceptable start age remains as early as age 9, with continued emphasis on vaccination before exposure risk increases.
This is one of the most consequential medical-practice changes in the new schedule and replaces earlier two-dose guidance for most children.
VACCINES MOVED OUT OF THE UNIVERSAL CATEGORY Several vaccines that were previously recommended for all children are now recommended only for specific high-risk populations or offered after shared decision- making.
This applies to:
• Hepatitis A
• Hepatitis B
• RSV vaccine
• Dengue vaccine (already geographically limited)
• Meningococcal ACWY and meningococcal B vaccines Children with medical, travel, or exposure-related risk factors may still be advised to receive these vaccines based on clinical judgment.
VACCINES SHIFTED TO “SHARED CLINICAL DECISION- MAKING” The new schedule formalizes a category in which a vaccine is no longer automatically recommended for all children, but may be offered after discussion between families and providers.
These include:
• Influenza (flu) vaccine
• Rotavirus vaccine
• COVID-19 vaccine
• Meningococcal disease vaccines • Hepatitis A vaccine
• Hepatitis B vaccine Under this approach, physicians review:
• personal and household risk factors
• prior illness history
• medical conditions
• local circulation of disease
• parental preference before offering vaccination. This marks a significant policy departure from earlier universal recommendations for these vaccines.
WHAT DID NOT CHANGE Despite the structural overhaul, the following elements remain consistent:
• No entirely new vaccines were added to the childhood schedule.
• Core early-childhood timing milestones remain recognizable.
• States continue to determine their own school-entry vaccination requirements.
The federal schedule influences clinical practice and insurance coverage but does not automatically redefine state school mandates.
WHAT THIS MEANS FOR PARENTS AND PROVIDERS For families, the biggest practical changes are:
• Fewer vaccines are now classified as automatically recommended for every child.
• More vaccination decisions will occur through one-on-one conversations with healthcare providers.
• HPV vaccination is now primarily administered as a one-dose schedule.
• Flu, COVID-19, rotavirus, meningococcal, and hepatitis A and B vaccination decisions are no longer universal defaults.
For clinicians, the new framework places greater emphasis on documenting individualized risk assessment and shared decision- making discussions.
BOTTOM LINE
The 2026 CDC/HHS childhood vaccination schedule marks a shift from a broad universal model toward a more tiered, individualized approach. The update reduces the number of immunizations recommended for all children, reclassifies several vaccines into risk-based and decision-based categories, and adopts a one-dose HPV schedule based on emerging long-term effectiveness data.
Rather than changing which diseases vaccines protect against, the new schedule changes how vaccination decisions are made — moving more of them into the clinical conversation between families and providers.
