Foundation provides guidance amid changing vaccine recommendations

On January 5, 2026, the Centers for Disease Control and Prevention (CDC) released a decision to reduce the recommended number of vaccines that all children receive. This decision does not protect the health of Americans and puts immunocompromised Americans of all ages, including those with primary immunodeficiencies (PIs), at greater risk.

To aid the PI community in making the best possible decisions about childhood vaccinations, the foundation offers the following clarification and guidance. This guidance has been reviewed and endorsed by the foundation’s Medical Advisory Committee.

Access

• The CDC has withdrawn recommendations that all children receive the following vaccines:
  • Nonviable:
    • COVID-19.
    • Hepatitis A.
    • Hepatitis B.
    • Meningococcal ACWY.
    • Meningococcal B.
    • Respiratory syncytial virus (RSV).
  • Live, attenuated:
    • Dengue [previously universally recommended in Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau only].
    • Rotavirus.
  • These vaccines are still available to all children through shared clinical decision-making.
  • Private and public insurance must still cover the full costs of these vaccines, with no out-of-pocket costs to families, if caregivers and providers agree that the child should receive the vaccine.

Children with primary immunodeficiency (PI)

• Should receive vaccines included in the American Academy of Pediatrics (AAP) schedule that their healthcare providers, in consultation with their immunologist, recommend they receive.
  • Note that immunoglobulin (Ig) replacement therapy may not provide protective antibody levels to some pathogens like influenza, COVID-19, or whooping cough (pertussis).
  • Most people with PI can make at least some antibody, even if they have an antibody deficiency like common variable immune deficiency (CVID). In addition, some vaccines induce T cell immunity, which is especially important for protection against viruses.
• Most children with PI can safely receive nonviable vaccines.
• Some children with PI can also safely receive live, attenuated vaccines, such as varicella (chickenpox) and measles, mumps, and rubella (MMR), and caregivers should discuss this with their child’s immunologist.
  • However, babies who have had an abnormal TREC newborn screening test, who are undergoing testing for a significant T cell deficiency, or who have a family member with a significant T cell deficiency that has not yet been ruled out in the baby should not receive any live, attenuated vaccines.

Children who are close contacts of people with PI (e.g., family or household members)

• Should receive all vaccines recommended for their age by AAP unless they have another contraindication.
• It is very important for close contacts of people with PI to be fully vaccinated in the setting of reduced vaccine uptake by the general public.
• Being surrounded by people who are fully vaccinated decreases the chances that a person with PI will come in contact with a vaccine-preventable infectious disease.

People who are immunocompromised have immune systems that do not work as they should. They are the segment of Americans most vulnerable to severe outcomes and death from infectious diseases of all kinds.

In addition, many immunocompromised individuals cannot mount a protective response to vaccines because of their immune dysfunction. Some cannot safely receive vaccines that contain live but weakened pathogens, like the varicella and MMR vaccines. Instead, people who are immunocompromised are best protected from infectious diseases by never encountering them in the first place.

The consequences of the change in CDC recommendations is that the incidence of the corresponding vaccine-preventable diseases will increase. Increased incidence of these diseases means that people who are immunocompromised will have greater exposure to them, increasing their risk of infection, serious complications, and death.