Last week, a mother stopped me in front of the school health office and asked whether her child really needed to get the flu shot, as she heard on the news that it was now optional. I couldn't give her a clear answer at that moment, so I went home and organized my thoughts.

The starting point is January 5 of this year. The CDC revised the childhood vaccination schedule, reducing the number of recommended diseases from 17 to 11. The number of recommended vaccines also decreased from 13 to 7.

The remaining 11 vaccines include diphtheria, tetanus, pertussis, Hib, pneumococcus, and polio. Additionally, measles, mumps, rubella, chickenpox, and HPV are included. The recommended doses for HPV have also been reduced from 2 to 1.

The vaccines that were removed have been divided into two categories. Rotavirus, flu, COVID-19, meningococcus, hepatitis A, and hepatitis B are now determined in consultation with a physician. Some, like RSV, are now recommended only for high-risk groups.

However, just over two months later, the situation changed dramatically. On March 16, a federal court in Massachusetts decided to halt the implementation of this new schedule. This was due to a lawsuit filed by the American Academy of Pediatrics and others.

The court found that the plaintiffs had a strong chance of winning their argument that the revised schedule was arbitrary under the Administrative Procedure Act. As a result, the schedule reverted to the previous version from May 2025.

With the same ruling, the appointments of the newly formed advisory committee ACIP members and their votes were also halted. The federal government appealed to the First Circuit Court of Appeals on April 29.

The oral arguments for the appeal were held on October 6 in Boston. As of the time of writing, the appellate court's decision has not yet been issued, and there is no timeline for when it will be.

So, the current standard is summarized as follows: the legally effective schedule is the old one. The flu, hepatitis B, and rotavirus vaccines are still standard recommendations for all children.

Looking at just the news headlines, it's easy to remember that "the number has been reduced to 11." However, the fact that the court has put a stop to it is less well-known. The mother in front of the health office had only heard up to that point.

Many are also concerned about insurance. The federal government has stated that vaccinations recommended as of December 31, 2025, will continue to be covered. This applies to ACA insurance, Medicaid, CHIP, and the VFC program.

If you are a parent living in New Hampshire, you should also consider state laws. The vaccines required for school entry are determined by state law, not CDC recommendations.

The New Hampshire state law requires diphtheria, mumps, pertussis, polio, rubella, measles, tetanus, and chickenpox. Hepatitis B and Hib are also included. Even though hepatitis B has been removed as an optional vaccine from the federal schedule, it still remains a school entry requirement in this state.

Last year, the state legislature removed the authority of the health commissioner to determine mandatory vaccines. Now, only vaccines approved by the legislature can be mandatory. However, existing mandatory vaccines are still recognized, so there have been no immediate changes.

This session, bills that would shake up these requirements have emerged. HB 1811, which aimed to eliminate almost all mandatory vaccinations, was defeated in the House in February by a vote of 155 to 192.

HB 1719, which sought to remove only the hepatitis B requirement, passed the House. However, the Senate has sent it to an interim study, so it has not been addressed this year. Therefore, the hepatitis B requirement remains unchanged.

In summary, there are three layers. The federal schedule is still in effect due to the court ruling. The state school entry requirements remain in place, and insurance coverage is also maintained.

Having spent a lot of time with children in the classroom, I feel that such changes leave parents with more anxiety than information. It's confusing to even know what has changed and what is correct.

The order I would recommend is simple. First, pull out your child's vaccination records. You can print them from the state system or pediatric portal.

Next, ask the school health office if there are any missing requirements for school entry. For vaccines that are not required, like the flu or COVID-19, you can discuss them during regular pediatric check-ups.

Each child's health status varies, so even the same vaccine may require different judgments. Please make decisions in consultation with your child's doctor or pharmacist.

Depending on the outcome of the appeal, the schedule may change again. When the ruling comes out, don't just check the CDC website. It's also safe to check the New Hampshire Department of Health notices and the American Academy of Pediatrics guidance.

I'm not trying to argue which political side is correct here. Both sides, whether advocating for reduced vaccinations or maintaining them, cite child health as their reason.

However, one thing is disappointing. When standards fluctuate like this over a few months, parents and teachers on the ground have to keep asking what to believe each time.

If it were me, I would use the old schedule that is currently in effect as the basis until the ruling is made. I don't see any reason to stop the schedule that was already being followed.

The next day, I gave the mother in front of the health office a note with three lines summarizing the current standards, state requirements, and insurance information.

She smiled and said, "Now I understand a bit better." It seems that breaking down complex news into calm, simple lines can make it feel a little less overwhelming.