Key takeaways
- Confirmed U.S. measles cases rose from 285 in 2024 to 2,289 in 2025 and 4,410 by October 15, 2026; in outbreaks CDC has detailed, about 95% of patients were unvaccinated or of unknown status123.
- In June 2025, all 17 members of the CDC’s vaccine advisory committee were replaced; in March 2026, a federal court paused the new members’ appointments and votes while a lawsuit continues4.
- As of October 2026, CDC still posts its 2025 adult schedule, the American Academy of Family Physicians publishes its own, and the two differ most on COVID-19 shots8910.
- Safety monitoring keeps working after approval: it found about 4.3 extra fever-related seizures per 10,000 first doses of the combined MMRV shot, compared with separate shots5.
- A Danish study of more than 1.2 million children found no link between aluminum in vaccines and autism or other conditions13.
In all of 2024, health departments across the United States reported 285 measles cases2. In 2025, the total reached 2,2891.
By October 15, 2026, CDC had counted 4,410 confirmed cases this year in 47 jurisdictions, 42 new outbreaks and three deaths1. CDC says the death count may change1. State tallies can differ: on October 12, Pennsylvania reported its sixth measles-associated death of the year4.
Early in the 2025 surge, 96% of patients were unvaccinated or had unknown status, and 11% ended up in the hospital2.
Meanwhile, the system that decides who should get which vaccine was shaken up. Federal advisers were replaced, some advice changed, and a court paused many of the changes. Medical societies and groups of states now issue their own advice.
If you value prevention and informed choice, this is a confusing moment. This guide explains how vaccines are watched for problems, who recommends what as of October 2026, what adult shots prevent and how to raise your questions.
Approval is the start of safety testing, not the end
Before the Food and Drug Administration licenses a vaccine, it is tested in people. Our article “How clinical trials decide, when most treatments tested in people fail” explains how phased trials work.
Monitoring continues after approval. CDC’s adult schedule tells clinicians to report any clinically significant reaction to the Vaccine Adverse Event Reporting System, or VAERS, at vaers.hhs.gov or 800-822-79678.
A VAERS report is a signal to check, not proof. Anyone can file one, and a report alone can’t show the shot caused harm, notes a policy update published with the University of Minnesota’s CIDRAP research center4.
The Vaccine Safety Datalink, a second system, can compare how often problems follow different shots. In data CDC’s advisers reviewed in 2025, as a first dose, MMRV, the combined measles, mumps, rubella and chickenpox shot, caused about 4.3 extra fever-related seizures per 10,000 doses compared with separate shots5. The seizures came 7 to 10 days later5. A study sponsored by the manufacturer, Merck, found a smaller increase that wasn’t statistically significant5.
Adults get the same scrutiny. Pooled data in 2025 found about 18 extra cases of Guillain-Barré syndrome, a rare nerve disorder that causes weakness, per million doses of Pfizer’s RSV vaccine, Abrysvo10. The AAFP judged that risk small next to the benefit for high-risk adults10.
On September 2, 2026, CIDRAP’s own Vaccine Integrity Project published a review of 155 new studies in JAMA. It found no new safety concerns4.
A federal program pays for some vaccine injuries, with gaps
The National Vaccine Injury Compensation Program (VICP) keeps a Vaccine Injury Table. For an injury on the table that appears within a set window after a shot, causation is generally presumed4.
The table lists 16 vaccine types7. Adding a vaccine requires a federal excise tax that Congress must enact, and the money goes to the program’s trust fund7.
Several adult vaccines fall outside VICP. It doesn’t cover the PPSV23 pneumococcal vaccine, RSV vaccines, the Shingrix shingles vaccine, mpox vaccine or COVID-19 vaccines8. COVID-19 and mpox claims go to a separate federal program, the Countermeasures Injury Compensation Program8.
Even covered claims take two to three years, the CIDRAP update notes4.
On October 8, 2026, HHS announced a vaccine injury plan4. It includes an NIH clinic for people with health problems after vaccination, a proposal to pay doctors for filing VAERS reports, new electronic record rules and a VAERS upgrade4. As of May 2026, HHS had not changed the injury table, the Congressional Research Service reported7.
What changed in 2025 and 2026, step by step
The Advisory Committee on Immunization Practices (ACIP) votes on recommendations, which join CDC’s schedule if the CDC director adopts them6.
| When | What happened | Status in October 2026 |
|---|---|---|
| June 2025 | HHS Secretary Robert F. Kennedy Jr. removed all 17 ACIP members and appointed replacements4 | Appointments and votes paused by a court in March 20264 |
| June 2025 | ACIP voted to recommend only thimerosal-free flu vaccines10 | Paused; not in effect10 |
| September 2025 | ACIP voted 8 to 3, with one abstention, against combined MMRV before age 45, and unanimously moved COVID-19 shots to individual decision-making for everyone 6 months and older6 | Paused with the other votes4 |
| December 2025 | ACIP replaced the universal hepatitis B birth dose with individualized decisions for babies whose mothers test negative12 | Paused4 |
| January 2026 | CDC moved six vaccines, including flu, off the list recommended for every child, without consulting ACIP7 | Stayed by the court; stay remains during the appeal47 |
| September 2026 | HHS rewrote CDC’s COVID-19 clinical guidance, dropping statements that benefits outweigh risks but keeping a recommendation that adults get a 2026–2027 shot4 | In effect4 |
| October 6, 2026 | The U.S. Court of Appeals for the First Circuit heard the government’s appeal of the part of the ruling covering ACIP4 | No decision reported as of October 154 |
The lawsuit, American Academy of Pediatrics v. Kennedy, was brought by medical and public health groups in federal court in Massachusetts7.
On March 16, 2026, the judge paused the schedule while the case goes on. The ruling found that CDC acted contrary to law by issuing it without properly consulting ACIP7. The government appealed on April 297.
Our article “Why the well-child schedule is so crowded before age two” covers the childhood details. This guide sticks to adults.
Who recommends what, as of October 2026
CDC. The adult schedule CDC posts is still the 2025 version. It was amended on April 27, 2026, to add an RSV recommendation that ACIP made in April 2025 and HHS adopted8.
Family physicians. The American Academy of Family Physicians (AAFP) adopted its own 2026 adult schedule and says it does not endorse CDC’s 2025 schedules9. Its fall 2026 respiratory vaccine advice rests on Vaccine Integrity Project reviews, and the AAFP says to follow its advice where groups differ10.
Infectious disease doctors. In guidelines updated in September 2026, the Infectious Diseases Society of America (IDSA) covers people with weakened immune systems. For everyone else, it points to the American Academy of Pediatrics for children, the AAFP for adults and the American College of Obstetricians and Gynecologists (ACOG) for pregnancy11.
States. The West Coast Health Alliance (California, Hawaii, Oregon and Washington) publicly backed keeping the hepatitis B birth dose. So did the Northeast Public Health Collaborative, whose members include New York, Pennsylvania and Massachusetts12.
The sharpest split is over COVID-19. The AAFP recommends a shot for every adult, with two doses a season at 65 and older10. FDA labels are narrower, covering people 65 and older or younger people with a high-risk condition, so the AAFP describes other uses as off-label10. HHS’s September 2026 guidance still recommends a shot for adults but marks the second dose at 65 and older as off-label4.
The adult vaccine check
This table is our own summary of CDC’s 2025 adult schedule and the AAFP’s 2026 advice, as of October 2026. Use it to start a conversation.
| Vaccine | Recommended for | What it prevents, in numbers | Cautions to raise |
|---|---|---|---|
| Flu | Every adult, every year; at 65 and older, high-dose, adjuvanted or recombinant preferred810 | In a 2025 trial of adults 65 to 79, high-dose vaccine cut flu hospitalizations 31.8% compared with standard dose10 | Guillain-Barré syndrome within 6 weeks of a past flu shot8 |
| COVID-19 | AAFP: all adults, two doses a season at 65+; FDA labels: 65+ or high risk10 | Protection against medically attended illness and hospitalization, per the AAFP’s evidence review10 | Heart inflammation within 3 weeks of a past COVID-19 dose8 |
| Shingles (Shingrix) | Adults 50+, and 19+ with weakened immunity; 2 doses, 2 to 6 months apart8 | About 97% efficacy against shingles in trials14 | No recommendation in pregnancy; consider waiting8 |
| Pneumococcal | Adults 50+ without a prior conjugate dose; younger adults with certain conditions8 | Pneumococcal disease; one PCV20 or PCV21 dose completes the series8 | Severe allergy to a prior dose8 |
| RSV | Everyone 75+; ages 50 to 74 at higher risk; one dose only8 | Fewer RSV lung infections and hospitalizations across two seasons, per the AAFP’s review10 | About 18 extra Guillain-Barré cases per million Abrysvo doses10 |
| Tdap or Td | Every adult every 10 years; Tdap in each pregnancy8 | Tetanus, diphtheria and whooping cough8 | Severe allergy to a prior dose8 |
| Hepatitis B | All adults 19 to 59; 60+ with risk factors or who ask8 | Reported U.S. acute cases fell from 18,003 in 1991 to 2,214 in 2023, or about 14,400 after adjusting for underreporting5 | Anaphylaxis about 1.1 per million doses5 |
| MMR | Adults born in 1957 or later; 1 or 2 doses, depending on the situation8 | Two doses are about 97% effective against measles3 | Not in pregnancy or with severe immune weakness8 |
Travel can change the list. CDC counts travel to countries where hepatitis B is common as a risk factor, for example8.
Uptake lags. By January 2026, 43.9% of adults had a 2025–2026 flu shot and 16.1% had a COVID-19 shot10.
A shingles shot and dementia: the natural experiment
In 2013, Wales started a shingles vaccine program with a strict birth-date rule. People born on or after September 2, 1933, could get the live vaccine; those born just before almost never did15.
That rule let researchers compare people of almost the same age who differed mainly in access to the shot. Because the cutoff was arbitrary, the comparison works almost like a randomized trial, though it isn’t one.
The study, published in Nature in 2025, followed 282,541 adults aged 71 to 88 for seven years14. The researchers estimated that getting vaccinated lowered new dementia diagnoses by about 20% in relative terms, or 3.5 percentage points in absolute terms14. Shingles cases fell 37%, and the effect on dementia was strongest in women14.
There are limits. The live vaccine used in Wales was discontinued in the U.S. in 202015. Whether Shingrix, the vaccine Americans get today, protects against dementia is unknown14. One natural experiment is a strong clue, not proof.
Common concerns, answered with evidence
Aluminum. Some vaccines use aluminum salts to strengthen the immune response. In July 2025, the Annals of Internal Medicine published a Danish study of more than 1.2 million children that found no association between vaccine aluminum and autism or other conditions13.
CDC’s revised autism page later leaned on results from 2 of the study’s 15 extra figures and tables, a choice FactCheck.org called selective13. The journal’s editor noted that the side analyses made more than 540 comparisons, so a few chance findings were expected13.
Autism. On November 19, 2025, CDC replaced its autism and vaccines page. It now says the statement “vaccines do not cause autism” is “not an evidence-based claim”13. A headline saying vaccines don’t cause autism remains, with a footnote saying it was kept under an agreement with Republican Sen. Bill Cassidy of Louisiana, a physician13.
The research record points the other way. More than 40 high-quality studies in seven countries, involving over 5.6 million people, have found no link, according to Susan Kressly, president of the American Academy of Pediatrics13.
Natural infection. Infection does build immunity. The question is the price. In the 2025 measles surge, two of the first three people who died were unvaccinated school-age children with no known underlying conditions2. About 90% of babies infected with hepatitis B at birth develop lifelong infection, according to data presented to ACIP5. About a quarter of people infected as children die early of its complications5.
Thimerosal and other ingredients. The 2025 vote favoring thimerosal-free flu vaccines is paused, and the AAFP advises not delaying a flu shot over thimerosal10. A severe allergic reaction to a vaccine ingredient generally rules out that vaccine, so ask for the ingredient list if you have allergies8.
Spacing. The IDSA says COVID-19, flu and RSV vaccines can be given together11. In September 2026, HHS changed CDC’s wording on same-visit COVID-19 shots from “recommended” to “acceptable”4. Neither calls same-day shots unsafe. If you prefer to space them out, remember timing matters: RSV vaccine works best given in late summer or early fall8.
How strong is the evidence?
| Claim | Evidence level | Basis |
|---|---|---|
| Two MMR doses prevent measles | About 97% effective3 | |
| Shingrix prevents shingles | About 97% efficacy in trials14 | |
| Hepatitis B vaccine with immune globulin prevents mother-to-baby spread | Prevents about 94% of transmission5 | |
| Severe allergic reactions to hepatitis B vaccine are rare | About 1.1 per million doses5 | |
| Shingles vaccination lowers dementia risk | One natural experiment with a live vaccine1415 | |
| Vaccine aluminum causes chronic childhood disease | No link in more than 1.2 million children13 | |
| Vaccines cause autism | More than 40 studies, 5.6 million people13 |
Talking with a clinician, and when to get help
Natural health puts prevention first and treats you as the decision-maker. Vaccines fit those values best when you get clear answers in numbers. Our article “What a clinician must tell you before you agree” covers informed consent.
Questions to bring to your appointment
- Which schedule are you following: CDC’s posted schedule, the AAFP’s or my state’s?
- What does this vaccine prevent, in absolute numbers, for someone my age and health?
- Which side effects are common, and which rare ones should I watch for?
- Is this vaccine covered by the federal injury compensation program8?
- Does anything in my history rule it out, such as a severe allergic reaction, pregnancy or a weakened immune system8?
- Can I get several shots on the same day, and what is the cost of waiting11?
- Will my insurance pay for it this season?
True medical reasons to skip a vaccine are specific. They include a severe allergic reaction to an earlier dose or an ingredient, and, for live vaccines like MMR and chickenpox, pregnancy or severe immune weakness8. School rules are a separate matter set by states. Florida, for example, has proposed ending school and child care requirements for hepatitis B, chickenpox, Hib and pneumococcal vaccines4.
When to get help
- Report a significant reaction to VAERS at vaers.hhs.gov or 800-822-79678.
- Before another dose, tell your clinician if you had Guillain-Barré syndrome within 6 weeks of a flu shot, or heart inflammation within 3 weeks of any COVID-19 shot8.
- Wait to get a vaccine if you have a moderate or severe illness, with or without fever, and ask when to reschedule8.
- For emergency warning signs of any kind, see our article “The symptoms that mean call 911 now.”
Questions readers ask
Which schedule should I follow?
For most adult vaccines, CDC’s posted schedule and the AAFP’s 2026 schedule agree89. The main difference is COVID-19, where the AAFP recommends shots for all adults10. Ask your clinician which schedule they use, and check your state health department’s guidance.
Do I need a measles shot as an adult?
CDC’s schedule lists one or two MMR doses for adults born in 1957 or later, depending on their situation8. With 42 new outbreaks reported in 20261, it’s worth asking whether your records show you’re protected. MMR isn’t given during pregnancy8.
Did the court ruling bring back the old recommendations?
The March 2026 order stayed the January 2026 childhood schedule and paused the new committee’s votes47. The appeal heard in October covers only the committee part, so the childhood schedule stays paused either way4. Rules could change again, so check the date on any schedule you read.
The bottom line
Vaccines are still tested and monitored, and monitoring does catch rare problems. What changed in 2025 and 2026 is who issues the advice. As of October 2026, CDC’s posted adult schedule and the AAFP’s schedule mostly agree, with COVID-19 the main exception.
The measles numbers show what’s at stake when protection slips. Bring this guide’s questions to a clinician you trust, ask for numbers, and make the decision that fits your health.
Related reading
About this article
This article was researched using CDC and HHS pages, ACIP meeting records, a Congressional Research Service report, medical society guidelines and university reports, listed below. It was reviewed in October 2026, while federal vaccine policy was still changing. It is general education, not medical, legal or financial advice.
Sources
- Centers for Disease Control and Prevention. “Measles Cases and Outbreaks.” CDC, data as of October 15, 2026. cdc.gov
- Centers for Disease Control and Prevention. “Measles Update — United States, January 1–April 17, 2025.” Morbidity and Mortality Weekly Report, CDC, 2025. cdc.gov
- CDC Center for Forecasting and Outbreak Analytics. “Scenario Assessment: 2025–2026 Measles Outbreak in South Carolina.” CDC, March 6, 2026. cdc.gov
- Brandstetter Figueroa I, Pearl Ben-Joseph E, Steier J, Mulholland R (Unbiased Science). “A Vaccine Injury Initiative, a Contested Hepatitis B Trial, and Edited CDC COVID-19 Vaccine Guidance: The State of US Vaccine Policy.” Biweekly series in partnership with the Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, October 15, 2026. cidrap.umn.edu
- Advisory Committee on Immunization Practices. “Meeting of the Advisory Committee on Immunization Practices, September 18–19, 2025: Summary.” CDC, 2025. cdc.gov
- U.S. Department of Health and Human Services. “ACIP Recommends COVID-19 Vaccination Based on Individual Decision-Making.” HHS press release, September 19, 2025. hhs.gov
- Congressional Research Service. “CDC’s Updated Childhood Vaccine Schedule: Litigation and Potential Implications for Vaccine Injury Compensation Program.” Legal Sidebar LSB11427, May 4, 2026. everycrsreport.com
- Centers for Disease Control and Prevention. “Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025” (revised July 2, 2025; amended April 27, 2026) and “Adult Immunization Schedule Notes.” CDC. cdc.gov and cdc.gov
- American Academy of Family Physicians. “Adults 19 and Older Immunization Schedules” (Adult Immunization Schedule by Age, 2026). AAFP, 2026. aafp.org
- American Academy of Family Physicians. “2026–2027 Influenza, RSV, and SARS-CoV-2 Immunization Recommendations.” American Family Physician, published online October 16, 2026. aafp.org
- Infectious Diseases Society of America. “IDSA 2026 Guidelines on the Use of Vaccines for the Prevention of Seasonal COVID-19, Influenza, and RSV Infections in Immunocompromised Patients.” IDSA, updated September 2, 2026. idsociety.org
- Association of State and Territorial Health Officials. “Outcomes and Implications of ACIP’s Vote on the Hepatitis B Vaccine for Newborns.” ASTHO blog, 2025. astho.org
- McDonald J, Yandell K. “Revised CDC Website About Autism and Vaccines Is Not Evidence-Based.” FactCheck.org (Annenberg Public Policy Center), November 20, 2025. factcheck.org
- Balasubramaniam V. “One Shot Ahead: Could the Shingles Vaccine Offer a New Defence Against Dementia?” Monash Lens, Monash University, April 8, 2025 (on Eyting M, Xie M, et al., Nature, 2025). lens.monash.edu
- Viveros A. “A Shingles Vaccine May Also Help Reduce Dementia Risk.” Science News, April 3, 2025. sciencenews.org