Lena H. Sun and Paige Winfield Cunningham walked through each of the childhood vaccines the CDC stopped broadly recommending, in the Washington Post. Their piece is what prompted this one. It is worth your time in full. But the hepatitis A entry runs a few paragraphs in a survey story, and hepatitis A is the one item on that list I have spent my whole career on.
On January 5, 2026, the administration rewrote the childhood immunization schedule, and hepatitis A was one of the vaccines demoted. CDC no longer recommends it for all children 12 to 23 months. The only children it is now affirmatively recommended for are those traveling internationally to places where the virus is common. Every other child falls into shared clinical decision-making. The number of vaccines routinely recommended for all children dropped from 17 to 11, and the Advisory Committee on Immunization Practices, which has made these calls since 1964, was not consulted.
A vaccine this country adopted because hepatitis A was a domestic food-safety problem has been reclassified as a travel vaccine. I have spent twenty-eight years on the other side of that decision.
The rarity argument eats itself
The assessment behind the change says the “benefit-risk ratio is at best very low for most children”, on two grounds: thin safety data, and a rare disease.
Hepatitis A is rare in American children because we vaccinate American children. ACIP recommended routine vaccination at 12 to 23 months in 2006, and reported cases fell about 95 percent; infection rates dropped roughly 97 percent between 1995 and 2015. Citing the low case count as grounds to stop is like disbanding the fire department because the building has not burned. As for thin data, the vaccine has been licensed since 1995 and given routinely to every toddler since 2006 — hundreds of millions of doses. If that is insufficient, nothing will ever be sufficient.
CDC’s own material notes children under six usually have no symptoms. The new guidance treats that as a reason the shot does little for them. It is the reason to give it. An unvaccinated toddler with no symptoms is a silent carrier who brings the virus home from day care to parents and grandparents, where hepatitis A means jaundice, weeks of lost work, hospitalization, and for older adults and anyone with liver disease, death.
Where this stands today
On March 16, 2026, Judge Brian Murphy in the District of Massachusetts stayed the January changes and the thirteen ACIP appointments. The schedules reverted to their pre-January form. The government appealed to the First Circuit in late April and moved to expedite in late August; no ruling yet. ACIP has had no quorum since March and has not met since December 2025. The universal recommendation survives, held up by a district judge, while the committee that should own the question cannot convene.
Thirty years of cases that a vaccine would have prevented
Here is what this looks like from my desk. Every one of these is on our outbreak roster, and every one of them was preventable by a shot that costs $30 to $120.
Contaminated food. Chi-Chi’s at the Beaver Valley Mall in Monaca, Pennsylvania, 2003 — green onions from Mexico, more than 650 cases, four deaths, a liver transplant, and over 9,000 people lined up for immune globulin. It was the largest single-source hepatitis A outbreak in American history. We resolved 78 victim claims and recovered $6.25 million for Richard and Linda Miller; Mr. Miller lost his liver. Townsend Farms frozen berries sold at Costco, 2013 — pomegranate seeds from Turkey, 165 cases in ten states, eight individual suits and nine class actions. Tropical Smoothie Café, 2016 — Egyptian frozen strawberries, 134 cases in nine states, 52 hospitalized; we represented about 75 people. Genki Sushi on Oahu and Kauai, 2016 — imported frozen scallops, 292 cases, 74 hospitalized, one death; we represented roughly 85 people including the family of the man who died. Then blackberries at Fresh Thyme and Woodman’s in 2019, fresh organic strawberries in 2022, frozen organic strawberries in 2023.
An infected worker. My first was a Seattle Subway in 1998: 30 people exposed, and a child who went into acute liver failure and needed an emergency liver transplant. Then McDonald’s in Washington and Taco Bell in Florida, Maple Lawn Dairy and Quizno’s in 2004, Houlihan’s in 2007, McDonald’s in the Quad Cities, Olive Garden in North Carolina, Alta and New Hawaii Sea in 2013, Red Robin in Missouri, the Mendham Golf & Tennis Club in New Jersey, 555 East American Steakhouse in Long Beach, Gino’s Ristorante & Pizzeria.
And then Famous Anthony’s in Roanoke in 2021. One infected cook worked three locations. Fifty-two people sick, at least 36 hospitalized, four dead. One family buried two of its members. One survivor needed a liver anda kidney transplant. Acute medical bills passed $6 million. The chain went into Chapter 11. All of it because one employee did not get a $30 shot.
I took this to CDC myself — with t-shirts
In June 2023 I flew to Atlanta with arguments, a letter to the ACIP Secretariat, medical summaries for 31 Famous Anthony’s victims and families, and a box of t-shirts. I have never been above using a t-shirt to make a point. The ask was modest: not a mandate from CDC, just a recommendation that food service workers be vaccinated. The answer has not changed. CDC says food handlers face no increased occupational risk. That answers a question nobody asked. They are not at greater risk of getting hepatitis A. They are a risk of givingit, and about a quarter of infections are asymptomatic, so neither the carrier nor the manager knows.
The places that require it — and the one that quit
You asked whether anyone actually does this. A few do, and the record is striking.
St. Louis County, Missouri passed its ordinance in December 1999, effective 2000, after a decade of food-handler outbreaks that ordinary interventions could not stop. The county’s case rate fell from 3 per 100,000 to 1. Fifteen food handler cases were reported in the region in 1999 and five in 2000; between 2001 and 2017 there were five total, three of whom worked outside the county. The region has not had a hepatitis A outbreak since 2000. That is a twenty-five-year natural experiment and it came out one way.
Franklin County, Missouri followed on July 30, 2019 after more than 50 cases: ninety days to the first dose, records for inspectors, $20 doses for the uninsured, covering restaurants, hospital cafeterias, school kitchens, day cares, nursing homes and sandwich carts. Boyd County, Kentucky and neighboring Ashland did the same in 2018. That is close to the whole national list.
Clark County, Nevada is the cautionary tale. Las Vegas required the two-dose vaccine for every food handler card starting in 1999, covering more than 125,000 workers a year. Case rates dropped and hit historic lows by 2010. The Southern Nevada Health District’s own history of the card shows the vaccine requirement ended in 2012, with the proof-of-vaccination rule formally eliminated in 2017 on the reasoning that there was no longer a public health benefit. Clark County then became part of the national outbreak. It still requires two doses of hepatitis A vaccine for its schoolchildren, but no longer for the people cooking their food.
Run the numbers
Two doses. Ninety-five percent protection after the first, ninety-nine after the second, lasting fifteen to twenty years. Thirty to a hundred and twenty dollars, or $20 in Franklin County if you are uninsured. Against that: $6 million in acute bills from one Roanoke restaurant chain, four funerals, transplants, free post-exposure clinics on the taxpayer every time a food handler tests positive, and litigation that ends companies. I have worked the expensive end of that comparison for most of my career.
Hepatitis A is the only common vaccine-preventable foodborne disease in the United States. It is the one bug where we can simply decide to stop having outbreaks. Narrowing the childhood shot to children with plane tickets, while still refusing to recommend it for the people who handle this country’s food, gets the question wrong twice, in opposite directions, at once.
The vaccine works. Requiring it is the whole point.