The Centers for Disease Control and Prevention took the unprecedented step Monday of dropping the number of vaccines it recommends for every child, adopting a policy that gives Rhode Island parents choice but very little guidance.

Officials said the overhaul to the federal vaccine schedule won’t result in any families losing access or insurance coverage for vaccines, but medical experts slammed the move, saying it could lead to reduced uptake of important vaccinations and increase disease.

See also: Flu, Respiratory Illnesses Increasing In Rhode Island

Rhode Island has the following requirements:

Students entering preschool, licensed Department of Human Services center-based and in-home child-care facilities must have:

• Four doses of DTaP (diphtheria, tetanus, pertussis) vaccine
• One dose of Flu vaccine each year
• Two doses of Hepatitis A vaccine
• Three doses of Hepatitis B vaccine
• Three doses of Hib (Haemophilus influenzae type b) vaccine
• One dose of MMR (measles, mumps, rubella) vaccine
• Four doses of Pneumococcal Conjugate vaccine (not routinely given to healthy children 5 years of age and older)
• Three doses of Polio vaccine
• Two doses of Rotavirus vaccine
• One dose of Varicella (chickenpox) vaccine

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Students entering kindergarten must have:

• Five doses of DTaP (diphtheria, tetanus, pertussis) vaccine
• three doses of Hepatitis B vaccine
• Two doses of MMR (measles, mumps, rubella) vaccine
• Four doses of Polio vaccine
• Two doses of Varicella (chickenpox) vaccine

Students entering seventh grade must have met the pre-kindergarten and kindergarten immunization requirements and have:

• One dose of HPV (human papillomavirus) vaccine
• One dose of Meningococcal Conjugate (MCV4) vaccine
• One dose of Tdap (tetanus, diphtheria, pertussis) vaccine

Students entering eighth grade must have met the grade seven immunization requirements and have:

• Two doses of HPV (human papillomavirus) vaccine

Students entering ninth grade must have met the grade eight immunization requirements plus:

• Three doses of HPV (human papillomavirus) vaccine
• Note: Per current ACIP recommendations, only two doses of HPV (human papillomavirus) vaccine are required if series is started at age 14 or younger

Students entering 12th grade must have met the grade nine immunization requirements plus:

• One dose of Meningococcal Conjugate (MCV4) vaccine as a booster dose

A student, upon entering any college or university, is required to get or has gotten the following:

• One dose of Tdap (tetanus, diphtheria, pertussis) vaccine
• Two doses of MMR (measles, mumps, and rubella) vaccine
• Completion of Hepatitis B vaccine series
• Two doses of Varicella (chickenpox) vaccine
• One dose of Meningococcal Conjugate (MCV4) vaccine in the last five years for newly enrolled full-time undergraduate and graduate students (younger than 22 years of age) in a degree program at a college or university who will live in a dormitory or comparable congregate living arrangement approved by the institution

See also: Get A Flu Shot, Says Rhode Island Health Czar

The vaccine schedule is similar to Denmark’s and recommends children get vaccines for 11 diseases, compared with the 18 the CDC previously recommended. The changes are effective immediately.

The change, which officials acknowledged was made without input from an advisory committee that typically consults on the vaccine schedule, came after President Donald Trump in December asked the U.S. Department of Health and Human Services to review how peer nations approach vaccine recommendations and consider revising its guidance to align with theirs.

HHS said its comparison to 20 peer nations found that the U.S. was an “outlier” in both the number of vaccinations and the number of doses it recommended to all children. Officials with the agency framed the change as a way to increase public trust by recommending only the most important vaccinations for children to receive.

See also: Get Your Baby The Hepatitis B Shot: Rhode Island Department Of Health

“This decision protects children, respects families, and rebuilds trust in public health,” Health Secretary Robert F. Kennedy Jr. said in a statement Monday.

Medical experts disagreed, saying the change without public discussion or a transparent review of the data would put children at risk.

“Abandoning recommendations for vaccines that prevent influenza, hepatitis and rotavirus, and changing the recommendation for HPV without a public process to weigh the risks and benefits, will lead to more hospitalizations and preventable deaths among American children,” said Michael Osterholm of the Vaccine Integrity Project, based at the University of Minnesota.

The Associated Press contributed reporting.

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