At-a-Glance
Aluminum vaccine adjuvants: Intramuscular aluminum forms a slow-release depot and is efficiently renally cleared, with no detectable rise in serum aluminum levels and no credible association with autism, asthma, or autoimmune disease.¹
Vancomycin trough timing: Troughs should be drawn at steady state, typically before the fourth dose. Early levels can appear falsely low and lead to unnecessary increases in dose.
Pediatric public health funding: The AAP has filed a lawsuit against HHS seeking restoration of $12 million in grants that support core pediatric screening, prevention, and training programs.²
New & Notable
Aluminum salts enhance immune responses to some vaccines. After intramuscular administration, aluminum forms an injection-site depot for slow release and then is cleared by the kidneys. Even in preterm infants, vaccination does not lead to increased serum aluminum levels.¹
Cumulative exposure: Total aluminum exposure across the AAP immunization schedule from birth through 18 years is estimated to be 4.12 to 7.52 mg of aluminum. This is well below the average daily exposure (12 mg) from historical infant antacid regimens and below common dietary sources, including breast milk and formula.¹
Aluminum in vaccines does not cause autism or disease: Large epidemiologic studies, including a nationwide cohort of more than 1.2 million children, show no causal association between aluminum-adjuvanted vaccines and autism spectrum disorder, asthma, or autoimmune disease.¹
Limitations: Some pharmacokinetic models do not begin before age 5, at which point the majority of aluminum-containing vaccines would have already been administered per the AAP (and CDC) immunization schedule.¹
Practical implication: Start conversations with patients’ parents, guardians, and caregivers by acknowledging their concerns and building trust. A confident clinician recommendation is the strongest predictor of vaccine acceptance.¹
Practical implication: Counsel parents, guardians, and caregivers that adverse effects related to aluminum adjuvants are largely local, mild, and transient.¹
Clinical Pearl
Vancomycin trough concentrations should be obtained at steady state, which is just before the fourth dose. Levels drawn too early may be low and lead to unnecessary dose escalation, increasing nephrotoxicity risk.
Optimal timing for obtaining the trough is 30 to 60 minutes before the fourth dose. Earlier sampling is reasonable if supratherapeutic exposure is a concern, such as with worsening renal function.
The video Vancomycin Trough Monitoring in Neonates and Pediatrics reviews when and why to time troughs this way.
Pediatric Pulse
AAP Lawsuit Challenges Federal Public Health Funding Cuts
On December 24, 2025, the American Academy of Pediatrics filed a lawsuit against the U.S. Department of Health and Human Services seeking restoration of nearly $12 million in terminated federal grants. The AAP alleges the cuts represent unlawful retaliation related to its public criticism of recent federal vaccine policy changes, including Hepatitis B birth dose and COVID-19 vaccine recommendations.²
These grants support programs used daily in neonatal and pediatric care, including universal newborn hearing screening, safe sleep initiatives to prevent sudden unexpected infant death, and training programs for rural pediatric clinicians. The loss of this funding could lead to program closures and delayed detection and intervention for high-risk infants.²
References
Nirenberg E, Maldonado YA, Hoffman SA. The role and safety of aluminum adjuvants in childhood vaccines. Pediatrics. Published online 2025. doi:10.1542/peds.2025-074874.
American Academy of Pediatrics. AAP lawsuit demands HHS restore $12 million in public health funding. AAP News. Published 2025. Accessed December 30, 2025. https://publications.aap.org/aapnews/news/34072/AAP-lawsuit-demands-HHS-restore-12-million-in
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— Dr. Su