AAP Vaccine Recommendations: A 2026-2027 Update

0:00There was a time when the vaccine conversation in pediatrics felt pretty straightforward. Here's a schedule, here's what your child needs, and here's when they need it. Today, it's anything but. The recommendations are evolving. The vaccine schedule is under a microscope. New guidance is emerging around COVID-19 and RSV, and at the same time, pediatricians are sitting across from families who may be confused, skeptical, or overwhelmed by what they're hearing online. So how do we make sense of all of it, and perhaps more importantly, how do we talk about it? This is charting pediatrics. From Children's Hospital, Colorado, charting pediatrics brings you the latest innovation, groundbreaking research, and educational resources in pediatric medicine. So, Hone of Iris is in the news. Those families are already aware they're something that's not right. I think that's great information to have. What is the child think? How do we start this difficult conversation? What would you recommend?

1:01Here is your host, Dr. Dan Nicholas, General Academic Pediatrician, and Children's Colorado. To break down the latest recommendations from the American Academy of Pediatrics, we are joined by Dr. Sean O'Leary. He specializes in infectious diseases, and is the director of the Colorado Pediatrics Practice-Based Research Network, also known as the Colorado Children's Outcomes Network. He is also a professor at the University of Colorado School of Medicine. Lastly, he is the immunization schedule editor for the American Academy of Pediatrics. Sean, welcome to the podcast. Happy to be here. So, we have so much to talk about, and not, you know, unlimited time. Why don't we maybe set the stage by setting the landscape of all the things that have changed, and I know the AAP came out with a statement just in September, September 2nd, about their stances on a lot of those changes. Sure. So, in some ways, so there have been a lot of changes,

2:04but in some ways a lot actually hasn't changed. So, just a little bit of background. The American Academy of Pediatrics has been making immunization recommendations actually since the 1930s, far before, long before the federal government sort of got into that business. That happened in 1964 with the creation of the Advisory Committee on the Immunization Practices. And even from the 60s into the 90s, a lot, there were two schedules. There was the ACIP schedule, and then there was the AAP schedule. And most physicians actually followed the AAP schedule for vaccine recommendations for kids. ACIP tended to be more for public health. In 1995, it was decided to harmonize those schedules. So, AAP began working very closely with ACIP and AAP, other professional societies to create one single harmonized schedule. And since that time, AAP has worked with ACIP closely with ACIP to produce the schedule.

3:10ACIP makes recommendations that schedule is published in an MMWR. AAP similarly has made a schedule every year. That schedule is published in Pediatrics. So, the AAP is continuing to make the same schedule. We can talk a bit about what's going on with ACIP, but essentially it's in limbo right now, due to a lot of things that your listeners probably already know about. So, the AAP schedule is very similar to what it's been for years. What came out on September 2nd was our fall respiratory guidance. And so, we think of respiratory guidance historically. It was flu, then of course with the pandemic. It's COVID, and now we have these products to prevent RSV. So, flu, those recommendations actually came out in August as they have for a number of years from AAP. And then September 2nd was the new COVID and RSV guidance.

4:12Now, I'll just say that COVID guidance hasn't changed. We recommend vaccination for all kids 6 through 23 months of age, plus certain kids with risk factors 2 and up. And then for anyone else who has either never previously been vaccinated or just wants to be vaccinated. RSV, there were a few changes. We still recommend nurse 7-Mab for all infants under 8 months of age, as well as Claserova-Mab, which is a new product. The thing that has changed is the second season recommendations. So, the up and through last year, the recommendation was for a few specific high risk groups. And those recommendations for that second season, so specifically children 8 to 19 months of age, those are actually based on the old polyvizumab recommendations. So, synergists. And so, when we can talk more about the process, but basically, when we looked at the data,

5:12looked at, you know, are there other kids that might benefit from that second season recommendation, we landed on a few additional categories. So, things like prematurely less than 32 weeks, regardless of the need for medication. Children with Down syndrome or other significant chromosome liab normalities. Children with neuromuscular disorders. So, those are some of the additional risk groups that we've added to that second season recommendation. Okay, so, what I'm hearing you say for COVID-19, it's recommended that all kids get it from six months to two years. And that's a 2-do series. From a Darnacorex. So, the Pfizer is no longer available for the younger kids, unfortunately. Okay. And then for RSV, we are still recommending it for all kids 8 months or less. Under 8 months. Under 8 months. Yeah. If their mother has not gotten the immunization herself. Correct. And it needs to be more than 14 days prior to delivery. Okay. That's very helpful. But in addition, the change is this year that in the second RSV season, we are still giving it again, a single dose, the second season for kids who are high risk.

6:20Correct. Okay. What are the recommendations for the flu shot this upcoming year? So, flu shot hasn't changed. So, all children six months on up should receive a flu shot under. So, if it's your first season under AJ, you get two to, it's two, it recommended two doses. Isn't that second dose does matter for those kids who have never had flu vaccine before? And then otherwise single dose for everyone. And there's been some discussion around like when is the best time to give it? And I think the simple answer is when the kids are in the office. The, there is some data around waning immunity, but it's, it seems to be more, a more significant issue in adults than it does in kids. So, we don't recommend waiting because of this concept of waning immunity. We also know that some flu seasons, flu comes earlier than others. So, if you have it, it's, you know, we're here recording this in kind of early to mid September.

7:20So, if you have a flu shot in the office, give it, don't wait. And then a subtle point about the flu vaccine, you would mention if it's your first season and your under eight that you need two doses. If, in your first season, you get one, in your second season, you want to give two, but you don't. You only give one in that third season. It's still, it's still one. Yeah, okay. I just wanted to call that out. And what are we thinking in terms of the flu season this upcoming year? How's it looking? You know, the only thing that's predictable about influenza is that it's unpredictable. So, I think what I will say is there has, there's been some data suggesting maybe this season will be milder than the last couple, which isn't saying much because the last couple of seasons have been pretty severe. But what we saw in the Southern Hemisphere is a somewhat less severe season. So, that's the hope, but you never know. How about for RSV? You know, RSV, so we don't think that these products are really going to affect seasonality to any meaningful degree.

8:25These products don't prevent infection. They prevent severe lower respiratory tract infections. So, the kids will probably, you know, kids can still get RSV even if they have received the immunization, either the maternal, the maternal vaccine or the immunization with one of the monoclonal antibodies. They can still get RSV. They're just less likely to get severe lower respiratory tract infection, less likely to be hospitalized. So, we don't think it's going to meaningfully change the circulation of RSV. But it's also, you know, RSV is also similarly hard to predict in terms of when it's going to peak, et cetera. I mean, we know it generally, you know, it sort of starts to pick up December, January, often peaks late January, February, but that varies year to year. So, there had a little bit later peak longer tail. So, hard to know for sure. Are there any contraindications to getting the RSV, nurse of MAP? Really, the only one is there's allergy to something within the product, which would basically be almost zero.

9:28So, essentially no real contraindications. Okay. So, this has been really helpful, sort of updates to current state. We're in September, 2026, thinking about our upcoming winter season in the Northern Hemisphere. Let's shift a little bit here and start talking a little bit about the vaccine landscape. So, you know, last year the group, the ACIP group was dismissed, basically. A new one was formulated. They were supposed to meet in February of this year. It was postponed and they haven't met yet. And then there was an executive order in August of this year, you know, making some suggestions for the way to deliver vaccines. Can you kind of set that landscape for our listeners? Sure. You know, I want to start off a little bit with the punch line, which goes back to your introduction of, you know, what used to be.

10:28I would say my recommendation would be go into your visits with the same mindset. These are the recommendations. And this is what your child does do for. I recommend to get these vaccines. The point I want to make there is that the vast majority of parents actually are still vaccinating their kids according to the recommended schedule. So, I would just, you as the pediatric pediatric clinician much more than they trust the headlines. They want to hear it from you what you recommend. So, I would caution against going in with a mindset of, oh my gosh, there's so much chaos. I'm going to have a tough conversation because a lot of parents just want to hear what you recommend. So, that's one of the main points I want to make. And in terms of what's going on, so going back earlier, so January 5th was this press conference that they attempted to change the schedule, move a bunch of vaccines into shared clinical decision making. That then was challenged in court successfully.

11:30And so, those changes were stayed up on the CDC website to this day are the original recommendations from going back to July of 2025. So, those all of that stuff is noise. And what it's done though is create a lot of confusion for families. And frankly, for a lot of clinicians too. The executive order that happened a few weeks ago, that didn't really meaningfully change anything. It repeated a lot of the same things that were said in the news conference January 5th. But the authority to change the vaccine schedule can, that doesn't happen with an executive order. So, what I am encouraging people to do is point to the professional societies, point to the American Academy of Pediatrics, point to the American Academy of Family Physicians, A-Cog, American College of Obstetricians and Gynecologists, handling maternal vaccines, AAP is handling adult vaccination, IDSA is helping with immunocompromised AAP is handling child, NADLS and schedule.

12:31So, I would ground recommendations not in what, not in the chaos of what's happening at the federal level, but in the professional societies. Yeah, you know, it was interesting you said earlier, a lot hasn't changed actually. And I think about my, you know, I've been doing pediatric practice for close to 20 years now. And I was thinking about, you know, I never, I have never once forced a vaccine down any patient's throat. I recommend vaccines and believe in them wholeheartedly. But ultimately, if someone has questions and concerns, you know, I meet them where they are. And we can get into that a little bit. And so, thinking about like a shared decision making model, not a lot has changed in terms of how I approach it. And I certainly still follow the American Academy of Pediatrics recommendations. Yeah, let me say a bit about this whole shared clinical decision making thing because I think there's a lot of confusion there. So, that came, that originally came out of ACIP.

13:33And this predates, this goes back close to a decade. Historically, what ACIP and AAP's recommendations would be either they recommend a vaccine or they didn't recommend a vaccine, or there was what they called a permissive recommendation. It was available and, you know, if people wanted it, they could get it. I actually liked that model better. But what ACIP did, they went to what they called category A and category B recommendations. So, category A was a routine recommendation. B was in certain clinical circumstances. Then around 2018-ish, they changed that category A and B to routine recommendation, shared clinical decision making recommendation or no recommendation. And the reasoning there was that, well, not entirely sure what the reasoning was for using that particular term because what it ended up leading to was a lot of confusion.

14:33But basically, they used that recommendation when there wasn't enough evidence for a new vaccine for a population level routine recommendation, but they still wanted it available. And so, the best example in pediatrics is the CIRC group B meningococcal vaccination. So, you remember that one is under, it was originally on a category B, then it was shared clinical decision making. And basically, it puts a lot on the clinician. It says, well, and what I've heard from clinicians actually, when that came out, what I heard from a lot of people was like, you guys are the experts, you're supposed to tell us what to recommend. How are we supposed to figure that out in a 10 minute office visit when you can't tell us if it's a good idea or a bad idea. So, there was a lot of confusion when that recommendation came out. But it was really not about the conversation, which is what, to come back to what we're talking about, what you just brought up, we have these, I mean, I've been in pediatrics since the 90s and have had many of these conversations myself.

15:42We talk about vaccines all the time. Now, we recommend, you know, here's what your child's do for, parent has questions, we have a discussion. You can label that shared decision making, right? You're talking with the family about the pros and cons, the risks, the benefits, etc. And then ultimately, the parent comes to a decision to somehow move these other vaccines into this other recommendation makes no sense. And that's what they did. And so, it doesn't change the fact that we're already having those conversations. It just makes it, it makes it sound like these vaccines are somehow less important. Yeah, I think for our providers out there, I want them to feel empowered that really nothing has changed for us. We are still making recommendations grounded in science. Right. Right. Up on these vaccination schedules from the American Academy of Pediatrics and, but as you called out, I think the public discourse is probably confusing for a lot of our families.

16:45It's reassuring to me that you say that there's no evidence that there's been a bump up in resistance since that. And, like, totally, I feel like within my patient population, there has been a little bump up. Yeah, I think it's complicated. You know, certainly, there are, there is a lot of confusion out there. And I have heard from plenty of pediatricians, the general concept, like a parent comes in, they've maybe vaccinated their other kids, or this is their first child. And they say, you know, there's just so much, like, there's just so much out there right now about vaccines. There's so much controversy. I just want to wait, you know, some version of that. Yeah. And it's not that they're anti-vaccine. They're just confused. And that's where we come in as pediatricians to kind of help navigate them through that, that challenging time. I mean, I think, you know, the vast majority of parents are not reading the details of all the chaos that's going around around vaccines.

17:45They're just hearing a lot of, you know, they're not paying attention to it the way we are as pediatricians, for example. And so, it's just, for a lot of families, it's just a lot of confusion around vaccines, not necessarily knowing all the specific details that we're talking about today. Let's call out a few that I think are the ones that are maybe met with the most resistance. Maybe, why don't we start, I'm going to start in opposite age order. Let's start with the HPV vaccine. Sure. Because that recent executive order, if I'm not mistaken, said you only need one now. So they did say that in the January, that January recommendation, they moved to a single dose. The executive order, I did read it, but I can't remember actually if they had moved that to a single dose. They did somewhat surprisingly keeping it, keep it in the routine recommendations, because there has been a lot. And I don't know how, you know, who knows what the decision making was behind that, because the, you know, recently, on a point today, CIP members, a lot of them were anti HPV vaccine.

18:55The health secretary himself has had, you know, been involved in lawsuits against the manufacturer, the HPV vaccine. So it was a little surprised to see that. But in any case, the single dose issue. So just for, for some background, a number of the World Health Organization several years ago, made a recommendation that it was potentially an option to do single dose based on a lot of observational data showing both duration protection from single dose. And a number of countries have already moved to a single dose. ACIP, and I was on the ACIP HPV workgroup until we were all sort of uninvited from the workgroups. ACIP was considering moving the US to a single dose recommendation. And in fact, there initially had been a vote planned for the June 2025 meeting.

19:56ACIP was considering two things. One was the move to a single dose. Another was a change in the language around HPV vaccine to move it to an earlier age, similar to what the AP already does. The vote for the single dose, I think they had planned up, they postponed that one, but they were still planning on voting maybe at the October 2025 meeting. And of course, all of that is now unhold. I will say this is moving into maybe a little bit of kind of our process at AAP. We are in the process of reviewing evidence for HPV vaccine, basically picking up the ball where ACIP left off. So just to tell you a little bit about our process, since we've now had to sort of take on a lot more responsibility on the immunization schedule, you know, previously our, it was, it was very much in collaboration with CDC. Now, of course, that's broken. And so we are working with the vaccine integrity project. We're working with with a number of other external partners gathering evidence around different vaccines. And so as you know, we've made the AP's immunization schedule.

21:04The other things we did, we already talked about RSV flu and COVID, we formed what we called subgroups. So ACIP had work groups, but we didn't want to pretend that we're trying to replicate ACIP. So we are calling these subgroups. So we had an RSV subgroup of COVID subgroup. And we have an HPV subgroup that is considering the data around single dose HPV vaccine, considering the data around age of recommendation. And if there are any changes to the HPV recommendations from AAP's perspective, and I should say this is in collaboration with the other professional societies, those would come out in December. Okay, so stay tuned for that. Yep. All right. So, you know, MMR has been a thing for a long time due to, you know, a fabricated research study in the Lancet in the late 1990s that has been retracted. And subsequent studies on whether or not MMR causes autism, I think there's been 16 studies. Many, many, many. Yeah. Yeah. And that initial study was only 12 kids. And anyway, what would you tell our audience about that?

22:10Yeah. So MMR, I mean, I'll just start with the top line. MMR is a very safe vaccine. And it is the best way to prevent measles, mumps, and rhubbos. Period. So just background, the, that retracted Lancet study that you mentioned, published in 1998 at a press conference, so when that paper came out, the lead author suggested separating MMR out into individual components, not stating, of course, at the time that he had applied for patents for other vaccines. So big conflict of interest there. But there's no scientific evidence. There's absolutely no reason to separate them out. And there are lots of reasons not to. And so he, he had suggested that back then. So what we heard from this executive order in the press conference was essentially a recycling of, you know, 30 year old myths.

23:10And we have not had separate MMR components available in the US for many years. It would take several years to even bring those back to the market if the manufacturers were even interested in doing so. So I think that's, that's really a non starter that's, it's, I really don't think that's going to happen. And there's no reason to. What about the combination of MMR and Varicella? I know, you know, it increases likelihood of febrile seizure at one. And so that generally is not done. But at four, a lot of the time it is done for one less poke for the kids. Sure. And in fact, so there is a subtle difference between the ACIP recommendation, the AP recommendation on this one. In general, both ACIP and AP prefer combination vaccines when they're available. For ACIP, they make an exception for MMRV and say that the separating them is preferred, but you can offer MMRV if you have it.

24:11AP says you could, you should basically leave it up to the parents because the, the risk is really minimal. As we know, as pediatricians, febrile seizures are scary, but they're benign. And there's no, there's no increased risk of development of seizures, seizure disorder, anything like that. So a lot of practices actually do offer MMRV at a year of age. Okay. But the risk is for the additional febrile seizure is pretty small. Okay. So those recommendations from the AP and the ACIP, are they for ages one and four or one? So it's for both. It's preferred. The MMRV is preferred at four to six. Okay. For the for the kindergarten dose. Great. Thanks for that distinction. Okay. Hepatitis B. Right. Yeah. That one is troubling because the hepatitis B is a very important thing. The hepatitis B birth dose has been such a cornerstone of our strategy to prevent hepatitis B for so many years. And we had, you know, a lot of people working very hard to get those rates up over the years and they have fallen dramatically.

25:25And unfortunately, what that's going to lead to is more kids getting hepatitis B. And just to be clear on the numbers, why do we give the birth dose? One, it predicts future vaccine uptake. Actually, that's one thing is parents who, and there's a lot of thoughts on why that mech, what that mechanism might be. But the, the, the B vaccine at birth is generally very well tolerated. And actually subsequent doses are very well tolerated as well. But that's the lesser reason. The bigger reason is it can actually prevent hepatitis B in the newborn by itself. We know roughly 15, 10 to 15% depending on the data source you use of pregnant women are not screened properly for hepatitis B during pregnancy. We also know that there are lots of transcription errors, some occasional lab errors. Sometimes someone is tested for hepatitis B early in their pregnancy. And then they see a convert later. They acquire hepatitis B later in pregnancy.

26:27Lots of reasons that a mother might unknowingly pass hepatitis B onto the infant. So giving that first dose within 24 hours by itself can prevent the infant from hepatitis B. Now if we know the mom is infected, we give H big hepatitis B immune globulin and the vaccine within 12 hours of birth. But even that simple birth dose can, can prevent it. Now the other thing that a lot of people don't realize is that it's not just paranoally acquired, though, that we're preventing with those that early hep B vaccination. Prior to widespread vaccination in the US, roughly half of pediatric cases of hepatitis B were acquired post-nally from someone in the household who usually didn't know they had hepatitis B. So there are lots of people in the US, probably roughly half of people that are infected with hepatitis B don't know they have it. Hepatitis B is very easily transmitted within households. And so getting those infants vaccinated early can prevent them from getting it from someone in the household.

27:34And then to be clear about why it's so important of kids who acquire hepatitis B in early childhood 90%. So almost all of them will go on to develop chronic hepatitis B. Of those roughly a quarter will die of the disease. Okay, so prior to widespread vaccination, we had roughly 20,000 cases of pediatric hepatitis B in the US. That was down to seven in 2023. So it has been a hugely effective program to prevent hepatitis B in children. And now we're backsliding and we've really got to work on that. Okay, how about flu? Yeah, so influenza, we all know it, deal with it every single year, some years are worse than others, but they're never good. We were up to roughly 60%, you know, the recommendation of course is all kids six months and older as we discussed. We were up to close to 60%, which is a pretty high number considering it's a seasonal vaccine and that's kept that's capturing all the adolescents who don't always come in for care, etc.

28:37So that was, you know, pretty good. You know, the goal is higher, of course, but some practices actually can get, I know practice in the Denver area that have gotten north of 80% on their flu vaccination coverage, which is really impressive. That now nationally has gone down to less than 50% where in the high 40s now in terms of annual flu vaccination. I think there's a lot of spillover from COVID fatigue, refusing COVID vaccines, people also refusing flu vaccines. I think there's also staffing issues in primary care that are a real problem right now. I think, you know, a lot of primary care practices are operating on very thin margins, they're short staffed. They may not be able to host the big flu clinics they used to host. They may not be able to have the nurse-only visits they used to have. So a lot of challenges to flu vaccination right now, but I do recommend continuing to recommend it to all your patients every year, use every opportunity to vaccinate your kids against flu. The evidence continues to accumulate on how effective flu vaccine is at preventing infection, but more importantly, hospitalization, ICU admission and death.

29:44Yeah, I mean, it's not in consequential. You know, kids are still dying of the flu. Yeah. And these other diseases, as you mentioned, hepatitis B as well. So yeah, I think we should be encouraging as much as possible. What would you say to our audience in terms of the people that do come in with some hesitancy? Do you have one? I know there's not one panacea, but like if you had one sort of methodology that you think works quite well with most families, what would it be? Yeah, I mean, I think going in with a strong recommendation, that's the most important thing. And actually having that across the clinic from the front desk through the medical assistance nurses, all the clinicians are all on the same page about vaccination. It's time for, you know, he's due for, you know, something along those lines, not sort of being wishy-washy about it. And that's true for all the vaccines that are routinely recommended. So that's probably the most important thing is not approaching it thinking, oh, got another vaccine conversation.

30:45Go in the same way you always have in terms of, you know, you believe strongly in vaccines, you know, they're important. You know why we're giving them and convey that to the family, make them understand that this is what we do, this is important. In terms of where you go from there, because, you know, certainly a lot of families have questions, a lot of push back. We of course have been teaching motivational interviewing around vaccine conversations for a long time here, based on some big studies that have been done here and elsewhere. And a few techniques I'll just toss out there. And a lot of this comes naturally. So affirmations, open-ended questions, you know, it's pediatricians, we do a lot of affirmations. You're doing such a great job, you're a great mom, you know, that kind of comes naturally to us. Because it's true, right? They're coming in, they care about their kids. Yes. And that's why they're there, right? I think that's an important thing for us to internalize too, is when parents have questions, don't take that personally, right?

31:46They have reasons to be confused, they have reasons that they have questions. They're just trying to do what's best for their kids. And as long as we sort of keep that mindset that we're all on the same page here, I think that helps those conversations a lot, keeps you from getting into arguments. Another trick, or another motivational interviewing technique that I really strongly recommend is just this concept of asking permission to share. So parent, you know, has some questions or maybe pushes back, oh, we don't want that vaccine today. You kind of just, let's explore that a little bit. Tell me a little, tell me more, tell me what's going on. And then they kind of share their concern. And then instead of just what, what, you know, it's very common for physicians in particular to do is the data dump. Just sort of come right back at them with all the reasons why they need to get that vaccine. Just say, oh, you know, I've heard that question before. Would it be okay if I went over what I found out about it? And simply asking that question triggers a little psychological switch that makes them more receptive to what you're then going to share with them, that rather than if you would just sort of dumped it on them.

32:53Trying to keep it relatively simple, stick to the question they asked. Don't overwhelm them with data with, you know, lots of numbers, lots of specific things. Just stick to the, stick to the question. Have a nice conversation and keep the conversation open. Right. So if they ultimately say, well, we still don't want to do that today, that's okay. What I would, I was in primary care for a long time. And what I would always say to families at the end of these conversations was, you know, just good naturedly say, you know, as a pediatrician, I, I, this is one of, this is probably the most important thing I do to protect children's health. And I'm going to bring it up every time just so you know, and they'd usually good naturedly say, okay, okay. And then, you know, we'd have another conversation the next time and didn't always work, but sometimes eventually I think we've all had families that eventually come around. Yeah, I do that same thing, Sean. And one of the things that is coming through and in the advice that you just gave is, you know, treating people with respect and everybody deserves dignity.

33:53And as you said, all families are there because they love their children. They're just trying to do right by their children. And as frustrated as we may get, because they don't agree with us, we do have to take a step back and empathize with their situation, especially given all the information that's circulating right now. So anyway, well, we've gone through a lot of things in the last 30 minutes. If there was one take home message, you would want our audience to have, what would it be? I think go easy on yourself. It's a pretty challenging time to be a pediatrician right now. I think for a lot of the reasons we've discussed. And, you know, we went into this field to take care of kids, focus on that. And, you know, acknowledge when you're when you're having a hard time because it can be pretty difficult right now. And, you know, talk with your colleagues. Be easy on yourself. Thanks, Sean. Thanks for all you do. And thanks for being here. Glad to be here. Charging Pediatrics is a production of Children's Hospital Colorado.

34:57Do you have questions on this topic or an idea for a future episode? Write to us at Charging Pediatrics at Children'sColorado.org. Follow us on Instagram and check us out on YouTube. Don't forget to rate us and share with others who might be interested. Our executive producer and managing editor is Jesse Mankle. Our leadership team includes Melanie Douglas and Matt Hughes. Thanks for listening and make sure to tune in next Tuesday.