Embargoed for release until 5:00 p.m. ET on Monday 19 October 2026
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine . The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Proposed changes to hepatitis B vaccination schedule could significantly increase infections, model suggests
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02135
URL goes live when the embargo lifts
A modeling study suggests that replacing universal hepatitis B vaccination at birth with delayed vaccination or a shared decision-making approach, as recommended by the U.S. federal government this year, could lead to substantially more chronic hepatitis B infections among U.S. children. Compared with the current universal birth-dose strategy, a shared decision-making approach was projected to increase chronic infections by 83% and more than 50% of children entering adulthood vulnerable to hepatitis B infection. The findings are published in Annals of Internal Medicine.
Researchers from Massachusetts General Hospital and Harvard Medical School developed a Markov state transition model to project the long-term impact of proposed childhood hepatitis B vaccination policy changes in a single year birth cohort of 3.6 million infants. The model compared the current practice of vaccinating all newborns against two alternative strategies: deferred (2-month) vaccination of infants born to women without HBV infection, consistent with the Advisory Committee on Immunization Practices (ACIP) recommendations of December 2025; and shared decision making for 2-month vaccination of infants born to women without HBV infection, consistent with the proposed Centers for Disease Control and Prevention (CDC) policy of January 2026. The analysis found that deferring vaccination to age 2 months would increase chronic HBV infections acquired by age 20 years by 19%, and a shared decision-making vaccination policy would increase chronic HBV infections acquired by age 20 years by 83%. The authors conclude that universal hepatitis B vaccination at birth remains the most effective strategy for preventing childhood infections and reducing future vulnerability to the virus.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Amir M. Mohareb, MD, please email amohareb@mgh.harvard.edu.
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2. 1 in 6 adults with type 1 diabetes report moderate to severe depression or anxiety symptoms
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01948
A nationally representative study of U.S. adults found that the prevalence of depressive or generalized anxiety disorder (GAD) symptoms was much higher among adults with type 1 diabetes compared to those with type 2 diabetes or without diabetes. Among adults with type 1 diabetes, women, younger adults, and people with less than a high school education were more likely to experience moderate to severe symptoms of depression and anxiety. The findings are published in Annals of Internal Medicine .
To better understand the mental health burden of type 1 diabetes, researchers from Johns Hopkins
Bloomberg School of Public Health analyzed data from more than 58,000 U.S. adults who participated in the National Health Interview Survey in 2019 and 2022, including 326 adults with type 1 diabetes. Participants completed validated questionnaires that measure symptoms of depression and anxiety. The study found that the prevalence of moderate to severe depressive symptoms was 17.1% of adults with type 1 diabetes compared with 12.4% of those with type 2 diabetes and 6.6% of those without diabetes. The prevalence for moderate to severe anxiety symptoms was 16.2% of adults with type 1 diabetes compared to 8.7% in those with type 2 diabetes and 6.1% in those without diabetes. The findings suggest that adults with type 1 diabetes face a substantial mental health burden and that improved screening, particularly among higher-risk groups, could help support better diabetes management and quality of life.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Michael Fang, PhD, please email mfang9@jh.edu.
3. AI models rarely recommend unnecessary care in Choosing Wisely tests
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01667
Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-26-03798
A benchmark evaluation found that large language models (LLMs) generally aligned with evidence-based medical guidance and rarely recommended unnecessary tests or treatments in scenarios based on recommendations from the Choosing Wisely initiative. Researchers found that LLMs recommended potentially unnecessary care in just 5.4% of responses and rarely failed to recommend care when it was appropriate. The findings are published in Annals of Internal Medicine.
Researchers from Clalit Health Services and Ben-Gurion University of the Negev created 225 clinical scenarios based on 15 Choosing Wisely recommendations to evaluate whether six commercial LLMs could correctly distinguish between situations where medical restraint was appropriate and those where testing or treatment should proceed. Overall, the models rarely withheld appropriate care, with a false restraint rate of just 0.6%, and did not recommend overuse in more than half of the recommendations tested. However, they were more likely to recommend unnecessary care in areas where medical societies disagree on recommendations (thyroid ultrasound for incidental small thyroid nodules) or in scenarios where symptoms could arguably be related to the intervention being tested (routine electrocardiograms in low-risk adults). The authors concluded that commercial LLMs generally performed well in applying Choosing Wisely principles, though targeted improvements may be needed in areas where overuse was more common.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Dean Ariel, MD, MPH, please email Ehud Zion Waldoks (Ben-Gurion University of the Negev) at ezw@bgu.ac.il or Neta Netivi (Clalit Health Services) at neta.netivi@gmail.com.
4. Cardiovascular diagnoses during Medicare home assessments rise yet follow-up care lacking
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01366
Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-26-03680
A population-based cohort study found that an increasingly large share of Medicare Advantage beneficiaries are being diagnosed with cardiovascular risk factors and heart conditions during in-home health assessments, a practice whereby insurers send health care professionals (typically nurses) to visit patients in their homes. However, patients diagnosed during these home visits were consistently less likely to receive follow-up treatment than those diagnosed during traditional medical encounters (outpatient visits or hospitalizations), suggesting in-home assessments may not be effective in connecting patients to care. The study is published in Annals of Internal Medicine .
Researchers from Beth Israel Deaconess Medical Center and Brigham and Women's Hospital examined Medicare claims data from more than 21 million Medicare Advantage beneficiaries between 2018 and 2022 to assess how often cardiovascular conditions were identified during in-home health risk assessments (HRAs), characteristics associated with HRA-based diagnoses, and treatment rates after diagnoses. The study found that diagnoses made during home visits increased across a range of conditions, including high blood pressure, diabetes, heart failure, and vascular disease. Racial and ethnic minority beneficiaries and those enrolled in lower-rated health plans were more likely to receive these home-based diagnoses. Despite the growing use of HRAs, treatment rates following these diagnoses were consistently lower than treatment rates following diagnoses made in clinics or other health care settings. The authors conclude that the diagnostic patterns of HRAs and follow-up treatment gaps warrant further evolution as policymakers consider Medicare Advantage reforms.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Andrew S. Oseran, MD, MBA, MSc, please email Peter Balvanz at pbalvanz@bidmc.harvard.edu and Lucy O'Brien at lobrie12@bidmc.harvard.edu.
Also in this issue:
Bemotrizinol Approval: A Step Toward U.S. Sunscreen Modernization
Aaron D. Smith, MD; and Micaela A. Shulman, BA
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02686
Iron Deficiency in Women: A Silent Pandemic With Consequences That May Reach the Classroom
Michael Auerbach, MD; and Malcolm G. Munro, MD
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-03091
Annals of Internal Medicine
News article
People
Projected Effect of 2026 Federal Changes to the Childhood Immunization Schedule on Chronic Hepatitis B Virus Infections in the United States
20-Oct-2026