By IDSE News Staff
The CDC updated its adult and child immunization schedules to apply clinical decision-making to COVID-19 vaccination and recommend that toddlers receive protection from varicella as a stand-alone immunization rather than in combination with measles, mumps, and rubella, and varicella (MMRV) vaccination.
COVID-19 Changes
Unlike the COVID-19 primary series that reached nearly 85% of the U.S. adult population, just 23% of adults followed the CDC’s most recent seasonal booster recommendation, according to its National Immunization Survey. Misinformation has prompted widespread risk–benefit concerns about vaccine safety and efficacy as SARS-CoV-2 became endemic following population-wide immunity acquired during the pandemic and from vaccination.
The Advisory Committee on Immunization Practices (ACIP) recommendation emphasized that the risk–benefit ratio of vaccination in individuals younger than 65 years of age is most favorable for those who are at an increased risk for severe COVID-19 and lowest for those who are not at an increased risk for hospitalization and death, according to the CDC. The FDA has approved marketing authorization for COVID-19 vaccines for individuals who have one or more of these risk factors, as well as for those 65 and older.
The CDC’s immunization schedules emphasize shared clinical decision-making, which references providers including physicians, nurses, and pharmacists. Like routine recommendations, shared clinical decision-making allows for immunization coverage through all payment mechanisms including entitlement programs such as the Medicare, Medicaid, Children’s Health Insurance Program, and the Vaccines for Children Program, as well as insurance plans regulated by the Affordable Care Act., the CDC said.
MMRV Versus MMR + V
The CDC child and adolescent immunization schedule’s new recommendation requires two shots: MMR and chickenpox separately for toddlers 12 to 36 months, which is the schedule that most children already follow. MMRV vaccine only accounts for 15% of the first dose for measles, mumps, rubella, and varicella vaccination, according to a presentation made at the ACIP meeting in September.
The new ACIP panel changed the recommendation because children in that age group have an increased risk for febrile seizures seven to 10 days after vaccination for the combined MMRV vaccine compared with those given two separate shots without conferring additional protection from varicella, ACIP said.
The former ACIP panel had already said MMR plus varicella as two separate shots was preferred, but still gave parents the choice to use the single-shot vaccine if they wanted their children to receive fewer needles. The original recommendation by the former ACIP members added that the decision should be made after discussing the risks of the combination vaccine: “Providers who are considering administering the MMRV vaccine should discuss the benefits and risks of both vaccination options with the parents or caregivers.”
The new recommendations remove this choice.
The schedules will be updated on CDC.gov by Oct. 7.
