The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention held a series of meetings to determine new recommendations that could significantly impact vaccine protocols; particularly for the measles, mumps, rubella, and varicella (MMRV), Hepatitis B, and COVID-19 vaccines. While these recommendations are not yet policies, they signal potential shifts that physicians should be aware of as the CDC reviews and decides on final guidance.

MMRV vaccine no longer recommended for children under 4

ACIP voted to withdraw its recommendation for the combined MMRV vaccine for children younger than four years of age. Instead, the committee now recommends that children in this age group receive separate doses of the MMR and varicella vaccines.

ACIP recommended that the Vaccine for Children (VFC) program no longer include the MMRV vaccine for children under four. If adopted by CDC, this would have broader implications for reimbursement. Removal from the VFC program would mean the MMRV vaccine would also no longer be covered by CHIP, Medicare, or many small-market private insurers for this age group.

Hepatitis B vote tabled

The committee was scheduled to vote on a proposal to delay the first dose of the Hepatitis B vaccine from birth to at least one month of age. However, the committee voted to table the motion, deferring the decision to a future meeting.

COVID-19 vaccine

Approved

• The administration of FDA-approved COVID-19 vaccine should be updated as follows:
  • For adults ages 65 and older, vaccination should be based on individual-based decision making*
  • For individuals ages 6 months to 64 years, vaccination should be based on individual-based decision making* with an emphasis that the risk- benefit of vaccination is most favorable for individuals who are at an increased risk for severe COVID-19 disease and lowest for individuals who are not at an increased risk, according to the CDC list of COVID-19 risk factors.
    *Also known as shared clinical decision making.
    

The committee also noted there should be no insurance coverage restrictions with the recommendation.

• The CDC should engage in an effort to promote more consistent and comprehensive informed consent processes, and as part of that, consider adding language accessible to patients and medical providers to describe at least the six risks and uncertainties included in the workgroup chair presentation.
  

• In conversations with patients before COVID-19 vaccination, authorized health care providers discuss the risks and benefits of the vaccination for the individual patient. The discussion should consider known risk factors for severe outcomes from COVID-19, such as age, prior infections, immunosuppression, and certain comorbidities identified by the CDC, and include a discussion of the potential benefits and risks of vaccination and related uncertainties, especially those outlined in the vaccine information statement, as part of informed consent.
  

Not Approved

• State and local jurisdictions should require a prescription for the administration of a COVID-19 vaccination.
  

What Happens Next?

It’s important to note that ACIP’s role is advisory. Their recommendations are submitted to the CDC, which may accept them as-is, modify them, or reject them entirely. Until the CDC issues its final guidance, current vaccine schedules and funding mechanisms remain in place. PAMED will continue to monitor CDC actions and provide timely updates as decisions unfold.