CDC Advisors Endorse Adding COVID Shots to Vax Schedule

The CDC's Advisory Committee on Immunization Practices (ACIP) voted unanimously Thursday to add COVID-19 vaccination to its panel of routine immunizations for both kids and adults.

The 15-0 vote does not mandate vaccination for children or adults or prevent unvaccinated children from attending school; it's simply an annual update to the child and adult immunization schedules, panelists pointed out.

Responding to concerns raised in public comments about making COVID vaccines part of the routine childhood schedule, Matthew Daley, MD, senior investigator for the Institute for Health Research at Kaiser Permanente in Aurora, Colorado, said the vote didn't reflect a new policy or a mandate.

"But I will acknowledge ... that there is symbolism in adding COVID-19 to the childhood immunization schedule, and that symbolism is that we view this as routine and that we view this as, COVID is here to stay," Daley said.

Daley said as a practicing physician he sees this as "an opportunity, in my patients, to prevent serious disease and death. ... But we acknowledge that there's concern on the part of the parents. ... [W]e just need to continue to do better at communicating why we think the benefits strongly outweigh the risks."

Nirav Shah, MD, JD, director of the Maine Center for Disease Control and Prevention in Augusta, distinguished Thursday's vote on the immunization schedule from Wednesday's vote to include COVID-19 in the Vaccines for Children program.

"Yesterday's vote, in effect, was a resolution about the coverage of the vaccine for un- and under-insured children, not a discussion of what pediatricians ought to be doing in an office setting," he said.

Thursday's discussion "does not constitute a requirement that any child receive the vaccine," he added. There are already vaccines on the immunization schedule, such as those for seasonal influenza, that are not required for school attendance in many jurisdictions, Shah noted.

"Local control matters, and we honor that. The decision around school entrance for vaccines rests where it did before, which is with the state level, the county level, and at the municipal level, if it exists at all," he said. "They are the arbiters of what vaccines are required, if any, for school entry."

Each year the ACIP Combined Immunization Schedule work group updates the child/adolescent and adult immunization schedules, which are then approved by the full advisory committee, said Sybil Cineas, MD, of the Warren Alpert Medical School of Brown University.

Cineas stressed that the updates don't constitute new policies, but reflect previously agreed-upon recommendations.

Updates to the Child and Adolescent Vaccine Schedule

The 2023 Child and Adolescent Immunization Schedule, for those age 18 and under, will now include Pfizer/BioNTech's COVID-19 vaccine (Comirnaty); Moderna's COVID-19 vaccine (Spikevax); Pfizer and Moderna's bivalent vaccines; and Novavax's COVID-19 vaccine.

For children who are not moderately or severely immunocompromised, it includes recommended intervals between doses for the COVID-19 primary series, said A. Patricia Wodi, MD, of Emory University in Atlanta.

However, "because booster dose recommendations are still evolving, we've included a link to the webpage with the most current recommendation," she noted.

With its unanimous vote, the committee also approved including:

• The measles mumps and rubella (MMR) vaccine, Priorix
• The 15-valent pneumococcal conjugate vaccine, Vaxneuvance
• Changes to the minimum interval dose for pneumococcal conjugate vaccines

The schedule also notes that for 18-year-olds who are at increased risk of poliovirus who have no evidence of a complete polio vaccination series, providers should administer the remaining doses in the three-dose series. If there is evidence of a completed vaccination series, providers may administer "one lifetime [inactivated poliovirus vaccine] booster."

With regard to hepatitis B vaccination, if there's evidence of a maternal hepatitis B infection, an infant should be cared for as if the mother is hepatitis B surface antigen positive. And for catch-up vaccinations, adolescents 18 years and older may be given Heplisav-B or PreHevbrio.

The schedule notes that Dengue vaccine should not be given to children traveling to endemic Dengue areas, Wodi said.

Updates to the Adult Immunization Schedule

The COVID-19 primary series is recommended for adults of all ages, and a link to additional information regarding boosters is included in the 2023 Recommended Adult Immunization Schedule.

Other changes include the addition of the first recombinant three-antigen hepatitis B vaccine, PreHevbrio, and the MMR vaccine Priorix.

Anyone age 60 and up who has known risk factors for hepatitis B infection should complete the hepatitis B vaccine series, the update states. The schedule also includes a note that Heplisav-B and PreHevbrio are not recommended in pregnant women due to a lack of safety data, said Neil Murthy, MD, MPH, a medical epidemiologist for the U.S. Public Health Service.

As for influenza, the schedule now states that even for adults with egg allergies, with the exception of hives, or individuals requiring epinephrine or another emergency medical intervention, "any influenza vaccine appropriate for age and health status may be administered to such patients."

However, certain egg-based influenza vaccines, namely IIV4 or LAIV4, should be administered in a medical setting under the supervision of a clinician prepared to recognized and manage severe allergic reactions, Murthy noted.

Finally, the schedule now states that COVID-19 vaccines, whether authorized or approved, are covered by the Countermeasures Injury Compensation Program.

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