CDC shifts COVID-19 vaccination to individual decision-making, separates chickenpox shot for toddlers

Editor's Note

The Centers for Disease Control and Prevention (CDC) has updated its immunization schedules to emphasize individual-based decision-making for COVID-19 vaccination and to recommend that toddlers receive a standalone varicella (chickenpox) vaccine rather than the combined measles, mumps, rubella, and varicella (MMRV) shot, a CDC October 6 release reports.

The changes reflect recent recommendations from the CDC Advisory Committee on Immunization Practices (ACIP), approved by Acting CDC Director and Deputy Secretary of Health and Human Services Jim O’Neill. The new schedules are being published on CDC.gov. O’Neill said the update restores space for providers and patients to weigh risks and benefits of COVID-19 vaccination rather than following blanket booster guidance.

COVID-19 vaccination is now listed under “shared clinical decision-making,” meaning physicians, nurses, and pharmacists should assess factors such as patient age, comorbidities, and vaccine characteristics to guide recommendations. The approach is expected to be most relevant for adults under 65, where the benefits are highest for those at greater risk of severe illness and lowest for those without such risk factors. For adults 65 and older, and for individuals with one or more risk factors, the Food and Drug Administration continues to authorize vaccine use. While uptake of early COVID-19 vaccines was high, CDC data show just 23% of adults received the most recent seasonal booster, highlighting waning demand.

Importantly, vaccination under shared decision-making remains covered by major payment mechanisms, including Medicare, Medicaid, the Children’s Health Insurance Program, the Vaccines for Children Program, and insurance plans regulated under the Affordable Care Act.

The updated child and adolescent schedule now calls for toddlers through age 3 to receive a separate chickenpox vaccine instead of the combination MMRV shot. Evidence presented to ACIP by the CDC’s Immunization Safety Office showed that healthy children ages 12 to 23 months face about double the risk of febrile seizure 7 to 10 days after receiving the combination vaccine compared with those who received standalone varicella immunization. The data indicated no added benefit in varicella protection from the combination shot, prompting the change.