CDC panel votes to limit MMRV vaccines

Why it matters: The deliberations by the Advisory Committee on Immunization Practices marked the most significant moves yet to carry out Kennedy's goal of revising childhood immunizations and immediately drew harsh criticism from public health officials.

• The recommendations still must be approved by the Centers for Disease Control and Prevention, an agency under Kennedy that currently does not have a full-time political leader.

Driving the news: The panel voted 8-3 with one abstention to recommend against giving the MMRV vaccine to children before the age of 4, citing concerns about the risk of seizures in younger children. That group should get the MMR and the varicella shot separately, they said.

• Many doctors already give separate vaccinations but make the combined option available for parents seeking to minimize the overall number of shots their children receive.
• The recommendation means it's possible that health insurers will no longer cover the MMRV vaccine for children under four. However, a second vote by the committee determined that the federal Vaccine for Children's Program should continue to cover the vaccine as it has.

The panel also debated limiting Hepatitis B vaccines to newborns whose mothers test positive for the virus, and delaying the shot for others until the child is at least one month old. They will vote on the matter on Friday.

• The Hepatitis B vaccine is delivered to infants to protect against both perinatal and environmental exposure, which could lead to chronic infection, lifelong complications and even death, according to a Centers for Disease Control and Prevention presentation at the meeting.
• Pushing back the timing could lead to gaps in vaccination and reduced access to the shot, CDC staff said, with 12% to 16% of U.S. pregnant women going unscreened for Hepatitis B.
• Risks associated with the birth dose are generally small, with adverse events resulting from the shots considered "mild", they said.
• However, Kennedy and members of the panel have criticized the universal delivery of the vaccine in newborns as unnecessary.

Between the lines: Liaisons from medical organizations including the American College of Physicians raised concerns during the daylong meeting that the panel was not considering enough data, such as information on real world delivery and potential impacts on health equity. They unsuccessfully pressed to delay the vote on MMRV.

• The medical groups also questioned the need to revise policies on the MMRV and Hepatitis B shots, both of which are mainstays of the childhood vaccination schedule.
• "What problem exists in the current schedule that has prompted this entire discussion?" said Amy Middleman, the liaison for the Society for Adolescent Health and Medicine. "We all know, I think, there are always some risks and benefits and we vet those risks and benefits and compare them."

• We have an immunization schedule for Hepatitis B that's been incredibly successful ... I'm trying to figure out what the question was that really prompted this?" she added.
• ACIP member Robert Malone responded that "a significant population of the United States has significant concerns about vaccine policy and about vaccine mandates," especially for shots delivered at birth.

Medical groups criticized the proceedings, saying they would help spread misinformation.

• The primary goal of this meeting "was to sow distrust and instill fear among parents and families," Sean O'Leary, chair of the American Academy of Pediatrics' committee on infectious diseases.
• "It's one thing to ... talk with parents and say, be careful of your sources of information. Be careful what you see on social media, those types of things. In this case, they're hearing it from their federal government, and it's just heartbreaking."

During the meeting, ACIP chairman Martin Kulldorff took exception with critics' characterizations of the panel as "anti-vaccine."

• He pointed to nine former CDC directors who criticized the makeup of the committee in a recent New York Times op-ed, saying Americans shouldn't trust them unless they were willing to engage in a public debate with him.

What to watch: Kulldorff announced during the meeting plans to create working groups to investigate vaccinations delivered during pregnancy, as well as other childhood vaccines.