ACIP to meet for MMRV, Hep B, COVID vaccine proposed recommendations | Image Credit: © JJHVEPhoto - © JHVEPhoto - stock.adobe.com.

COVID-19 Proposed recommendations

In its second meeting in as many days, the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) proposed and voted on the following recommended changes related to COVID-19 vaccines.¹

According to the YouTube live stream of the meeting's second day, the ACIP has listed 4 proposed recommendations to vote on. The recommendations and vote tallies as voted by the ACIP included:

Vote 1:

"It is the sense of the committee that the CDC engages in an effort to promote more consistent and comprehensive informed consent processes, and as part of that considers adding language accessible to patients and medical providers to describe at least the 6 risks and uncertainties included in the WG chair presentation."

ACIP voted by 11 "yes" and 1 "no" to pass this recommendation.

Vote 2:

"It is the sense of the committee that state and local jurisdictions should require a prescription for the administration of a COVID-19 vaccination."

ACIP voted by 6 "yes" and 6 "no" on this recommendation. Because of the tie, the Chair of the committee held the tie-breaking vote, which was a "no" vote. As a result, this recommendation failed.

Vote 3:

"It is the sense of the committee that 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."

ACIP voted by 12 "yes" and 0 "no" to pass this recommendation.

Vote 4:

"The pediatric and adult immunization schedules for administration of FDA-approved COVID-19 vaccines should be updated as follows:

• Adults 65 and older: Vaccination based on individual-based decision-making" (shared clinical decision making)
• "Individuals 6 months to 64 years: Vaccination 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."

ACIP voted by 12 "yes" and 0 "no" to pass this recommendation.

Recap from Day 1: Mumps, measles, rubella, and varicella

On Thursday, September 18, 2025, the ACIP voted to change its recommendation on the combined measles, mumps, rubella, and varicella (MMRV) vaccines.^2,3

Specifically, according to the YouTube live stream of the ACIP meeting, the Committee will vote on the proposed recommendation.³

"The pediatric vaccine schedule should be updated to reflect the following change:

• For measles, mumps, rubella, and varicella vaccines given before age 4 years, the combined MMRV vaccine is not recommended.
• Children in this age group should receive separate measles, mumps, and rubella vaccine and varicella vaccine (MMR+V)."

The ACIP voted 8-3 in favor of the change after presenting on febrile seizure risk in the age group associated with the combination vaccine. The Committee recommended that children younger than 4 years of age receive separate MMR and varicella vaccines (MMR+V), and not the combination MMRV vaccine.²

The vote on Thursday did not change any recommendation related to timing and receipt of 2 doses of MMR vaccine, the first at 12 to 15 months of age, with the second at 4 to 6 years of age.^3,4

The Committee did not vote on combination vaccines for the second dose, meaning children could still receive the combination MMRV vaccine so long as they are aged 4 years and older. Currently, varicella vaccination is recommended by the CDC at age 12 to 15 months for the first dose, with the second at ages 4 to 6 years.

According to data used in the meeting, approximately 85% of parents give their children stand-alone vaccinations for MMR and a separate varicella vaccine.³

Following Thursday's meeting, the Infectious Diseases Society of America (IDSA) released a statement that read:⁵
"Vaccines for measles, mumps, rubella, and varicella have been extraordinarily successful in preventing infections, serious illness, hospitalizations, and deaths, making it imperative to maintain vaccination coverage, access, and uptake. While studies show a small increased risk of febrile seizures after the first dose of the MMR or MMRV vaccine, the risk remains very small.

The IDSA also stated that MMRV represents a large share of the MMR vaccines in the United States and that it is "unclear" if there is enough MMR supply if MMRV is not recommended.

Susan Kressly, MD, FAAP, president of the American Academy of Pediatrics (AAP) also released a statement following the conclusion of day 1 of the ACIP's 2-day meeting.

"All children should be vaccinated against measles, mumps, rubella, and varicella at 1 year and again at 4-6 years. The combination MMRV vaccine should remain an option for families for both doses," said Kressly in the statement.⁶

Hepatitis B vaccine

According to the original schedule posted by the ACIP⁶, the Committee was set to vote on a proposed recommendation to move the hepatitis B immunization schedules for newborns from the date of birth timeline to 30 days after birth. As our sister publication Contagion reported, the vote was first delayed until Friday, September 19th, before being tabled completely during Friday's meeting.⁸

Friday, September 19

On day 2 of the ACIP September meetings, the Committee will begin with an introductory update on COVID-19 epidemiology, as well as "updates to 2024-2025 COVID-19 implementation considerations."

Arjun Srinivasan, MD, is then scheduled to provide an update on COVID-19 vaccine effectiveness and safety. Discussions on COVID-19 will continue through the lunch hour before the Committee will propose recommendations. After a public hearing, votes will take place on COVID-19 vaccine recommendations.

New vaccine appointees

The September meeting of the ACIP comes just 3 days after the CDC announced 5 new Committee members. The new members include:⁹

• Catherine M. Stein, PhD, professor, Department of Population & Quantitative Health, Case Western Reserve University, Cleveland, Ohio.
• Evelyn Griffin, MD, obstetrician and gynecologist, Baton Rouge General Hospital, Baton Rouge, Louisiana.
• Hillary Blackburn, PharmD, MBA, director of Medication Access and Affordability, AscensionRx, St. Louis, Missouri.
• Kirk Milhoan, MD, PhD, medical director, For Hearts and Souls Free Medical Clinic, Kihei, Hawaii.
• Raymond Pollak, MD, FACS, FRCS, who previously served as chief of Liver Transplantation and director of Multi-organ Transplant Programs at the University of Illinois, has held leadership roles with the United Network for Organ Sharing and the American Society of Transplant Surgeons.

Recap of June's ACIP meeting

In June, the newly constructed Committee voted on several pediatric-related vaccine recommendations. Among the decisions, the Committee endorsed Merck’s monoclonal antibody clesrovimab (Enflonsia) for the prevention of respiratory syncytial virus (RSV) in infants. The FDA approved the therapy earlier in June for use in infants aged 8 months and younger who are not protected by maternal vaccination. The Committee also voted to update the Vaccines for Children (VFC) program to include clesrovimab, ensuring access for eligible children.¹⁰

READ MORE: Committee recommends clesrovimab for RSV, reaffirms routine influenza vaccination

The RSV vote was supported by Merck as a significant step forward in reducing the disease burden among infants, families, and health care systems. The recommendation comes ahead of the 2025–2026 RSV season, when the antibody is expected to be available as a preventive option. Final sign-off on the ACIP votes will require approval from Health and Human Services Secretary Robert F. Kennedy Jr. in the absence of a confirmed CDC director.

In addition, the ACIP reaffirmed its recommendation for annual influenza vaccination for all persons aged 6 months and older. The Committee further recommended that children up to age 18 years and pregnant women receive only single-dose influenza vaccine formulations free of thimerosal as a preservative for the upcoming season.

References:

1. Advisory Committee on Immunization Practices (ACIP) - September 19, 2025 – Day 2 of 2. YouTube. Published September 19, 2025. Accessed September 19, 2025. https://www.youtube.com/watch?v=_9ChY9SpPlY
2. Moniuszko S. CDC's vaccine advisory panel, with new members picked by RFK Jr., votes on measles shot. CBS News. Published September 18, 2025. Accessed September 19, 2025. https://www.cbsnews.com/live-updates/cdc-vaccine-advisory-committee-rfk-jr-vote-measles-hepatitis-b/
3. Advisory Committee on Immunization Practices (ACIP) - September 18, 2025 - Day 1 of 2. YouTube. Published September 18, 2025. Accessed September 18, 2025. https://www.youtube.com/live/-6uBNXsYRHQ
4. Measles vaccination. CDC. Published January 17, 2025. Accessed September 19, 2025.
5. Statement update. Infectious Disease Society of America. LinkedIn. September 18, 2025. Accessed September 19, 2025. https://www.linkedin.com/company/idsociety/posts/?feedView=all
6. Kressly SJ. AAP continues to support routine immunizations for every child in every community. AAP. Press release. Published September 18, 2025. Accessed September 19, 2025.
7. Meeting of the Advisory Committee on Immunization Practices (ACIP). CDC. Published September 17, 2025. Accessed September 18, 2025. https://www.cdc.gov/acip/downloads/agendas/final-posted-2025-09-17-508.pdf
8. Parkinson J. CDC vaccine advisors table hepatitis B vaccine vote, keeps current policy in place. Contagion. Published September 19, 2025. Accessed September 19, 2025. https://www.contagionlive.com/view/cdc-vaccine-advisors-table-hepatitis-b-vaccine-vote-keeps-current-policy-in-place
9. HHS, CDC announce New ACIP members. US Department of Health and Human Services. Published September 15, 2025. Accessed September 18, 2025. https://www.hhs.gov/press-room/hhs-cdc-announce-new-acip-members-sept-2025.html
10. Fitch J. ACIP updates: Committee recommends clesrovimab for RSV, reaffirms routine influenza vaccination. Contemporary Pediatrics. Published June 26, 2025. Accessed September 18, 2025. https://www.contemporarypediatrics.com/view/acip-updates-committee-votes-5-2-to-recommend-clesrovimab-to-protect-against-rsv