Reactions to the September ACIP meeting surrounding MMRV, Hep B, COVID | Image Credit: © JJHVEPhoto - © JHVEPhoto - stock.adobe.com.

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) concluded its September 2-day meeting with several key vaccine discussions and votes.

Below, find a brief recap of the meeting (or click here for our full coverage as the meeting occurred), followed by reactionary comments by members of the Contemporary Pediatrics Editorial Advisory Board, including from Tina Tan, MD, FAAP, FIDSA, FPIDS; Candice Jones, MD; and Donna Hallas, PhD, CPNP, PPCNP-BC, FAAN, FAANP.

ACIP September 2025 meeting recap

On Thursday, September 18, the Committee voted to change recommendations for the measles, mumps, rubella, and varicella (MMRV) vaccine, determining that children younger than 4 years should receive separate MMR and varicella vaccines (MMR+V) rather than the combined MMRV vaccine, citing concerns over febrile seizure risk. The updated guidance does not affect the timing of the 2-dose series, with the first dose recommended at 12 to 15 months of age and the second at 4 to 6 years. Children may still receive the combined vaccine for the second dose if aged 4 years or older.

Hepatitis B vaccines were also scheduled for review, with a proposed recommendation to delay the birth dose to 30 days after birth. However, the Committee tabled the vote following extended discussion, leaving the current birth dose recommendation unchanged. Meanwhile, Friday’s session centered on COVID-19, with ACIP reviewing epidemiology updates, vaccine safety, and implementation considerations for 2024–2025 before voting on several proposed recommendations.

Four COVID-19 vaccine-related recommendations were brought to a vote. The Committee approved language to strengthen informed consent processes (11-1) and endorsed provider-patient discussions addressing risks, benefits, and individual factors such as age, prior infection, and comorbidities (12-0). A recommendation requiring prescriptions for COVID-19 vaccination was narrowly defeated after a tie-breaking “no” vote from the Chair (6-6). Finally, ACIP voted unanimously (12-0) to update the immunization schedule, recommending vaccination for adults 65 years and older and individuals aged 6 months to 64 years based on shared clinical decision-making, with the most favorable benefit-risk balance for patients at increased risk of severe disease.

Commentary from members of the Contemporary Pediatrics Editorial Advisory Board

Tina Tan is the editor-in-chief of Contemporary Pediatrics, president of the Infectious Disease Society of America, attending, Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, and professor of Pediatrics at the Northwestern University Feinberg School of Medicine.

Contemporary Pediatrics:

Regarding the committee recommending a separate vaccine for MMR and varicella for patients under 4 years because of febrile seizure, what is your reaction to that recommendation, and can you provide any context as to how long this combination vaccine has been in place?

Tan:

There is a slightly higher incidence of febrile seizures, but the recommendation to limit it to those over 4 years of age is not based on any scientific data. This vaccine has been around since 2005. It is a safe and effective vaccine.

Contemporary Pediatrics:

Can you touch on the seizure risk factors vs benefits of the combination vaccine?

Tan:

The benefits of the combination vaccine far outweigh the slightly increased seizure risk factor and helps to provide access to 2 recommended vaccines in a single shot.

Contemporary Pediatrics:

It has been a several months now with the newly-formed ACIP. What are your takeaways of the decisions made by the committee and what should providers keep in mind as headlines swirl and big decisions continually appear on the agenda related to childhood health?

Tan:

Providers need to do what is best for their patients and continue to provide them with the routinely recommended vaccines that they need.

Contemporary Pediatrics:

What else would you like to include about childhood vaccines?

Tan:

AAP, AAFP, Vaccine Integrity Project are putting out recommendations for use of the childhood vaccines. Practitioners should follow these recommendations and not anything that comes out of the current ACIP.

Candice Jones, MD, is a board-certified pediatrician based in Orlando, Florida, and an Editorial Advisory Board member of Contemporary Pediatrics.

Jones:

The American Academy Pediatrics (AAP) Immunization Schedule documents no preference between giving MMR and Varicella vaccines separately or in combination, MMRV (Proquad) for children aged 12-15 months. Therefore, I will continue to offer this vaccine in clinical practice as recommended. With that said, if families request the vaccines separately and it is available, I will gladly administer it. I will also educate families that risk of serious disease and death because of these preventable infections out weigh the small risk of febrile seizure in this age group.

Additionally, letting families know all possible side effects of vaccines which include fever is important. When small children get a fever due to vaccines or even an infection, febrile seizures can occur. The good news, although scary for parents, there is generally no long-term problems or deaths with vaccine-related febrile seizures.

Donna Hallas, PhD, CPNP, PPCNP-BC, PMHS, FAANP, FAAN, is an Editorial Advisory Board member of Contemporary Pediatrics, clinical professor, program director, Pediatrics NP, New York University Rory Meyers College of Nursing.

Contemporary Pediatrics:

Regarding the committee recommending a separate vaccine for MMR and varicella for patients under 4 years because of febrile seizure, what is your reaction to that recommendation, and can you provide any context as to how long this combination vaccine has been in place?

Hallas:

I have worked with high-risk children whose prenatal and infant personal medical records were often not available. Based on the recommendations from the CDC dating 2024, and earlier, I only administered the MMR and Varicella vaccines separately for all the children in my practice.

The previous recommendations included an option for parents to ask for the MMRV vaccine. I do not recall any parents or caregivers asking for the combination vaccine. However, this decision should be based on the results of a detailed prenatal, birth history, infant/child health history, and family history.

Contemporary Pediatrics:

It has been a several months now with the newly-formed ACIP. What are your takeaways of the decisions made by the committee and what should providers keep in mind as headlines swirl and big decisions continually appear on the agenda related to childhood health?

Hallas:

In 2024 and earlier years, ACIP members were highly regarded experts in the field of vaccines and vaccine schedules for children based on the scientific evidence. The current committee members do not have the expertise to make decisions on vaccines for children of any ages. The members admitted that when votes were taken and decisions were not made.

Today, the ACIP decisions are not based on scientific evidence and are causing major confusion for parents making decisions for their children and for all adults making decisions for themselves about vaccines. Many health care providers today have not seen such horrible diseases, such as acute epiglottitis and meningitis caused by Haemophilus influenzae type B.

I recall taking care of young children with these diseases and the heartbreak parents felt when their young children contracted and died from these diseases. The Hib vaccine, introduced in 1985, has protected children from both of these horrible and deadly diseases.

I commend the decision of the AAP for developing and sharing a vaccine schedule that is consistent with the known evidence-based, scientifically-valid vaccine schedules.

Reference:

Fitch J. ACIP completes September meeting with votes on COVID-19 vaccines. Contemporary Pediatrics. Published September 18, 2025. Accessed September 23, 2025. https://www.contemporarypediatrics.com/view/acip-to-meet-for-mmrv-hep-b-covid-vaccine-proposed-recommendations