Advisory Committee Recommends Postponing MMRV Vaccine Till Child Reaches 4

In recent developments, a government health advisory committee has, in an 8-3 majority, recommended postponing the combined measles, mumps, rubella, and chickenpox (MMRV) vaccine till a child reaches 4 years of age. The delay is primarily triggered by data suggesting a marginally higher risk of febrile seizures in children of an early age group. However, experts highlight that while febrile seizures may cause initial alarm, they are often brief and benign following vaccinations. The experts warn that removing the vaccine option prematurely may lead to reduced vaccination rates against measles, mumps, and rubella—diseases known to be particularly harmful in childhood.

The group making these propositions, the Advisory Committee on Immunization Practices (ACIP), plays a vital role in guiding the US Centers for Disease Control and Prevention on the use of vaccines. The recommendations presented are often accepted and implemented by the CDC, with wide-reaching implications for school vaccination requirements, vaccine coverage by insurance companies, and vaccine accessibility at pharmacies. Surprisingly, it appears that at least one member of the panel was previously uninformed about these far-reaching effects.

The committee’s recent decision reflects a broader shift in the country’s vaccine administration approach. Kennedy, in his brief tenure as the HHS secretary, has made significant changes in the distribution of Covid-19 vaccines and revamped the ACIP by discharging all 17 incumbents and replacing them with 12 new members, some of whom were initiated only this week.

During Thursday’s assembly, the committee participants were tasked with reviewing whether to advise against administering the combined MMRV vaccine to children under 4 years. Additionally, they evaluated whether the first dose of the hepatitis B vaccine should be delayed until the child is at least one month old.

Presently, parents are given two options to immunize their children against measles, mumps, rubella, and chickenpox. One route involves a unified MMRV shot, and the other entails separate inoculations—one for MMR and another for chickenpox. Among these choices, about 85% of children opt for the separate vaccines.

In the case of hepatitis B, a severe liver infection potentially leading to cirrhosis and cancer, the vaccine is customarily administered in the hospital shortly after childbirth due to the risk of transmission during delivery. Approximately 25,000 newborns annually have mothers diagnosed with the hepatitis B virus in the US. Without vaccination, as many as 90% of these infants may develop chronic infections. The World Health Organization advises an immediate dose of the hepatitis B vaccine after birth.

The risk associated with the MMRV vaccine has been acknowledged for quite awhile, and the CDC encourages healthcare providers to discuss with parents the decision between the combined MMRV shot and individual vaccines.

Scientific data reveals a minor increased risk for febrile seizures following the initial dose of either the MMR or MMRV vaccines, with a slightly heightened risk associated with the MMRV combination vaccine. However, research shows no escalated risk of febrile seizures after the standalone chickenpox vaccine.

Further, it’s emphasized that there’s no increased risk for febrile seizures following the MMRV vaccine administration in children aged between 4 to 6 years. This stage usually represents the schedule for the second dose of the vaccine.

Meissner, a professor of pediatrics at Dartmouth College and one of the three committee members who disagreed with the majority decision, draws parallels between the current conversation and events in 2008, when preliminary evidence of the increased risk of febrile seizures started to surface. The MMRV vaccine was granted licensing in the United States in 2005.

In his dissent, Meissner stressed that discouraging the combined MMRV vaccine for children younger than 4 intrudes on parental autonomy. He expressed concern that parents are being deprived of the choice to administer a single shot that provides identical protection levels as two separate injections. The removal of the single-dose option questions parental judgement, according to Meissner.

Similar concerns were raised by Hibbeln, a formerly leading section staff at the National Institutes of Health and a current psychiatrist and neuroscientist. He voiced apprehension that the removal of the vaccination choice against measles, mumps, and rubella may intensify the existing downtrend in childhood vaccination rates. He advocates that any vaccine-related changes should be underpinned by substantial reason.

Yet another medical practitioner, a pediatrician specializing in population and family health, asserts that though administering MMR and chickenpox individually for the first dose is commonplace, no compelling reason calls for a change in guidelines allowing parents or caregivers who prefer the unified vaccine make an informed choice after considering the associated risks. Despite the advisory committee’s suggestion to not administer the MMRV vaccine to children less than 4 years old, the Vaccines for Children program—a federal initiative providing free vaccines to children from low-income families or those uninsured—continues to include the MMRV vaccine, as an 8 to 1 vote with a participant abstaining decided.