美国疾病控制和预防中心(Centers for Disease Control and Prevention)的一组有影响力的顾问周四投票缩小了对预防麻疹、腮腺炎、风疹和水痘的MMRV联合疫苗的现有建议。
疾病预防控制中心疫苗咨询委员会，称为ACIP，投票8-3缩小建议。一人因利益冲突而放弃投票。
另一项关于放弃所有新生儿出生时接种乙肝疫苗的长期建议的投票被推迟到周五。
关于MMRV疫苗，顾问们的投票意味着在一针中包含麻疹、腮腺炎、风疹和水痘的联合疫苗将不再推荐给12个月左右的年幼儿童接种第一针。
相反，委员会建议这些孩子应该分别注射两种疫苗，一种是麻疹/腮腺炎/风疹混合疫苗，另一种是水痘疫苗。在4-6岁之间，儿童第二剂疫苗将继续推荐使用混合疫苗。
关于MMRV疫苗变更的投票需要代理CDC主任或卫生与公众服务部长的签字。
然而，即使进行了投票，小组成员似乎也不愿意做任何可能限制联邦资助的儿童疫苗(VFC)计划覆盖的大约50%的美国儿童获得疫苗的事情，投票反对任何改变。
但HHS表示，他们仍然需要考虑非约束性顾问的投票结果，在一份声明中说:“在代理主任最终决定采纳之前，HHS将根据今天的ACIP建议检查所有保险覆盖范围的影响。如果被疾病预防控制中心主任采纳，ACIP的建议将成为疾病预防控制中心免疫计划的一部分。”
简单地说，如果疾病预防控制中心接受该组织的建议，接受VFC疫苗的孩子的父母仍然可以选择给他们的孩子注射MMRV的第一剂组合疫苗，如果他们不想分开注射，这两种选择都是免费的，但其他人只建议他们在不到4岁的情况下注射第一剂疫苗时分别注射MMR和水痘疫苗。
在投票前的讨论中，一些委员说他们担心提议的改变可能会剥夺父母的选择，尤其是在MMRV联合疫苗方面。
目前，根据以前的建议，所有父母都可以选择给4岁以下的儿童注射一针麻疹、腮腺炎、风疹和水痘疫苗，或者他们可以选择分开注射，一针注射麻疹、腮腺炎和风疹疫苗，同时单独注射水痘疫苗。一些研究表明，当12至15个月大的孩子同时注射这四种药物时，癫痫发作的风险会略微升高，但总体来说非常罕见。
但是许多父母和诊所可能仍然更喜欢一针。儿童也在4岁后接种第二剂MMRV。
委员会没有考虑完全取消或反对MMRV或乙肝疫苗。但是专家警告说，提议的改变可能会导致重大的混乱和更多的疾病。
专家表示，这些变化也可能导致混乱，更多的医生预约和更多的儿童个体注射，这可能会导致错过病例或更多的感染。这也可能使疫苗供应和生产物流复杂化。
ACIP成员Cody Meissner博士说:“给予两剂疫苗的缺点，或者正如有人建议的那样，分开两剂，是我们知道依从性下降，而联合疫苗的优点是，如果以单剂形式给予，儿童和成人更有可能完成疫苗要求。”
周三，肝病医生、共和党参议员比尔·卡西迪告诉记者，如果美国人对当前的疫苗接种计划做出某些改变，他们不应该对该委员会的决定有信心。
“我可以向你保证，将会有一些乙肝传播，”当被问及如果委员会改变现有的建议会发生什么时，卡西迪告诉记者。
本周的会议是该委员会自1998年以来的第二次会议健康和公众服务部长小罗伯特·F·肯尼迪。解雇了所有17名成员六月。在此后被任命的12名顾问中，许多人先前表达了对疫苗持怀疑态度的观点。
大多数主要保险提供商表示，他们将至少在2026年前继续覆盖现有疫苗。但许多人担心准入和任何变化的影响，这些变化可能会对超过一半的美国儿童产生负面影响，这些儿童通过联邦计划获得免费注射，该计划与疾病预防控制中心委员会的建议挂钩。
CDC advisers vote to restrict MMRV vaccine options for younger children, delay vote on hepatitis B vaccine
An influential group of advisers for the Centers for Disease Control and Prevention voted Thursday to narrow existing recommendations for the combined MMRV shot that protects against measles, mumps, rubella and chickenpox.
The CDC vaccine advisory committee, called ACIP, voted 8-3 to narrow the recommendations. One person abstained from voting due to a conflict of interest.
Another vote on dropping a longstanding recommendation to give all newborns a hepatitis B vaccination at birth was delayed until Friday.
Regarding the MMRV vaccine, the advisers' vote means the combined shot, which contains measles, mumps, rubella and varicella (chickenpox) all in one shot, will no longer be recommended for younger kids getting their first dose around 12 months old.
Instead, the committee recommended these kids should get two separate shots, one combining measles/mumps/rubella, and a second shot for chickenpox. The combo shot will continue to be recommended as an option for a child's second dose, which is given between ages 4-6.
The vote on the MMRV vaccine changes needs sign-off from the acting CDC director or the Health and Human Services secretary.
However, even with that vote, the panel members seemed reluctant to do anything that could potentially restrict access for the roughly 50% of American children covered through the federally funded Vaccines For Children (VFC) program, voting against any changes.
But the HHS says they still need to consider the outcome of the non-binding advisers' vote, saying in a statement: "HHS will examine all insurance coverage implications following today’s ACIP recommendation, prior to a final decision on adoption by the Acting Director. A recommendation from ACIP becomes part of the CDC immunization schedule if it is adopted by the CDC director."
In simple terms, if the CDC accepts the group's recommendations, parents of kids who receive VFC vaccines, can still choose to give their kids a combination shot of MMRV for their first dose if they don’t want to separate shots and both options will be cost-free, but others are only recommended to get a separate MMR shot and chicken pox shot if they are less than 4 years old for their first dose.
During the discussion ahead of the vote, some committee members saidthey were concernedthe proposed changes could take away parents' choices -- especially regarding the combined MMRV vaccine.
Currently, based on the previous recommendation, all parents have a choice of giving their children less than 4 years old measles, mumps, rubella and chickenpox all as one shot, or they can opt to separate the doses, giving measles, mumps and rubella as one shot, and chickenpox as a separate dose at the same time. Some studies have suggested a slightly elevated -- but overall very rare -- risk of seizures when all four are given as a combo shot to kids 12 to 15 months old.
But many parents and clinics may still prefer a single shot. Children also get a second dose of MMRV after the age of 4.
The committee was not considering eliminating or recommending against either the MMRV or hepatitis B vaccines completely. But the changes that have been proposed could result in major disruptions and more illness, experts warned.
Experts say these changes could also cause confusion, more doctors' appointments and more individual shots for children, which could potentially lead to missed cases or more infections. It could also complicate vaccine supply and manufacturing logistics.
"The disadvantage of giving two doses, or as was suggested, separating the two doses, is that we know compliance falls, and the advantage of combination vaccines is that children and adults are more likely to complete the vaccine requirements if it's given as a single dose," said ACIP member Dr. Cody Meissner.
On Wednesday, Republican Sen. Bill Cassidy, a liver doctor, told reporters that Americans should not have confidence in this committee's decisions if they make certain changes to the current vaccination schedule.
"I can promise you there will be some hepatitis B transmission," Cassidy told reporters when asked what would happen if the committee makes changes to that existing recommendation.
This week's meeting is the committee's second sinceHealthand Human Services Secretary Robert F. Kennedy Jr.dismissed all 17 of its membersin June. Of the 12 advisers who have since been appointed, many have previously expressed vaccine-skeptical views.
Most major insurance providers have said they will continue covering existing vaccines at least through 2026. But many worry about access and the impact of any changes that could negatively impact the more than half of American children who receive no-cost shots funded through a federal program, which is tied to the CDC committee recommendations.
