'CDC Now Advises Shared Decision-Making for Kids' COVID Shots'

 The CDC now advises shared clinical decision-making when it comes to COVID-19 shots for kids, a narrowing of its previous broad recommendation.

The change follows an announcementopens in a new tab or window by HHS Secretary Robert F. Kennedy Jr. earlier this week that the CDC would no longer recommend COVID shots for kids and pregnant women.

Late Thursday, the CDC updated its childhood immunization scheduleopens in a new tab or window to reflect that for kids ages 6 months to 17 years who aren't moderately or severely immunocompromised, the decision to vaccinate should be made via a discussion between parents and healthcare providers.

"Where the parent presents with a desire for their child to be vaccinated, children 6 months and older may receive COVID-19 vaccination, informed by the clinical judgment of a healthcare provider and personal preference and circumstances," the recommendationopens in a new tab or window now states.

Previouslyopens in a new tab or window, language about shared decision-making was not included and it was recommended that all children 6 months and older should receive the vaccine. The rest of the updated recommendations, stratified by age, remain largely the same. However, recommendations for children who are immunocompromised were moved up from a "special situations" section, into the main recommendation section.

The changes appear to maintain the same primary series for the youngest kids ages 6 months to 4 years -- two doses of the Moderna vaccine or three doses of the Pfizer vaccine.

The move also appears to ensure that health insurers will still be required to cover COVID shots for kids.

Nonetheless, COVID shots have not been popular among young patients. COVID vaccination coverage for kids remains low, at 13% for this past season among those ages 6 months to 17 years, according to CDC dataopens in a new tab or window. When looking at the youngest kids (6 months to 4 years), the percentage falls even lower, to just 5.6%.

As of Friday morning, there were no changes to the adult immunization scheduleopens in a new tab or window pertaining to the COVID vaccine. Last week, FDA Commissioner Marty Makary, MD, MPH, and Center for Biologics Evaluation and Research Director Vinay Prasad, MD, MPH, announced changesopens in a new tab or window to the way COVID shots would be approved by the agency -- allowing immunogenicity endpoints for high-risk groups, while calling for randomized controlled trials for those at lower risk.

As for pregnancy, a "medical conditions" table now shows "no recommendationopens in a new tab or window" for pregnancy, whereas it was previously recommended. However, as of Friday morning, a CDC websiteopens in a new tab or window pertaining to shots for pregnant women continued to state that "everyone ages 6 months and older is recommended to get the updated COVID-19 vaccine, including if you are pregnant, breastfeeding a baby, trying to get pregnant now, or might become pregnant in the future."

Pregnancy also remains on a CDC list of immunocompromising conditionsopens in a new tab or window that Makary and Prasad pointed to when allowing COVID vaccination for high-risk groups.

It's not known if the CDC's Advisory Committee on Immunization Practices (ACIP), which is tasked with evaluating vaccination data and making recommendations to the agency, weighed in on recent changes. It is set to meetopens in a new tab or window at the end of June, and at its last meeting in April, members considered switchingopens in a new tab or window to a risk-based strategy for COVID vaccination.

Susan Kressly, MD, president of the American Academy of Pediatrics, said in a statement that the organization is "relieved" to see that CDC "updated its schedules for child and adolescent immunizations to allow families to maintain the choice to immunize their children against COVID in consultation with their doctor."

Kressly acknowledged that including the vaccine on the schedule means it will be covered by insurance. "However," she said, "the deeply flawed process to reach the recommendation raises serious concerns about the stability of the nation's immunization infrastructure and commitment by federal leaders to make sure families can access critical immunizations, whether for COVID or other infectious diseases."

https://www.medpagetoday.com/infectiousdisease/covid19vaccine/115822