Confused about current vaccine recommendations? Here's what to know

With shakeups at a key federal agency that releases vaccine guidelines, it's been a confusing past few months regarding immunization for younger people.

Health Secretary Robert F. Kennedy Jr. in June fired all 17 members on the Advisory Committee on Immunization Practices, leading to outrage among independent medical societies and the formation of multistate health coalitions, including the Northeast Public Health Collaborative that Pennsylvania joined in September.

ACIP was revamped with 12 new members, many of whom have criticized the COVID-19 vaccine, opposed mandates or posted health misinformation. Former member Noel Brewer told NPR in September that members of the new panel "fundamentally do not understand vaccines in a deep way."

Still, many who support the "Make America Healthy Again" movement are emboldened by Kennedy's commitment to shepherding research into chronic diseases and relieved to see a panel of fresh faces willing to criticize federal policy.

"ACIP and (the American Academy of Pediatrics) have been in lockstep pretty much forever, and now that they're out of step, it's confusing for a lot of different people," said Jeffrey Lancaster, associate chief medical officer for WVU Medicine Children's Hospital and a pediatric hospitalist.

Here's what to know about vaccines and the ACIP rulings as respiratory virus season — which typically spans from October to February — descends.

What has ACIP ruled so far?

Thimerosal: In July, the panel voted, 5-1, to remove thimerosal from influenza vaccines, citing a decades-old debate about its potential harm.

Thimerosal is a preservative used in some multi-dose vaccines to prevent contamination from bacteria. The American Academy of Pediatrics in 1999 asked vaccine manufacturers to remove it out of an abundance of caution.

Thimerosal is a mercury-based product, and the public was concerned about infant exposure to mercury. As a result, most vaccines in the U.S. do not contain thimerosal.

Kennedy regularly stresses the importance of removing mercury from vaccines, a framing health experts have called irresponsible and misleading.

Informed consent: A September ACIP meeting brought about multiple updates to federal vaccine policy.

For the updated version of the COVID vaccine, the panel chose to move from the blanket guideline it had offered since the vaccine's release in 2020. Instead, ACIP now recommends the vaccine be given on the basis of individual decision-making.

"Informed consent is back," said Deputy Health Secretary Jim O'Neill in an October news release about the ruling. "CDC's 2022 blanket recommendation for perpetual COVID-19 boosters deterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent. That changes today."

This confused some providers.

"The COVID ruling was interesting," said Andy Nowalk, associate professor of pediatrics at the University of Pittsburgh's School of Medicine and clinical director in the Division of Infectious Diseases at UPMC Children's Hospital of Pittsburgh.

"From a practitioner's perspective, I don't feel like we are lacking anything in terms of getting informed consent right now. We routinely counsel when we give vaccines about the risks and benefits of vaccines for every dose."

Barbara Nightingale, deputy director of clinical services for the Allegheny County Health Department, concurred.

"Everybody receives an information sheet about vaccines, as required by the federal government," she said. "That has not changed."

MMRV: Splitting a common combination vaccine was another outcome of ACIP's Sept. 18 and 19 meetings.

Some providers give the MMR shot, which protects against measles, mumps and rubella, and the varicella shot, which protects against chickenpox, in a combo version. This gives parents an opportunity to reduce the number of immunization visits for their child.

"Anything that decreases barriers to vaccines is something we promote," said Dr. Nightingale. "It just gives more options at the parent's discretion."

Health and Human Services said in September that there were concerns about the risk of febrile seizure with the combination vaccine, or an acute seizure accompanied by a fever, leading to the recommendation against it.

Studies have found an increased risk of febrile seizure with the combination shot, but have said the absolute risk overall is small. In a paper published in 2014 in the Canadian Medical Association Journal, authors said policymakers should balance their findings with the potential benefits of giving the combo vaccine.

"This is a known phenomenon," said Dr. Nowalk. "It's a really good example of the fact that we are always paying attention to vaccine safety, even after they're on the market. They are among the most tightly controlled and safely regulated medical products that we have out there."

He also pointed out that the risk of severe events from chickenpox outweighs the small risk of seizure, which is why the combo vaccine was supported previously.

To make a general recommendation against the MMRV combination vaccine because of the small risk of febrile seizure seems to Dr. Nowalk to be "an interpretation of the evidence that is shared by none of the major societies involved in vaccination."

It's among the challenges "we're running into," he said, "that a lot of the views that are coming out are really dramatically minority views that are not well supported by the evidence."

Drs. Lancaster and Nightingale said their practice is to always give the MMR and varicella shots separately for the child's first dose, then provide an option for the combination vaccine when the child is about 4 years old.

Following ACIP's September meeting, Pennsylvania's governor's office and Department of Health issued guidelines pointing parents to trustworthy sources of information and highlighting the American Academy of Pediatrics' vaccine schedule for kids.

What about side effects?

"The vaccines we use have been studied over and over again. They are extremely safe and low risk," said Dr. Lancaster. "That does not mean it's impossible to have a side effect."

The most common side effect to vaccination tends to be a local reaction to the vaccine — a sore arm. Over the two days following, patients may experience mild flu-like symptoms as the immune system mounts a response to the particles in the vaccine.

Just like any medication, a vaccine is not 100% risk-free, said Dr. Nightingale.

"One of the challenges that people face is that they're looking at, 'OK, this vaccine may have some type of risks with it,' and they're not balancing that with the risk of the disease itself," she said.

It's a maxim providers repeat constantly: Vaccines are victims of their own success.

"Polio wasn't that long ago," said Dr. Lancaster. "We've lost touch with that. My mom's best friend had polio and had a lisp and walked with a limp for the rest of her life. We are a victim of our own success as far as vaccines go."

The provider's role

Dr. Nowalk says he discusses this all with parents, as well as past issues that may have come up with a certain vaccine. The heart condition myocarditis, for one, was cropping up in cases of COVID infection and, for some, after COVID vaccination.

A meta-analysis published in 2022 in Frontiers in Cardiovascular Medicine of 58 million people with myocarditis found that the relative risk of developing the condition after COVID infection was more than seven times higher than from the vaccine, and that rates of the condition decreased over time.

Dr. Nowalk said he's never afraid of a conversation about a vaccine's risks and benefits.

"If we're not willing, as physicians, to be really open and honest about, 'Here's the data, here are the risks and benefits,' and to really advocate for vaccines in a collaborative way with patients and families, then we're not doing our job the right way."

Dr. Lancaster said that when parents ask such questions, it's a healthy sign they care about the well-being of their child.

"Having these discussions with parents can make visits a little bit longer," he said, "but this is the heart and soul of doctoring."

The bottom line

The onslaught of health information online can be overwhelming.

If parents have questions about vaccines, it's always best to talk to a health care provider and not rely on social media for the sole source of health information, said Dr. Nightingale.

"We know that people are exposed generally to a lot of misinformation, and the way that misinformation works is it tends to feed off things like fear that make people very anxious," she said. "And so we want to make sure that they talk to someone who has accurate information about that, rather than just having social media as their exclusive source of information."

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