New CDC guidelines: COVID-19 vaccine based on individual risk, toddlers’ chickenpox shot split from MMR

The Centers for Disease Control and Prevention (CDC) has announced updates to the US adult and child immunization schedules, introducing individual-based decision-making for COVID-19 vaccination and recommending standalone varicella (chickenpox) shots for toddlers rather than combination with the MMR (measles, mumps, rubella) vaccine. The revised schedules will be published on CDC.gov by October 7, 2025.

Individual-based COVID-19 vaccination

The updated guidance allows healthcare providers to discuss the risks and benefits of COVID-19 vaccination with individual patients, reversing the CDC’s previous blanket booster recommendation from 2022. Deputy Secretary of Health and Human Services Jim O’Neill emphasized, “Informed consent is back,” highlighting the importance of shared decision-making in assessing whether COVID-19 vaccination is appropriate for adults and children based on individual risk factors.

The CDC notes that while the initial COVID-19 vaccine series reached nearly 85% of US adults, only 23% of adults received the most recent seasonal booster, reflecting public concerns about vaccine safety and efficacy as COVID-19 became endemic.

The updated recommendations particularly target:

-Individuals under 65 at increased risk for severe COVID-19, based on CDC risk factors.

-Individuals 65 and older, for whom COVID-19 vaccination continues to be recommended.

Shared clinical decision-making

The CDC’s “shared clinical decision-making” framework enables providers—including physicians, nurses, and pharmacists—to evaluate vaccination based on:

-Patient-specific risk factors for disease

-Vaccine characteristics

-Evidence of who may benefit most

Standalone Chickenpox vaccination for toddlers

The CDC now recommends that children aged 12–36 months receive varicella as a separate vaccine, instead of the combined MMRV shot. This change is based on data showing that healthy toddlers given the combination vaccine have a higher risk of febrile seizures—approximately double—seven to ten days after vaccination, compared with those receiving chickenpox immunization separately.

According to the CDC, the standalone varicella vaccine provides the same protection against chickenpox as the combined MMRV vaccine while reducing the risk of post-vaccination febrile seizures.