CDC Immunization Schedule Adopts Individual-Based Decision-Making for COVID-19 and Standalone Vaccination for Chickenpox in Toddlers

The U.S. Centers for Disease Control and Prevention (CDC) today updated its adult and child immunization schedules to incorporate individual-based decision-making for COVID-19 vaccination. The CDC recommends that toddlers receive protection from varicella as a standalone immunization, rather than in combination with measles, mumps, and rubella vaccination.

The schedules will be updated on CDC.gov by October 7, 2025.

The immunization schedules adopt recent recommendations by the CDC Advisory Committee on Immunization Practices (ACIP), which were approved last week by the Acting Director of the CDC and the Deputy Secretary of Health and Human Services.

ACIP's recommendation emphasized that the risk-benefit of vaccination in individuals under age 65 is most favorable for those who are at an increased risk for severe COVID-19 and lowest for individuals who are not at an increased risk, according to the CDC list of COVID-19 risk factors.

Individual-based decision-making is referred to on the CDC's immunization schedules as vaccination based on shared clinical decision-making, which references providers, including physicians, nurses, and pharmacists.

It means that the clinical decision to vaccinate should be based on patient characteristics that, unlike age, are difficult to incorporate in recommendations, including risk factors for the underlying disease as well as the characteristics of the vaccine itself and the best available evidence of who may benefit from vaccination.

Like routine recommendations, individual-based decision-making allows for immunization coverage through all payment mechanisms.

Unlike the COVID-19 primary series vaccination, which reached an estimated nearly 85% of the U.S. adult population, only 23% of adults followed the CDC's most recent seasonal booster recommendation, according to its National Immunization Survey.

The booster shots prompted widespread concerns about their safety and efficacy.

Additionally, the CDC child and adolescent immunization schedule's new recommendation of standalone chickenpox vaccination for toddlers through age three follows evidence presented to ACIP by the CDC Immunization Safety Office's that healthy 12–23 months old toddlers have increased risk of febrile seizure seven to 10 days after vaccination for the combined measles, mumps, rubella, and varicella vaccine compared to those given immunization for chickenpox separately.

The combination vaccine doubles the risk of febrile seizures without conferring additional protection from varicella compared to standalone vaccination.