A federal panel of experts on Wednesday recommended an expansion of RSV vaccinations for adults and a new combination shot as another option to protect teens against meningitis.

The Advisory Committee on Immunization Practices also voted to recommend a shot to protect travelers from a mosquito-borne illness called chikungunya.

But it’s not clear who will decide whether to accept those recommendations.

The 15-member expert panel makes recommendations to the director of the Centers for Disease Control and Prevention on how regulator-cleared vaccines should be used. CDC directors almost always approve the recommendations.

The Trump administration named Susan Monarez as acting CDC director in January, and last month picked her to lead the agency. But while she’s awaiting Senate confirmation, she has essentially recused herself from regular duties because of federal law around vacancies, according to two CDC officials speaking on condition of anonymity because they were not authorized to discuss agency matters and feared being fired.

That means any committee recommendations made Wednesday may move to U.S. Health Secretary Robert F. Kennedy Jr., a leading voice in the U.S. anti-vaccine movement.

A Department of Health and Human Services spokesperson has told The Associated Press he was looking into how the agency would decide on the panel's recommendations.

Those recommendations on Wednesday were:

— People 50 to 59 should be able to get vaccinated against respiratory syncytial virus have risks including heart disease, diabetes and chronic obstructive pulmonary disorder.

— Endorsement of a new combination shot made by GSK that protects against five strains of meningococcal bacteria, including a strain that caused a spate of outbreaks on college campuses about 10 years ago. It would join other products that also target the germs.

— Adding a second chikungunya vaccine to the options for Americans age 12 and older who are traveling to countries where outbreaks are occurring. About 100 to 200 cases are reported annually among U.S. travelers.

— Adding a new precaution for the older chikungunya vaccine that uses weakened but live virus: People 65 and older should weigh the risks of benefits of that version of the shot, the panel said. The precaution was added after panel members heard about an investigation into six reports of people 65 and older — most of them with other medical problems — who became ill with heart or brain symptoms less than a week after vaccination. The investigation is continuing.