Updated COVID-19 Vaccine Recommendations are Now Available
September 12, 2023, 9:00 PM EDT
Updates on respiratory illness and vaccine-preventable diseases.
Key Takeaways:
- Updated COVID-19 vaccines are recommended for everyone 6 months and older and will be available by the end of this week at most places you would normally go to get your vaccines.
- Older adults and persons with weakened immune systems are at greatest risk for hospitalization and death. In addition, healthy children and adults can still experience severe disease.
- The updated vaccines should work well against currently circulating variants of COVID-19, including BA.2.86, and continue to be the best way to protect yourself against severe disease.
- The benefits of COVID-19 vaccination continue to outweigh any potential risks. Serious reactions after COVID-19 vaccination are rare.
- In one study, the risk of cardiac complications, including myocarditis, in males 12-17 years old was 1.8 – 5.6 times higher after COVID-19 infection than after COVID-19 vaccination.
- The vaccines are covered by insurance, including private insurance, Medicare plans, and Medicaid plans. Uninsured children and uninsured adults also have access through the Vaccine for Children Program and Bridge Access Program, respectively.
Background
COVID-19 burden is currently lower than at previous points in the pandemic; however, the absolute number of hospitalizations and deaths remains high. Older adults and persons with weakened immune systems are at highest for severe illness. Additionally, children and adults with no underlying medical conditions can still experience severe illness due to COVID-19.
Last fall and winter virus season, people who received the 2022-2023 COVID-19 vaccine had greater protection against severe illness and hospitalization than those who did not receive that vaccine. We are still at risk of COVID-19 since the virus continues to change and new variants emerge. Additionally, protection from COVID-19 vaccines and infection decline over time. An updated COVID-19 vaccine provides enhanced protection against the variants currently responsible for most hospitalizations in the United States.
Actions for the Public
On September 12, 2023, CDC recommended a COVID-19 vaccine updated for 2023-2024 for everyone aged 6 months and older to protect against serious illness.
The main reason to get vaccinated against COVID-19 is to protect yourself against severe illness, hospitalization, and even death. COVID-19 vaccines also reduce the chance of having Long COVID. This vaccine is expected to provide better protection against variants that are currently making people sick.
The updated COVID-19 vaccines are similar to earlier COVID-19 vaccines that were safely administered to hundreds of millions of Americans during the pandemic.
Scientific Understanding of the updated COVID-19 vaccines:
Immune responses to the updated COVID-19 vaccine. People vaccinated with Moderna’s updated COVID-19 vaccine, which includes a component that corresponds to the XBB lineage of the Omicron variant, showed a strong immune response against some of the variants that are common now (XBB.1.5, EG.5.1, and FL.1.5.1). They also had an overall boost in COVID-19 immunity that may have waned since their last vaccination or infection. Their antibody responses after vaccination were about 17-times higher against XBB 1.5 and about 10-times higher against BA.2.86 (a rare new variant that CDC is closely monitoring) compared to before vaccination. These data signal that the updated 2023-2024 COVID-19 vaccine likely can provide strong protection against COVID-19 during this fall and winter virus season.
In preclinical studies, Pfizer’s updated COVID-19 vaccine also produced strong immune responses to XBB.1.5.
Safety of COVID-19 vaccines. CDC closely monitors the safety of COVID-19 vaccines. Almost 700 million doses of COVID-19 vaccines have been administered in the United States to date, and monitoring in multiple safety systems has established their favorable safety profile.
The most common reactions following COVID-19 vaccines are pain, redness, and swelling where the shot was given, and headache, fever, muscle aches, chills, or fatigue. Anaphylaxis (severe allergic reaction to the vaccine) has been rarely observed following COVID-19 vaccines. These types of allergic reactions can rarely occur with any kind of vaccine or medical product.
Myocarditis is an inflammation of the heart muscle. Viral infections, like COVID-19, are a common cause of myocarditis. Symptoms include chest pain, shortness of breath, and feelings of having a fast beating, fluttering, or pounding heart. Myocarditis has been reported after COVID-19 as well as after COVID-19 vaccination. Myocarditis after vaccination is rare, and when it occurred, most of the cases were in adolescent or young adult males and happened about a week after completion of the second of two “primary doses” of vaccine. Myocarditis cases occurring after mRNA COVID-19 vaccination have generally been less severe than myocarditis caused by viral infection. In one study, the risk of cardiac complications, including myocarditis, in males 12-17 years old was 1.8 – 5.6 times higher after COVID-19 infection than after COVID-19 vaccination. In another study evaluating cases of myocarditis at least 90 days following symptom onset after mRNA COVID-19 vaccination, most patients were judged by their healthcare provider as fully or probably fully recovered. CDC is hearing about fewer cases of myocarditis related to COVID-19 vaccination over time. This may at least partially be related to the lower numbers of young males who have received a vaccine more recently.
CDC has estimated the number of COVID-19 hospitalizations that have been prevented among adolescents 12-17 years old as compared to the number of myocarditis cases observed. For every million COVID-19 doses administered among adolescents, we can prevent anywhere between 19-95 hospitalizations, 5-19 ICU admissions, and perhaps one death. In one study in the same age group, no cases of myocarditis were observed after a single bivalent booster following their primary series in nearly 56,000 administrations. Because of the relatively small number of vaccinations in this age group, the rate of myocarditis is estimated to be zero with a wide 95% confidence interval of 0-53.8 cases per million doses.
Risk of Severe Disease from COVID-19. Thankfully, we’re in a different place with COVID-19 now than we were at the beginning of the pandemic, but COVID-19 is here to stay. It continues to be a major cause of serious respiratory illnesses in the United States, with more than 200,000 deaths (including more than 600 in children and adolescents 0-19 years old) reported since January 2022. Vaccination is the most effective tool to protect yourself this fall and winter.
In the past two months, emergency room visits and hospitalizations due to COVID-19 have increased across the country. Infants less than 6 months and adults over 75 years are at highest risk for hospitalization.
Gray boxes indicate potential reporting delays. Interpretation of trends should be excluded from these weeks.
Older adults and people with weakened immune systems are at highest risk for severe COVID-19 illness and should make sure they get the updated COVID-19 vaccine. At present, most COVID-19 deaths are in these groups. Older adults often also have underlying medical conditions that put them at greater risk for hospitalization and death from COVID-19. People who are immunocompromised have weak immune systems that can’t fight infections very well and can get very sick from COVID-19. If you live with or are frequently around older adults or immunocompromised people, getting the updated COVID-19 vaccine may help protect them, as well as yourself.
COPD = chronic obstructive pulmonary disease; chronic kidney disease includes patients with and without dialysis; obesity includes patients with a body mass index ≥30; immunocompromised includes patients with solid organ or hematologic cancer, solid organ transplant, bone marrow/stem cell transplant, HIV infection, congenital immunodeficiency syndrome, use of an immunosuppressive medication within the past 30 days, splenectomy, or another condition that causes moderate or severe immunosuppression.
Although children are less likely than adults to get seriously ill with COVID-19, over 300 deaths in children and adolescents 5 to 19 years were were reported in 2021 and 2022. The number of COVID-19 hospitalizations and deaths in this age group are comparable to the burden seen in other vaccine-preventable diseases for which there are universal recommendations.
More than half of children younger than 2 years of age who were admitted to an intensive care unit with COVID-19 had been previously healthy with no underlying medical conditions. Infants younger than 6 months, who are not eligible to get the COVID-19 vaccine, have the highest rates of hospitalization. COVID-19 vaccines are safe to give during pregnancy. Pregnant people should get the updated COVID-19 vaccine to protect themselves and their baby.
| Hepatitis A1 | Meningococcal (ACWY)2 | Varicella3 | Rubella4 | Rotavirus5 | COVID-196 | |
|---|---|---|---|---|---|---|
| Age | <20 years | 11–18 years | 5–9 years | All ages | <5 years | 6 months–<18 years |
| Time period | 1990–1995 | 2000–2004 | 1990–1994 | 1966–1968 | 1985–1991 | 2022 |
| Average deaths per year | 3 | 8 | 16 | 17 | 20 | ≤1 year: 156 1–4 years: 101 5–19 years: 292 |
1Vogt TM , Wise ME, Bell BP, Finelli L. Declining hepatitis A mortality in the United States during the era of hepatitis A vaccination. J Infect Dis2008; 197:1282–8.2National Notifiable Diseases Surveillance System with additional serogroup and outcome data from Enhanced Meningococcal Disease Surveillance for 2015-2019.2National Notifiable Diseases Surveillance System with additional serogroup and outcome data from Enhanced Meningococcal Disease Surveillance for 2015-2019.
3Meyer PA, Seward JF, Jumaan AO, Wharton M. Varicella mortality: trends before vaccine licensure in the United States, 1970-1994. J Infect Dis. 2000;182(2):383-390. doi:10.1086/315714
4Roush SW , Murphy TV; Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA 2007; 298:2155–63.
5 Glass RI, Kilgore PE, Holman RC, et al. The epidemiology of rotavirus diarrhea in the United States: surveillance and estimates of disease burden. J Infect Dis. 1996 Sep;174 Suppl 1:S5-11
6 http://wonder.cdc.gov/mcd-icd10-provisional.html on Aug 1, 2023 . COVID vaccine first introduced in 12-17 years in May 2021; in 5-11 years in November 2021 and in 6 months – 4 years in June 2022
FOR PROVIDERS: Vaccine Availability and Access
The updated COVID-19 vaccines will be available for everyone who wants them. Patients will be able to find this vaccine almost anywhere they normally would go to get their vaccines, like a health care provider’s office or local pharmacy.
Under the Affordable Care Act, all insurance companies are required to cover vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP), including the updated COVID-19 vaccines. All children without insurance can get their COVID-19 vaccine under the Vaccines for Children Program. Uninsured or underinsured adults can get their COVID-19 vaccine for free under the Bridge Access Program through the end of 2024 from participating providers, HRSA-supported health centers, and pharmacies. Uninsured or underinsured adults can go to vaccines.gov to find COVID-19 vaccines at no cost to them. The COVID-19 vaccines available at no cost through the Bridge Access Program will become available across the United States at the same time as these vaccines become available through regular insurance and standard mechanisms.