Patients will ask if they need another COVID-19 vaccine this spring.

Explain CDC now says that patients age 65 or older who already had a 2023-2024 COVID-19 vaccine should get an additional dose.

It’s partly because COVID-19 transmission remains substantial year-round and cases tend to go up in the summer...unlike flu or RSV.

And vaccine effectiveness is expected to wane over time.

But some experts aren’t convinced that every older adult needs a second dose...and there’s concern about increasing vaccine fatigue.

Plus about 60% of patients 65 and up still haven’t even received a first 2023-2024 COVID-19 vaccine. Continue to explore concerns with these patients...offer to share info...and recommend immunization ASAP.

For example, point out there are still about 20,000 COVID-19 hospitalizations and 2,000 deaths weekly...and older adults are most at risk. But vaccination may cut the risk of severe illness by about half.

If older patients already got a 2023-2024 COVID-19 vaccine, offer an additional dose...especially to those over 75, in long-term care facilities, or with chronic conditions (heart disease, diabetes, etc).

Educate that studies from previous years indicate an additional dose boosts protection against severe outcomes.

But check that it’s been at least 4 months after their last COVID-19 vaccine...or 3 months since a COVID-19 infection...prior to administering.

Encourage getting the additional dose by the end of June...this timing will allow patients to also get a COVID-19 vaccine in the fall.

Give any brand of COVID-19 vaccine for the additional dose in patients 65 and older. Use standard adult doses...0.3 mL for Comirnaty (Pfizer-BioNTech)...or 0.5 mL for Spikevax (Moderna) or Novavax.

Be aware, there’s no change to the recommendations for moderately or severely immunocompromised patients 6 months and older. Continue to use shared decision-making to consider additional doses of the 2023-2024 COVID-19 least 2 months after the prior dose as needed.

Don’t give an additional dose to immunocompetent adults under 65...there’s not enough added benefit and it’s not cost-effective. But recommend annual COVID-19 vaccination if patients aren’t current.

Anticipate that FDA will decide on the strains for the 2024-2025 COVID-19 vaccines in May...and CDC will vote on the fall plan in June.

Check our resource, COVID-19 Vaccines, for updates.

Key References

  • CDC. Use of COVID-19 vaccines in the United States. Interim clinical considerations. Last updated March 1, 2024. (Accessed March 5, 2024).
  • CDC. ACIP Presentation Slides: February 28-29, 2024 Meeting. Last updated February 29, 2024. (Accessed March 5, 2024).
  • Wallace M. Evidence to Recommendations Framework: Additional Dose of 2023-2024 Formula COVID-19 Vaccine in Older Adults. Last updated February 28, 2024. (Accessed March 5, 2024).
  • DeCuir J, Payne AB, Self WH, et al. Interim Effectiveness of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years — VISION and IVY Networks, September 2023–January 2024. MMWR Morb Mortal Wkly Rep. 2024 Feb 29;73(8):180-188
Prescriber Insights. April 2024, No. 400405

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