By Marie Rosenthal, MS
The CDC endorsed the recommendation of the Advisory Committee on Immunization Practices (ACIP) for people 65 years of age and older and certain immunocompromised individuals to receive a second dose of the 2024-2025 COVID-19 vaccine six months after their first dose.
These updated recommendations also allow people who are moderately or severely immunocompromised to get three or more COVID-19 vaccines if needed. The ACIP recommends that the choice for more than two vaccines be part of shared clinical decision making.
The ACIP’s recommendation received a unanimous vote, and the CDC director, Mandy Cohen, MD, MPH, was quick to endorse the recommendations.
Between October 2023 and April 2024, adults 65 and older accounted for 70% of all hospitalizations associated with COVID-19, according to Robert Schechter, MD, the ACIP COVID-19 Vaccines Work Group chair, and most of them had multiple underlying conditions. In that time, COVID-NET identified 40,761 COVID-19–associated hospitalizations, of which more than 95% (38,900) occurred among adults 18 years and older (MMWR Morb Mortal Wkly Rep 2024;73[39]:869-875).
Only 12% of those hospitalized had received the recommended COVID-19 2023-2024 formula vaccine, according to Dr. Schechter, the medical director at the California Department of Public Health, Immunization Branch.
COVID-19 also affected younger people: The rate of COVID-19–associated hospitalization rates among infants younger than 6 months was similar to adults between 65 and 74 years last season. Many of these were born to people who were not vaccinated during pregnancy. Only 18% of people were vaccinated with a COVID-19 vaccine while pregnant, according to Dr. Schechter.
Despite the risk being higher among older people, having an immunocompromising condition, including taking therapies that suppress immunity, increases the risk for severe COVID-19, according to Christopher A. Taylor, PhD, an epidemiologist with COVID-NET in the CDC’s Coronavirus and Other Respiratory Viruses Division (NCIRD), National Center for Immunization and Respiratory Diseases.
One in 6 people (15.6%) who were hospitalized with COVID-19 had an immunocompromising condition. Surveillance found that 16% of those 18 to 49; 22% of those 60 to 64; and 15% of those 65 and older had at least one immunocompromising condition. The most common among those hospitalized with COVID-19 were people taking immunosuppressive therapy, followed by solid-organ malignancy and various other cancers, those who received a bone marrow transplant, and various other immunocompromising conditions, such as AIDS.
Very few of them received any COVID-19 vaccines during the 2022-2023 season, according to Dr. Taylor.
However, the acceptance of COVID-19 vaccines appear to be increasing this season, according to Georgina Peacock, MD, MPH, the director of the Immunization Services Division in the NCIRD. “I just wanted to give you the latest numbers on vaccine coverage for this season that we posted today on the web,” Dr. Peacock said on Oct. 23. “For children, it’s 3.7% compared with 3.1% last year at this time; for adults 18 and older, it’s 11.7% compared with 6.8% at the same time last year; and for 75 plus, it is 30.6% compared with 17.7% last season.”
Demetre Daskalakis, MD, MPH, the director of the NCIRD, reiterated that good news and said the expeditious rollout of fall vaccines could be a contributing factor.
“All three strategies for vaccination against RSV [respiratory syncytial virus], COVID and influenza are now in the field. And we are really seeing some interesting changes by launching early,” Dr. Daskalakis said. “We are seeing higher uptake of COVID-19 vaccine compared with the same date last year, which is again, I think a testament to the fact that we worked so closely together across the various components of government and industry.”
The new recommendation acknowledges the increased risk for severe disease from COVID-19 in older adults and those who are immunocompromised, along with the currently available data on vaccine effectiveness and year-round circulation of COVID-19. The recommendation also provides clarity to healthcare providers about how many doses should be given per year to people who are moderately or severely immunocompromised and is meant to increase coverage of this second dose for that group, according to the speakers at the ACIP meeting.
Data continue to confirm the importance of vaccination to protect those most at risk for severe outcomes of COVID-19, and being vaccinated each season can restore and enhance protection against the circulating virus variants responsible for most infections and hospitalizations in the United States, as well as reduces the risk for long COVID.
For more information on updated COVID-19 vaccines, visit Coronavirus Disease 2019 (COVID-19) | CDC.
“This vote allows people to make the best decisions possible to keep themselves and their loved ones safe from COVID-19. CDC will continue to educate the public on how and when to get their updated vaccinations so they can risk less severe illness and do more of what they love,” Dr. Cohen said in a statement.
