What COVID-19 (Coronavirus Disease 2019) vaccine is currently recommended for adults?

COVID-19 Vaccination Recommendations for Adults

All adults should receive one dose of the 2024-2025 COVID-19 vaccine formulation targeting the Omicron JN.1 lineage strains to protect against severe COVID-19-associated illness and death. 1

Current Vaccine Recommendations

The Advisory Committee on Immunization Practices (ACIP) and CDC recommend the following for adults:

• For most adults (≥18 years): One dose of the 2024-2025 COVID-19 vaccine is recommended to be up to date

  • Options include Moderna, Pfizer-BioNTech (KP.2 strain), or Novavax (JN.1 strain) 1
  • Previously unvaccinated adults choosing Novavax should receive 2 doses, 3-8 weeks apart 2

• For immunocompromised adults: At least one dose of the 2024-2025 COVID-19 vaccine is recommended

  • Additional doses may be needed depending on vaccination history 1
  • Unvaccinated immunocompromised adults should receive either 3 doses of 2024-2025 mRNA COVID-19 vaccine or 2 doses of 2024-2025 Novavax COVID-19 vaccine 1

Timing Considerations

• Previously vaccinated individuals should receive the 2024-2025 COVID-19 vaccine ≥8 weeks after their last COVID-19 vaccine dose 2
• Individuals who recently had SARS-CoV-2 infection may consider delaying vaccination by 3 months from symptom onset or positive test 2
• For cancer patients or immunocompromised individuals:
  • No specific optimal timing during treatment cycles is recommended 1
  • Consider vaccination 4 weeks before or 6 months after anti-CD20 medications 2
  • For transplant recipients, vaccination is generally postponed for 3-6 months after transplantation 2

Vaccine Effectiveness

The 2024-2025 COVID-19 vaccines have demonstrated:

• 33% effectiveness against COVID-19-associated ED/UC visits among adults ≥18 years 2
• 45-46% effectiveness against COVID-19-associated hospitalization among immunocompetent adults ≥65 years 2
• 40% effectiveness against COVID-19-associated hospitalization among immunocompromised adults ≥65 years 2

Previous COVID-19 vaccines have shown:

• Effectiveness against COVID-19-associated hospitalization during the BA.4/BA.5 period among immunocompetent adults was 49% at 14-149 days after dose 3 and 34% ≥150 days after dose 3 1
• Booster doses provide increased protection against infection and severe disease, though effectiveness wanes over time 1

Safety Profile

• Common reactions include injection site pain, fatigue, headache, and muscle pain 2
• Serious adverse events are rare 2
• Two statistical signals were identified in the 2023-2024 vaccine safety monitoring:
  • Guillain-Barré syndrome (GBS) among persons aged ≥65 years (evidence inconclusive) 1
  • Ischemic stroke among adults aged ≥50 years (no clear and consistent evidence of a safety problem) 1

Special Populations

Cancer Patients

• COVID-19 vaccination reduces the risk of severe COVID-19 illness in patients with cancer 1
• Five nonrandomized studies support that vaccinated cancer patients were significantly less likely to experience hospitalization for COVID-19 or death compared to unvaccinated patients 1
• Providers should strongly recommend additional vaccine doses after a 2-month interval for patients receiving therapies known to weaken vaccine responses 1

Economic Considerations

• COVID-19 vaccines are most cost-effective in adults aged ≥65 years ($23,308 per QALY) 1
• Cost-effectiveness is less favorable but still present in younger adults:
  • Ages 50-64: $113,248 per QALY
  • Ages 18-49: $212,225 per QALY 1

Common Pitfalls to Avoid

1. Waiting too long after infection: Natural immunity wanes over time, leaving individuals vulnerable to reinfection 2

2. Getting vaccinated while symptomatic: This could potentially worsen symptoms and complicate assessment of vaccine side effects 2

3. Relying solely on natural immunity: Vaccination after infection provides more durable and broader protection than infection alone 2

4. Neglecting booster doses for high-risk individuals: Particularly important for older adults who received Pfizer as their primary series, as some evidence suggests potentially lower long-term protection compared to Moderna for this age group 3

5. Overlooking vaccination for cancer patients: COVID-19 vaccines protect patients with cancer, reducing the risk of severe COVID-19 illness and hospitalization 1

By following these evidence-based recommendations, adults can optimize their protection against COVID-19 and reduce their risk of severe illness, hospitalization, and death.