Is a Covid-19 (Coronavirus disease 2019) booster dose recommended if the last booster was received in 2022?

COVID-19 Booster Recommendation After Last Dose in 2022

Yes, a COVID-19 booster is recommended if your last dose was in 2022, as bivalent boosters provide additional protection against severe COVID-19 outcomes including hospitalization and death. 1, 2

Current Booster Recommendations

• The CDC recommends bivalent mRNA COVID-19 vaccine booster doses for all eligible persons aged ≥5 years, administered ≥2 months after completing the primary series or after receipt of a previous monovalent booster dose 1
• Bivalent boosters are specifically designed to target both the original SARS-CoV-2 strain and Omicron subvariants (BA.4/BA.5), providing broader protection against currently circulating variants 1
• For adults aged ≥18 years, either Moderna or Pfizer-BioNTech bivalent boosters are recommended options 1

Effectiveness of Boosters

• Bivalent booster doses significantly reduce the risk of COVID-19-associated hospitalization compared to those who haven't received a booster, with an adjusted hazard ratio of 0.28 (95% CI 0.19-0.40) 3
• Among adults without immunocompromising conditions, vaccine effectiveness against COVID-19 hospitalization is 62% (95% CI = 57%-67%) during the first 7-59 days after bivalent vaccination 2
• Protection against critical outcomes, including ICU admission or in-hospital death, is sustained through at least 179 days after bivalent vaccination 2
• Research shows that the risk of severe COVID-19 outcomes reduced after receiving a booster (rate change: 8.8 events per 1000 person-years to 7.6 events per 1000 person-years) 4

Special Considerations

• For immunocompromised individuals:

  • Vaccine effectiveness is lower (28%, 95% CI = 10%-42%) but still provides important protection 2
  • These individuals may also benefit from pre-exposure prophylaxis with Evusheld (tixagevimab and cilgavimab) administered every 6 months to supplement vaccine protection 1

• For those who cannot or will not receive mRNA vaccines:

  • A monovalent Novavax booster dose may be used as an alternative to bivalent mRNA boosters in adults aged ≥18 years who have completed any FDA-approved or FDA-authorized primary series 1
  • The Novavax monovalent booster is authorized ≥6 months after the last primary series dose 1

• For those with recent SARS-CoV-2 infection:

  • Consider delaying a booster dose by 3 months from symptom onset or positive test result (if asymptomatic) 1
  • Prior infection provides some protection, but vaccination plus prior infection offers more robust protection 4

Safety Profile

• Systemic reactions following booster doses are generally less frequent than those following dose 2 of the primary series:
  • 58.4% reported systemic reactions after Pfizer-BioNTech booster vs. 66.7% after dose 2 5
  • 64.4% reported systemic reactions after Moderna booster vs. 78.4% after dose 2 5
• The vast majority (92.4%) of adverse events reported to VAERS following booster doses were non-serious 5

High-Risk Groups Who Should Prioritize Getting Boosters

• Adults aged ≥80 years (3.6 times higher risk compared to 18-49 years) 4
• Individuals with multiple comorbidities (≥5 comorbidities: 9.5 times higher risk compared to none) 4
• Those receiving immunosuppressants (5.8 times higher risk) 4
• Patients with chronic kidney disease (stage 5: 3.7 times higher risk) 4
• Males (1.2 times higher risk compared to females) 4

Given the evidence of waning immunity over time and the improved protection offered by updated boosters against currently circulating variants, a COVID-19 booster is recommended if your last dose was in 2022, especially if you belong to a high-risk group.