Should all individuals aged 65 and older receive the COVID-19 (Coronavirus Disease 2019) booster vaccine?

COVID-19 Booster Vaccination for Adults Aged 65 Years and Older

Yes, all individuals aged 65 years and older should receive the COVID-19 booster vaccine as it is routinely recommended by the Advisory Committee on Immunization Practices (ACIP) to reduce risk of severe COVID-19 outcomes in this high-risk population. 1

Current Recommendations for Adults ≥65 Years

• COVID-19 vaccination is now routinely recommended for all adults, including those aged ≥65 years, with both primary series and booster doses 1
• The 2024-2025 COVID-19 vaccines are updated monovalent vaccines specifically targeting current virus variants, providing enhanced protection against circulating strains 2
• For individuals who have already received a primary COVID-19 vaccine series, a single dose of the current COVID-19 vaccine is recommended with a minimum interval of 8 weeks since the last dose 2

Evidence Supporting Booster Vaccination in Older Adults

• Adults aged ≥65 years are at significantly increased risk for severe COVID-19 outcomes including hospitalization and death 3
• Vaccine effectiveness studies show that full vaccination provides 94% protection against COVID-19-associated hospitalization among adults aged ≥65 years 4
• Following the introduction of COVID-19 vaccines prioritizing older adults, significant decreases in COVID-19 cases, emergency department visits, hospital admissions, and deaths were observed in this age group 5
• A large retrospective cohort study of over 1.6 million participants showed low incidence of severe COVID-19 outcomes following booster vaccination, with particularly beneficial effects for those aged ≥65 years 6

Vaccine Selection for Older Adults

• For the 2024-2025 vaccination season, individuals can choose from various vaccine options including Moderna (monovalent, KP.2-strain), Pfizer-BioNTech (monovalent, KP.2-strain), and Novavax (monovalent, JN.1-strain) for individuals 12 years and older 2
• The vaccine manufacturer for the booster dose does not need to match prior vaccinations 2
• For influenza vaccination (which often occurs simultaneously with COVID-19 vaccination), adults aged ≥65 years should preferentially receive one of the following: quadrivalent high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, or quadrivalent adjuvanted inactivated influenza vaccine 1

Special Considerations

• Individuals who have recently had a SARS-CoV-2 infection may consider delaying vaccination by 3 months from symptom onset or positive test result 1, 2
• Persons with moderate or severe immunocompromise may require additional doses according to specific guidelines 1, 2
• COVID-19 vaccines can be administered during the same visit as other vaccines, including the seasonal influenza vaccine 1

Importance for Public Health

• By May 2021,82% of persons aged ≥65 years had received at least one COVID-19 vaccine dose, contributing to significant reductions in severe outcomes 5
• Despite high initial uptake, continued efforts are needed to ensure older adults receive recommended booster doses, as only 44.1% of eligible adults aged ≥65 years had received a booster or additional primary dose during the August-November 2021 period 7
• Vaccination remains the most effective tool for reducing severe COVID-19 outcomes in high-risk groups, including older adults 4, 3

Implementation Approach

1. Identify all adults aged ≥65 years who have not received the current COVID-19 booster
2. Provide clear information about the benefits of vaccination, particularly for preventing severe outcomes 4, 3
3. Address any concerns about vaccine safety or effectiveness with evidence-based information 2
4. Consider co-administration with other recommended vaccines for this age group, such as influenza and pneumococcal vaccines 1
5. For those who recently had COVID-19, discuss the optimal timing of vaccination (potential 3-month delay) 1, 2