What COVID-19 vaccination recommendations are advised for an elderly patient?

COVID-19 Vaccination Recommendations for Elderly Patients

All elderly patients should receive at least one dose of the 2024-2025 COVID-19 vaccine regardless of their previous vaccination history to protect against severe disease, hospitalization, and death. 1

General Recommendations for Elderly Patients

• Elderly patients without moderate or severe immunocompromise need one dose of the 2024-2025 COVID-19 vaccine (Moderna, Pfizer-BioNTech, or Novavax) to be considered up to date with their vaccination 1
• The recommended interval is at least 8 weeks after the last COVID-19 vaccine dose 1, 2
• COVID-19 remains a significant threat to elderly patients, with 67% of all COVID-19-associated hospitalizations occurring among persons aged ≥65 years during the 2023-2024 respiratory season 3
• Vaccine effectiveness against COVID-19-associated hospitalization among immunocompetent adults aged ≥65 years is approximately 45-46% during the first 7-119 days after vaccination 4

Vaccine Options for Elderly Patients

• Elderly patients can choose from:
  • Moderna (monovalent, KP.2-strain) 2
  • Pfizer-BioNTech (monovalent, KP.2-strain) 2
  • Novavax (monovalent, JN.1-strain) for individuals 12 years and older 2
• The choice of vaccine manufacturer does not need to match prior vaccinations 2
• For previously unvaccinated elderly patients who choose Novavax, a 2-dose series is recommended with 3-8 weeks between doses 1

Special Considerations for Immunocompromised Elderly Patients

• Elderly patients who are moderately or severely immunocompromised should receive at least one dose of 2024-2025 COVID-19 vaccine 1
• Unvaccinated elderly patients who are moderately or severely immunocompromised should complete an initial vaccination series with either:
  • 3 doses of a 2024-2025 mRNA COVID-19 vaccine from the same manufacturer, or
  • 2 doses of 2024-2025 Novavax COVID-19 vaccine 1
• Vaccine effectiveness among adults aged ≥65 years with immunocompromising conditions is approximately 40% during the first 7-119 days after vaccination 4
• Elderly immunocompromised patients who have completed an initial series and received at least one dose of a 2024-2025 COVID-19 vaccine may receive one additional age-appropriate dose at least 2 months after the last recommended dose 1

Safety Profile

• Safety monitoring shows that adverse events after COVID-19 vaccination are consistent with those reported after previous vaccine formulations 5
• Common reactions include injection site reactions (60.8%) and systemic reactions (54.8%), with fewer than 1% requiring medical care 5
• Health impacts after COVID-19 vaccination are less frequent and less severe than those associated with COVID-19 illness 5

Clinical Considerations

• For elderly patients who have recently had a SARS-CoV-2 infection, a delay in vaccination of 3 months after symptom onset or positive test may be considered 2
• The 2024-2025 COVID-19 vaccines are updated monovalent vaccines developed specifically against current virus variants (Omicron JN.1-line, including JN.1 and KP.2) 2
• Waning of vaccine-conferred protection against disease is expected over time, making the current recommendation for vaccination particularly important for elderly patients 3

Common Pitfalls to Avoid

• Do not delay vaccination beyond the recommended timeframe, as this may prolong the period of suboptimal protection 2
• Do not assume that previous vaccination with older formulations provides adequate protection against current circulating variants 6
• Do not overlook the importance of vaccination for elderly patients even if they have had COVID-19 infection previously 2