Current COVID-19 Vaccination and Booster Recommendations
The Centers for Disease Control and Prevention (CDC) recommends that all persons aged ≥5 years should receive a bivalent mRNA COVID-19 vaccine booster dose at least 2 months after completing their primary series or after receiving a monovalent booster dose to improve protection against COVID-19, particularly for those at increased risk for severe illness and death. 1
Primary Vaccination Series Recommendations
- For most persons aged 6 months-4 years: 2-dose Moderna (0,4-8 weeks) or 3-dose Pfizer-BioNTech (0,3-8,11-16 weeks) 2
- For most persons aged 5-11 years: 2-dose Moderna (0,4-8 weeks) or 2-dose Pfizer-BioNTech (0,3-8 weeks) 2
- For most persons aged 12-17 years: 2-dose Moderna (0,4-8 weeks), 2-dose Novavax (0,3-8 weeks), or 2-dose Pfizer-BioNTech (0,3-8 weeks) 2
- For most adults aged ≥18 years: 2-dose Moderna (0,4-8 weeks), 2-dose Novavax (0,3-8 weeks), or 2-dose Pfizer-BioNTech (0,3-8 weeks) 2
- For immunocompromised individuals, additional doses are recommended in the primary series 2, 1
Booster Dose Recommendations by Age Group
- Children aged 5 years should receive a Pfizer-BioNTech bivalent booster ≥2 months after primary series or monovalent booster 1
- Children aged 6-11 years should receive either Moderna or Pfizer-BioNTech bivalent booster ≥2 months after primary series or monovalent booster 1
- Adolescents aged 12-17 years should receive either Moderna or Pfizer-BioNTech bivalent booster ≥2 months after primary series or monovalent booster 1
- Adults aged ≥18 years should receive either Moderna or Pfizer-BioNTech bivalent booster ≥2 months after primary series or monovalent booster 1
Special Considerations
- For adults who cannot or will not receive mRNA vaccines, the Novavax monovalent booster may be used if they completed any FDA-approved or FDA-authorized primary series, have not received any booster doses, and are unable or unwilling to receive an mRNA vaccine 2, 1
- The Novavax monovalent booster is authorized ≥6 months after the last primary series dose 2
- Persons who recently had a SARS-CoV-2 infection may consider delaying a primary series dose or booster dose by 3 months from symptom onset or positive test result (if asymptomatic) 2, 1
- Immunocompromised individuals may benefit from additional protection with Evusheld (tixagevimab and cilgavimab) administered every 6 months to supplement vaccine-conferred protection 2
Safety Profile of Booster Doses
- Local and systemic reactions following booster doses are generally similar to or less frequent than those experienced after dose 2 of the primary series 3, 4
- Among v-safe registrants who reported a homologous COVID-19 mRNA booster dose, systemic reactions were less frequent following the booster (58.4% for Pfizer-BioNTech and 64.4% for Moderna) than after dose 2 (66.7% and 78.4%, respectively) 4
- The majority (92.4%) of adverse events reported to VAERS following booster doses were non-serious 4
Effectiveness of Booster Strategies
- Bivalent COVID-19 vaccine booster doses might improve protection against SARS-CoV-2 Omicron sublineages and, along with completion of a primary series in persons who remain unvaccinated, are important to protect against COVID-19 2
- For those who received the Janssen (Johnson & Johnson) vaccine as their primary dose, a heterologous mRNA booster provides higher protection (79% effectiveness against ED/UC visits) compared to a homologous Janssen booster (54% effectiveness) 5
- The CDC recommends preferential use of an mRNA COVID-19 vaccine for booster doses, even for persons who received the Janssen COVID-19 vaccine for their primary series 4, 5
Common Pitfalls to Avoid
- Delaying vaccination beyond recommended timeframes, as this may prolong the period of suboptimal protection 6
- Using Janssen (Johnson & Johnson) vaccine except in very limited situations due to the risk for thrombosis with thrombocytopenia syndrome 2
- Failing to recognize that immunocompromised individuals require special vaccination considerations, including additional primary doses 1, 7
- Not reporting vaccination errors or adverse events to the Vaccine Adverse Event Reporting System (VAERS) 3, 4