As the Advisory Committee on Immunization Practices last week approved the Pfizer COVID-19 vaccine for children aged 5-11, a significant swathe of the population previously susceptible to infection is now eligible for vaccination. Simultaneously, efforts to ‘boost’ the waning immunity of 65+ and susceptible adults who received their initial shots more than 6 months ago are ongoing.
Right out of the gate, we know that the J&J vaccine is less efficacious overall and loses effectiveness more rapidly than Pfizer and Moderna. As such, those individuals that received J&J have been recommended to have a booster 2 months (rather than 6 months for Pfizer/Moderna) after their initial shot. For J&J recipients, the booster can be another J&J or one of the mRNA vaccines (Pfizer or Moderna). Everybody who received a J&J shot should get a booster in 2 months.
So who should be getting a booster for the mRNA vaccines (Moderna and Pfizer). Currently, the CDC recommends the following groups obtain a booster if it has been at least 6 months since completion of the primary vaccine series (so 6 months from the administration date of the second shot):
- Adults 65 years or older should receive a booster dose.
- Adults 50 years or older at risk for severe COVID-19 because of comorbidities (listed in Table 1 below) should receive a booster dose.
- Adults 18 years or older in long-term care settings should receive a booster dose.
- Adults aged 18 to 49 years and at risk for severe COVID-19 because of comorbidities ((listed in Table 1 below) may receive a booster dose after weighing the individual risks and benefits.
- Adults aged 18 to 64 years who have occupational or institutional risk of exposure to SARS-CoV-2 (eg, health care workers or those living in congregate settings) may receive a booster dose after weighing the individual risks and benefits.
COMORBILITIES THE CDC CLASSIFIES AS RISK FACTORS FOR SEVERE COVID-19
Established probable, and possible risk factors (comorbidities that have been associated with severe COVID-19 in at least 1 meta-analysis or systematic review in observational studies or in case series)E
- Cerebrovascular disease
- Children with certain underlying conditions
- Chronic kidney disease
- COPD and other lung disease (including interstitial lung disease, pulmonary fibrosis, pulmonary hypertension, cystic fibrosis)
- Diabetis mellitus, type 1 and type 2
- Down syndrome
- Heart Conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
- Neurologic conditions, including dimentia
- Obesity (BMI ≥30 kg/m ) and overweight (BMI 25 to 29 kg/m )
- Smoking (current and former)
- Sickle cell disease or thalassemia
- Solid organ or blood stem cell transplantation
- Substance use disorder
- Use of corticosteroids or other immunosuppressive medications
Possible risk factors but evidence is mixed (comorbidities have been associated with severe COVID-19
in at least 1 meta-analysis or systematic review, but other studies had reached different conclusions)
- Immune deficiencies
- Liver disease
COVID-19: coronavirus disease 2019; CDC: Centers for Disease Control and Prevention; COPD:
chronic obstructive pulmonary disease; BMI: body mass index. These comorbidities are associated with severe COVID-19 in adults of all ages. Risk of severe disease also rises steadily with age, with more than 80% of deaths occurring in adults older than age 65 years. People of color are also at increased risk of severe disease and death, often at a younger age, due to systemic health and social inequities.
Underlying medical conditions are also associated with severe illness in children, but evidence
implicating specific conditions is limited. Children with the following conditions might be at
increased risk for severe illness: medical complexity; genetic, neurologic, or metabolic conditions;
congenital heart disease; obesity; diabetes; asthma or other chronic lung disease; sickle cell disease;
Reference: 1. Centers for Disease Control and Prevention. Underlying medical conditions associated with high risk for severe COVID-19: Information for healthcare providers. Available at: https://www.cdc.gov/coronavirus/2019- ncov/hcp/clinical-care/underlyingconditions.html (Accessed on April 5, 2021). 2. Centers for Disease Control and Prevention. Science brief: Evidence used to update the list of underlying medical conditions that increase a person's risk of severe illness from COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlying-evidence-table.html (Accessed on April 5, 2021). 3. Official reprint from UpToDate www.uptodate.com © 2021 UpToDate, Inc. and/or its affiliates. All Rights Reserved.