Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
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COVID-19 Vaccine Policy and Next Steps
October 26, 2023
Megan Wallace, DrPH, MPH
COVID-19 Epidemiology
3
Trends in weighted variant proportion estimates and Nowcast –
United States, June 25 – October 14, 2023
PI=Prediction Interval
Source: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Weekly population-based rates of COVID-19-associated hospitalizations by
season – COVID-NET, United States, March 2020–September 2023
Source: Coronavirus Disease 2019 (COVID-19) Hospitalization Surveillance Network (COVID-NET); https://www.cdc.gov/coronavirus/2019-
ncov/covidnetdashboard/de/powerbi/dashboard.html. Accessed October 16, 2023.
Oct Nov Dec Jan Feb Mar Apr May June July Aug Sep
Hospitalizations per 100,000
0
10
20
30
40
Surveillance Month
2020-2021
2019-2020
2021-2022
2022-2023
4
5
Weekly population-based rates of COVID-19-associated hospitalizations by
age group – COVID-NET, United States, October 2022–September 2023
Source: Coronavirus Disease 2019 (COVID-19) Hospitalization Surveillance Network (COVID-NET); https://www.cdc.gov/coronavirus/2019-
ncov/covidnetdashboard/de/powerbi/dashboard.html. Accessed October 16, 2023.
Oct Nov Dec Jan Feb Mar Apr May June July Aug Sep
Surveillance Month
Hospitalizations per 100,000
0
10
20
30
60
50
40
5-17 years
0-4 years
18-49 years
50-64 years
≥65 years
6
Weekly COVID-19 new hospital admissions – National Healthcare Safety
Network (NHSN), United States, August 2020 – September 2023
Source: COVID-19–associated hospitalization data reported to CDC’s National Healthcare Safety Network (NHSN).
https://covid.cdc.gov/covid-data-tracker/#trends_weeklyhospitaladmissions_select_00
7
Weekly provisional COVID-19 deaths – National Vital Statistics System
(NVSS), United States January 2020 – September 2023
Source: Provisional Deaths from the CDC’s National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS). https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_weeklydeathrateaa_00
Data during recent periods are incomplete because of the lag in time between when a death occurs and when a death certificate is completed, submitted to NCHS, and processed for reporting. This delay can range
from 1 week to 8 weeks or more, depending on the jurisdiction. The most recent 3 weeks of mortality counts are shaded grey because NVSS reporting is <95% during this period.
COVID-19 Vaccine Policy
▪ ACIP met September 12, 2023 to review the available evidence for
updated COVID-19 vaccines (monovalent, XBB.1.5 component)
▪ ACIP recommended updated COVID-19 vaccines as authorized under EUA
or approved by BLA in persons aged ≥6 months
– Moderna COVID-19 vaccine in persons ≥6 months
– Pfizer-BioNTech COVID-19 vaccine in persons ≥6 months
– Novavax COVID-19 vaccine in persons ≥ 12 years
▪ All anticipated updated (2023–2024 Formula) vaccines are now
authorized or approved
COVID-19 Vaccine Policy
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▪ All doses should be homologous (i.e., from the same manufacturer)
▪ All Moderna doses in ages 6 months – 11 years are now 25 µcg
Recommendations for children aged 6 months – 4 years without
immunocompromise
Doses recommended:
▪ Initial series of 2 Moderna vaccine doses OR 3 Pfizer-
BioNTech vaccine doses
▪ Including at least 1 dose of 2023–2024 COVID-19 vaccine
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Recommended 2023–2024 COVID-19 mRNA vaccines for people who are NOT
immunocompromised, aged 6 months–4 years*
†
*For information about administration intervals and children who transition from age 4 years to age 5 years, see Table 1 in the Interim Clinical Considerations for
Use of COVID-19 Vaccines
† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for people
ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people ages 18
years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses.
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▪ Exceptional situations: In the following exceptional situations, a different age-
appropriate COVID-19 vaccine may be administered:
– Same vaccine not available
– Previous dose unknown
– Person would otherwise not complete the vaccination series
– Person starts but unable to complete a vaccination series with the same COVID-19
vaccine due to a contraindication
▪ A Vaccine Adverse Event Reporting System (VAERS) report is not indicated for these
exceptional situations.
Prior Version of Interim Clinical Considerations on
Interchangeability of COVID-19 vaccines
Clinical Guidance for COVID-19 Vaccination | CDC
12
▪ COVID-19 vaccine doses from the same manufacturer should be administered
whenever recommended. In the following circumstances, an age-appropriate COVID-19
vaccine from a different manufacturer may be administered:
– Same vaccine not available at the vaccination site at the time of the clinic visit
– Previous dose unknown
– Person would otherwise not receive a recommended vaccine dose
– Person starts but unable to complete a vaccination series with the same COVID-19
vaccine due to a contraindication
▪ A Vaccine Adverse Event Reporting System (VAERS) report is not indicated in these
circumstances.
Updated Version of Interim Clinical Considerations on
Interchangeability of COVID-19 vaccines
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▪ Updated guidance for children who transition during the initial COVID-19 vaccination
series from age 4 years to age 5 years and children who are moderately or severely
immunocompromised and transition from age 11 years to age 12 years to receive the
age-appropriate dosage based on their age on the day of vaccination
Additional Updates to Interim Clinical Considerations
Clinical Guidance for COVID-19 Vaccination | CDC
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Recommendations for people aged 5 years and older without
immunocompromise
Doses recommended:
• 1 dose of 2023–2024 COVID-19 vaccine
▪ mRNA COVID-19 vaccines authorized or approved for ages ≥6 months and Novavax COVID-19 vaccine
authorized for ages ≥12 years
▪ Unvaccinated persons receiving Novavax COVID-19 should complete a 2-dose initial series
▪ New harmonized age cutoff for recommendations for young children for Moderna and Pfizer-
BioNTech COVID-19 vaccines resulting in simplified recommendations for 5-year-olds
▪ All Moderna doses in ages 6 months – 11 years are now 25 µcg
▪ 2023–2024 COVID-19 vaccine dose is recommended at least 2 months after receipt of the last
COVID-19 vaccine dose
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Recommended 2023–2024 COVID-19 mRNA vaccines for people who are NOT
immunocompromised, aged 5–11 years*
†
*For information about administration intervals and children who transition from age 4 years to age 5 years, see Table 1 in the Interim Clinical Considerations for
Use of COVID-19 Vaccines
† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for people
ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people ages 18
years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses.
16
Recommended COVID-19 vaccination schedule for people who are NOT moderately or
severely immunocompromised, aged ≥12 years
*†
*For information about administration intervals and children who transition from age 4 years to age 5 years, see Table 1 in the Interim Clinical Considerations for
Use of COVID-19 Vaccines
† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for people
ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people ages 18
years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses.
17
Recommendations for people aged ≥6 months who are
moderately or severely immunocompromised
Doses recommended:
▪ Initial COVID-19 vaccine series*
▪ At least 1 2023–2024 COVID-19 vaccine dose
▪ May receive 1 or more additional 2023-2024
COVID-19 vaccine doses**
*Series of 3 homologous mRNA COVID-19 vaccine doses or 2 homologous Novavax COVID-19 vaccine doses
at time of initial vaccination. This could also include a history of receipt of 1 or more doses of Novavax or
Janssen, including in combination with mRNA vaccine dose(s).
**Further additional dose(s) may be administered, informed by the clinical judgement of a healthcare
provider and personal preference and circumstances. Further additional doses should be administered at
least 2 months after the last 2023-2024 COVID-19 vaccine dose.
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Recommended 2023–2024 COVID-19 vaccines for people who ARE moderately or severely
immunocompromised, aged 6 months–4 years*
†
* For information about administration intervals and children who transition from age 4 years to age 5 years or age 11 years to age 12 years during an mRNA
vaccination series, and administration of additional dose(s), see Table 2 in the Interim Clinical Considerations for Use of COVID-19 Vaccines
† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for
people ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people
ages 18 years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses.
19
Recommended 2023–2024 COVID-19 vaccines for people who ARE moderately or severely
immunocompromised, aged 5–11 years*
†
* For information about administration intervals and children who transition from age 4 years to age 5 years or age 11 years to age 12 years during an mRNA
vaccination series, and administration of additional dose(s), see Table 2 in the Interim Clinical Considerations for Use of COVID-19 Vaccines
† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for
people ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people
ages 18 years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses.
20
Recommended COVID-19 vaccination schedule for people who ARE moderately or
severely immunocompromised, aged ≥12 years
*†
* For information about administration intervals and children who transition from age 4 years to age 5 years or age 11 years to age 12 years during an mRNA
vaccination series, and administration of additional dose(s), see Table 2 in the Interim Clinical Considerations for Use of COVID-19 Vaccines
† COVID-19 vaccination history refers to previous receipt of doses of Original monovalent mRNA or bivalent mRNA vaccine or a combination of the two; for
people ages 12 years and older, Original monovalent Novavax COVID-19 Vaccine doses, alone or in combination with any mRNA vaccine doses; and for people
ages 18 years and older, Janssen COVID-19 Vaccine doses, alone or in combination with any mRNA or Original monovalent Novavax vaccine doses.
21
▪ Consideration of additional COVID-19 vaccine doses in older adults
– Anticipated for February 2024 ACIP meeting
– Policy discussion will occur prior to individuals reaching 6 months since their last dose
▪ Preparations for future COVID-19 vaccine formula updates
– Discussions will begin at June 2024 ACIP meeting
▪ Continue to monitor vaccine effectiveness, vaccine safety, and COVID-19 epidemiology
– COVID-19 vaccine recommendations can be updated if needed
Upcoming COVID-19 policy discussions
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Acknowledgements
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▪ Monica Godfrey
▪ Danielle Moulia
▪ Katherine Fleming-Dutra
▪ Ruth Link-Gelles
▪ Sarah Meyer
▪ Elisha Hall
▪ Susan Goldstein
▪ Mary Chamberland
▪ JoEllen Wolicki
▪ Natalie Thornburg
▪ Sierra Scarbrough
▪ Aron Hall
▪ Christopher Taylor
▪ Fiona Havers
▪ Dave Wentworth
▪ Meredith McMorrow
▪ COVID-NET Team
▪ Coronavirus and other Respiratory Viruses Division
▪ National Center for Immunization and Respiratory
Diseases
For more information, contact CDC
1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.
