CDC vaccine advisers recommend second COVID vaccine dose for seniors, immune-compromised

The Centers for Disease Control and Prevention (CDC) vaccine advisory group today recommended a second 2024-25 COVID-19 vaccine dose, spaced 6 months apart, for people ages 65 and older and for people in younger age-groups who have moderate or severe immunocompromising conditions.

The group also recommended an extra dose, three or more, in people with immunocompromising conditions, based on shared decision-making between patient and doctor.

The recommendation replaces a vaguer “additional doses” wording that the Advisory Committee for Immunization Practices (ACIP) used in its advice over the summer for at-risk groups for the 2024-25 vaccines. The group made the change to simplify and standardize language used for its routine immunization schedules. 

The three-part vote passed unanimously.

Challenges in maintaining protection

The ACIP work group that proposed the recommendation grappled with several factors, including a lack of seasonality of SARS-CoV-2 circulation, the epidemiology of the disease, waning vaccine effectiveness, and variant changes. 

Vaccine timing has become complex, especially given tough-to-predict waves involving new COVID variants that sometimes spike in warm-weather months, after protection from vaccination in the fall months has waned, but before updated vaccines arrive on the market. For example, over the past spring and summer, COVID activity circulated at a high level over many months. 

Hospitalization rates from COVID remain higher in seniors, especially those ages 75 and older.

According to the CDC’s latest data for the last respiratory disease season, 40% of adults ages 65 and older received one dose of the vaccine and 8.9% received a second dose, with second-dose levels higher in people in urban areas and in certain geographic regions. CDC experts told the group that a healthcare provider recommendation helped sway patients to receive a second dose.

Meanwhile, second-dose coverage in immunocompromised people ages 18 and older was lower, at 5.4%.

Extra flexibility for immunocompromised groups

Also, along with the general two-dose recommendation for immunocompromised people ages 6 months to 64 years, in a move to create more flexibility with COVID vaccination, ACIP recommended additional doses—three or more—of the 2024-25 vaccine in people ages 6 months and older who are moderately to severely immunocompromised with shared clinical decision-making. 

CDC experts recommended a minimal 2-month vaccination interval to allow for flexibility based on the patient’s risks and circumstances.

The CDC director considers ACIP recommendations before making a formal recommendation.