Document text
cdc.gov/coronavirus
Summary and Work Group
Considerations
Megan Wallace, DrPH, MPH
ACIP Meeting
June 23 , 2023
U.S. COVID -19 vaccine uptake among ages ≥12 years,
August 2021 -June 2023
01,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,000
Primary Series, Adolescents Ages 12-17 Primary Series, Adults Ages 18-49 Primary Series, Adults Ages 50-64 Primary Series, Adults Ages 65+
Booster, Adolescents Ages 12-17 Booster, Adults Ages 18-49 Booster, Adults Ages 50-64 Booster, Adults Ages 65+Primary series authorization
1stbooster authorization
2ndbooster authorization 1stbivalent booster
authorization
2ndbivalent
booster
authorization Doses Administered
Source: IZ Data Lake
Coverage / Age (years) <22–45–1112–1718–2424–4950–64>65
At least one dos e† 8.9 10.9 40.0 72.2 82.3 85.5 95.0 95.0
At least one bivalent dose 0.6 0.6 4.8 7.8 7.4 12.1 21.7 43.3
Unvaccinated 91.1 89.1 60.0 27.8 17.7 14.5 —†—†U.S. COVID -19 Vaccination Coverage (%) of Total Population by
Age Group —May 10, 2023
†Note: Coverage is capped at 95%
Source: https://covid.cdc.gov/covid -data -tracker/#vaccination -demographics -trends Updated June 1, 2023 3
PI=Prediction Interval, VOC=Variants of Concern, VBM=Variants Being Monitored . https://covid.cdc.gov/covid -data-tracker/#variant -proportions Accessed June 1 , 2023Trends in weighted variant proportion estimates & Nowcast
United States, February 19, 2023 –June 10, 2023
Collection date, week ending
4
Weekly population -based rates of COVID- 19-associated hospitalizations
by age group— COVID-NET, March 2020–May 2023
Age Group
.
https://covid.cdc.gov/covid -data -tracker/#covidnet -hospitalization -network Accessed June, 2023
5
▪COVID -19 during pregnancy is associated with severe maternal health outcomes and
adverse pregnancy outcomes
▪Risk of complications lower, but still elevated, during the Omicron predominant
period compared to pre -Omicron period
–Possibly due to the impact of prior infection and vaccination
▪Most hospitalized pregnant persons with a positive SARS -CoV-2 test were not up to
date with vaccinationsCOVID -19 in pregnant people
Summary
6
▪COVID -19-associated hospitalization rates in infants ages 0 –5 months increased in
the Omicron period
–Hospitalization rates similar to those in adults ages 65 –75 years
▪Majority of infants ages 0 –5 months hospitalized with a positive SARS -CoV-2 test
were hospitalized with COVID -19-like symptoms
▪Vaccination at any point in pregnancy appears to be beneficial to infants <6 monthsCOVID -19 in infants
Summary
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▪Pregnancy remains a risk factor for severe maternal disease and adverse pregnancy
outcomes, even with new variants
▪COVID -19 vaccination improves outcomes for pregnant people, their pregnancies and
their infants
▪Growing body of evidence that COVID -19 mRNA vaccines are safe during pregnancy1
▪Current uptake of updated COVID -19 vaccine is low among pregnant people
–23% of pregnant people received an updated dose2
▪Work group emphasized that pregnant people should receive recommended COVID -19
vaccine dose for protection of themselves and their infants
▪Continue to review data and evaluate COVID -19 recommendations for pregnant
people as neededWork Group interpretation
COVID -19 in pregnant people and infants
1. https://www.cdc.gov/vaccinesafety/research/publications/index.html . COVID -19 Vaccine Safety Articles and Studies by Topic. Pregnancy.
2. https://covid.cdc.gov/covid -data -tracker/#vaccinations -pregnant -women 8
▪Hybrid immunity likely provides better protection than either infection or
vaccination alone
▪Protection likely influenced by cumulative number of vaccine doses, number of
times infected, timing of most recent vaccination or infection, and how closely the
circulating variant matches the vaccine or prior infection
▪Protection can wane over time after both infection and vaccination
▪Receipt of updated vaccine dose can provide additional protection beyond that
received by prior doses or infection and restore protection after waningInfection -induced and hybrid immunity
Summary
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Current recommendations for mRNA COVID -19 vaccines
≥6 years 6 months –4 years 5 years2 doses
bivalent
Moderna3 doses
bivalent
Pfizer-
BioNTechOR2 doses
bivalent
Moderna1 dose
bivalent
Pfizer-
BioNTechOR1 dose
bivalent
Moderna1 dose
bivalent
Pfizer -
BioNTechOR
Current recommendations for mRNA COVID -19 vaccines
6 –23months 2 –4 yearsQuestion discussed by the Work Group :
Do children ages 2 –4 years continue to
need a multi -dose initial series, or could
they also move to a single (annual?) dose
like older populations
Possible future recommendations for simplification
mRNA COVID -19 vaccines
≥2 years 6–23months2 doses
bivalent
Moderna3 doses
bivalent
Pfizer -
BioNTechOR1 dose
bivalent
Moderna1 dose
bivalent
Pfizer-
BioNTechOR
COVID -19-associated hospitalization rates in infants, children and adolescents aged 6
months through <18 Years —COVID -NET, March 2020 –May 2023
Source: COVID -NET: https://www.cdc.gov/coronavirus/2019 -ncov/covid -data/covid -net/purpose -methods.html . Data March 1, 2020 through March 31, 2023. Pre -Delta: March 1, 2020 –June
19, 2021; Delta: June 20 –December 18, 2021; Omicron BA.1: December 19, 2021 –March 19, 2022; Omicron BA.2: March 20 –June 18, 2022; Omicron BA.5 (J une 19, 2022 –May 27, 2023)Pre-Delta DeltaOmicron
BA.1Omicron
BA.2Omicron BA.5 and later
1302468101214161820
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5/7/2023Rate per 100,000
6 months <2 years 2-4 years 5-11 years 12-17 years
63828993
0102030405060708090100
Mar-Apr May-Jun Jul-Aug Sep-Oct Nov-DecSeroprevalence (%)
Month7585929799
0102030405060708090100
Mar-Apr May-Jun Jul-Aug Sep-Oct Nov-DecSeroprevalence (%)
MonthPediatric infection -induced and combined (vaccine -and infection -induced)
Seroprevalence from U.S. commercial laboratories —March –December 2022
Source: https://covid.cdc.gov/covid -data -tracker/#pediatric -seroprevalence and unpublished data (CDC) Data from repeat, cross -sectional study on blood specimens collected by commercial laboratories.
Vaccine history is unknown in this study. Infection -induced seroprevalence estimated from blood specimens tested for anti -nucleo capsid antibodies: the number of specimens per 2 -month collection
period were, by age group: 6 –11 months: 157; 12 –23 months: 724; 2 –4 years: 2,165; 5 –11 years: 9,247; and 12 –17 years: 14,570. C ombined (vaccine -and infection -induced seroprevalence estimated
from specimens tested for both spike and nucleocapsid antibodies: >99% of samples tested for anti -nucleocapsid antibodies were t ested for anti -spike antibodies. 14Infection -induced Combined (vaccine -and infection -induced)
▪Children ages 6 –23 months have higher COVID -19 hospitalization rates; hospitalization
rates among children ages 2 –4 years similar to rates in children 5 –17 years
▪Children ages ≥2 years more likely to be seropositive and may have multiple exposures
through either infection or vaccination
▪However, no randomized, clinical trials compared efficacy or immunogenicity of single
dose versus multiple dose in young pediatric population in the context of high
seroprevalence Children ages 2 –4 years
Multiple initial doses or single (annual?) dose
15
▪COVID -19 vaccines effectively protect children from hospitalization and severe disease
from COVID -19
–Uptake of COVID -19 vaccines in children remains low
▪Work Group would be supportive of a move toward recommendation for a single
(possibly annual) dose in ages 2 –4 years based on hospitalization rates and rates of
seropositivity in this age group
–Work Group did highlight differences in transition to a single dose series from a two-dose
series , compared to a three -dose series
▪Simple recommendations may lead to increased coverage
▪Continue to review data and evaluate COVID -19 vaccine program in context of evolving
epidemiology Work Group interpretation
Multiple doses in children ages 2 -4 years
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▪June 15, 2023 FDA’s Vaccines and Related Biological Products Advisory Committee
(VRBPAC) met to discuss fall strain composition
▪VRBPAC unanimously voted that the vaccine composition be updated to a
monovalent COVID -19 vaccine with an XBB -lineage of the Omicron variant
▪FDA advised manufacturers to develop vaccines with a monovalent XBB.1.5
composition
▪Anticipate updated vaccine doses will be broadly available in the fall
▪Following updated vaccine authorizations, ACIP will review evidence to inform
updated recommendationsSteps toward recommendation of updated vaccine
https://www.fda.gov/advisory -committees/advisory -committee -calendar/vaccines -and-related -biological -products -advisory -committee -june -15-2023 -meeting -announcement
https://www.fda.gov/vaccines -blood -biologics/updated -covid -19-vaccines -use-united -states -beginning -fall-2023 17
▪COVID -19 vaccines and treatments will likely transition to the commercial
marketplace in fall 2023
–CDC continues to partner closely with state, local, and interagency partners toward
continued successful distribution of COVID -19 vaccines and treatments during this time,
including clarification of processes for ordering, shipping and distribution
–Guidance for partners will be published in summer 2023, prior to the transition to the
commercial marketplace
▪Most Americans will continue to pay nothing out -of-pocket for the COVID -19vaccine
due to their insurance coverage
▪However, approximately 25 million uninsured adults will lose access to affordable
COVID -19 vaccines and treatments if no action were taken
▪The Bridge Access Program for COVID -19 Vaccines and Treatment is a public -private
partnership which serves as a temporary measure to prevent the loss of under -and
uninsured adults' access to COVID -19 vaccines and treatments at no -cost after
commercializationPlanning for Fall 2023
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▪COVID -19 continues to cause substantial morbidity and mortality across the population,
particularly in groups like older adults and persons with immunocompromising conditions
▪COVID -19 vaccines continue to be the most effective tool we have to prevent serious illness,
hospitalization and death from COVID -19
▪COVID -19 vaccination is important for pregnant people for the protection of themselves and
their infants
▪Most of the population hasn’t received a bivalent vaccine dose
▪Ongoing review of data to continue efforts toward simplification
–Work Group would be supportive of additional simplification for children ages 2 –4 years in the future
▪FDA advised manufacturers to develop vaccines with a monovalent XBB.1.5 composition
▪Anticipate benefits from updated vaccine prior to possible increases in cases over the winter;
ACIP can discuss future vaccine recommendations at upcoming meetings following updated
vaccine authorizationsSummary
19
▪Sara Oliver
▪Danielle Moulia
▪Monica Godfrey
▪Evelyn Twentyman
▪Hannah Rosenblum
▪Lauren Roper
▪Katherine Fleming -Dutra
▪Ruth Link -Gelles
▪Amadea Britton
▪Sarah Meyer
▪Susan Goldstein
▪Mary Chamberland
▪Elisha Hall
▪Valerie Morelli▪JoEllen Wolicki
▪Fiona Havers
▪Romeo Galang
▪Sierra Scarbrough
▪Jefferson Jones
▪Aron Hall
▪Barbara Mahon
▪Coronavirus and other Respiratory Viruses Division
▪National Center for Immunization and Respiratory
DiseasesAcknowledgments
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.
Thank you