CDC Panel Backs Boosters for All Adults

All adults ages 18 and up may get a booster dose of COVID-19 vaccine at least 6 months following the Pfizer or Moderna primary series, but adults ages 50 and up should receive one, the CDC’s Advisory Committee on Immunization Practices (ACIP) said Friday.

In two 11-0 votes, ACIP voted to recommend that adults ages 18 and older can receive a COVID booster dose based on their individual benefits and risks, and adults ages 50 and older are recommended to receive one. Previously, only adults ages 65 and older, as well as those with high-risk medical conditions and high occupational risk exposure, were recommended to receive a booster.

They also advised that adults ages 18 and up in long-term care facilities should receive a booster dose.

The recommendations consolidated the previously fragmented risk-based recommendations addressing both high-risk medical conditions and occupational and institutional exposure, which certain public health experts decried as being too confusing, noting that four out of 10 people were not sure if they were even eligible for a booster.

ACIP member Matthew Daley, MD, of Kaiser Permanente Colorado in Aurora, said the prior recommendations were not easy to implement, especially when patients and providers “have to go check a list of 50 medical conditions.”

“The list of medical conditions is so expansive, it actually creates a barrier where there was no barrier intended,” he added.

ACIP members also thought it was prudent to add adults ages 50-64 because data have shown that three-quarters of this population has a medical condition that would put them at high risk of severe COVID, while their risks for vaccine-associated myocarditis and pericarditis were very low.

Simplicity was the word of the day, as the 3-hour meeting opened with remarks from Sam Posner, PhD, acting director of CDC’s National Center for Immunization and Respiratory Diseases, discussing how the FDA’s emergency use authorization (EUA) on Friday morning would help healthcare providers, as “simplification of booster dose recommendations will reduce confusion.”

ACIP chair Grace Lee, MD, of Stanford University School of Medicine in California, said that she personally felt that making the vaccine accessible to all adults ages 50 and up was an equity issue. “If my 60-year-old friend who didn’t have any high-risk medical conditions asked me if [they] needed a booster, I would tell them yes,” she said. “Even in a healthy individual, I would personally say … it’s hard to say that others shouldn’t get it.”

The vote on adults ages 18 and up was fairly straight-forward, with Sarah Long, MD, of Drexel University in Philadelphia, summing it up by noting “it doesn’t harm, and it might even help,” though she added that she thought protection against transmission might only last a couple of months. Other members brought up the issue of the upcoming holidays, when COVID cases are expected to spike.

There were no safety issues seen in available booster data, with CDC staff sharing that there had been 12 confirmed cases of vaccine-associated myocarditis or pericarditis following a booster dose, which occurred in patients with a median age of 46. Ten of these patients were hospitalized and all were discharged home.

However, based on available data, the rate of vaccine-associated myocarditis was lower than after the second dose of mRNA vaccine, they pointed out.

“As a clinician deep in the clinical trenches, I’m glad we have streamlined recommendations,” said Camille Kotton, MD, of Massachusetts General Hospital in Boston.

All recommendations from ACIP are not considered final until they are published in the Morbidity and Mortality Weekly Report.