COVID-19 Vaccine Recommendations for Fall 2023

Column Author: Christine A. Symes, MSN, APRN, CPNP

Column Editor: Angela Myers, MD, MPH | Pediatric Infectious Diseases; Division Director, Infectious Diseases; Medical Director, Center for Wellbeing; Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine

As the SARS-CoV-2 virus has changed, so have vaccines and vaccine recommendations. Keeping up with current recommendations and vaccine schedules can be confusing. Here are the latest recommendations from the Advisory Committee on Immunization Practices (ACIP) for COVID-19 vaccines for the fall of 2023. On Sept. 12, 2023, the ACIP recommended vaccination with updated COVID-19 vaccines for all persons ≥6 months of age.

The previously used bivalent COVID-19 vaccines were designed to protect against virus strains that are no longer circulating widely. The newest vaccines are monovalent vaccines with a component targeting the current variants, most notably Omicron XBB.1.5. The Food and Drug Administration (FDA) approved the updated COVID-19 mRNA vaccines by Moderna and Pfizer-BioNTech for persons aged ≥12 years and authorized these vaccines for persons aged 6 months through 11 years under Emergency Use Authorization (EUA) on Sept. 11, 2023. On Oct. 3, 2023, the FDA authorized the updated COVID-19 vaccine by Novavax for persons aged ≥12 years under EUA.¹ The Novavax vaccine is not an mRNA vaccine. It is an adjuvanted protein vaccine that contains a purified recombinant spike antigen of the SARS-CoV-2 virus.²

The following vaccine schedules are for those 6 months of age or older who are not moderately or severely immunocompromised.¹

Children 6 months through 4 years of age who have not received any previous COVID-19 vaccine doses should receive either of the following:

• Three doses of Pfizer-BioNTech with the first dose at any time from 6 months-4 years of age, the second dose three to eight weeks after the first dose, and the third dose at least eight weeks following the second dose.
• Two doses of the Moderna vaccine with the first dose at any time from 6 months-4 years of age and then the second dose four to eight weeks after the first dose.

Children 6 months through 4 years of age who have received any previous COVID-19 vaccine doses before Sept. 12, 2023 should receive one of the following:

• If the child received one previous dose of Pfizer BioNTech vaccine, two additional doses should be administered, with the second dose three to eight weeks after the original dose, and the third dose at least eight weeks after the second dose.
• If the child received two or more previous doses of the Pfizer-BioNTech vaccine, one additional dose should be given at least eight weeks after the last dose given.
• If the child received either one or two previous doses of the Moderna vaccine, one additional dose should be given four to eight weeks after the last dose.

Children aged 5 years or older who are not vaccinated or have received previous COVID-19 vaccine(s) prior to Sept. 12, 2023 should receive one dose of the updated Pfizer BioNTech or Moderna vaccine.

For children >12 years of age, the Novavax vaccine is also an option:

• Children who have not previously received COVID-19 vaccine should receive two doses eight weeks apart.
• Children who received any COVID-19 vaccine(s) prior to Sept. 12, 2023 should receive one Novavax vaccine.

For children 6 months of age-4 years of age and are moderately or severely immunocompromised, recommendations can be found at: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.

For children 5 years of age or older with moderate to severe immunocompromise, recommendations can be found at: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.

Of note, COVID-19 vaccines are changing from a federal procurement and distribution structure into the vaccine commercial marketplace this fall. COVID-19 vaccines adopted by the Centers for Disease Control and Prevention (CDC) and listed on the CDC Immunization Schedules should be covered without any cost-sharing for patients by Affordable Care Act health plans, by Medicare Part B and nearly all Medicaid plans, and through the Vaccines for Children Program.

References:

1. 1. Regan JJ, Moulia DL, Link-Gelles R, et al. Use of updated COVID-19 Vaccines 2023–2024 formula for persons aged ≥6 months: recommendations of the Advisory Committee on Immunization Practices — United States, September 2023. MMWR Morb Mortal Wkly Rep. 2023;72:1140-1146. doi:15585/mmwr.mm7242e1
   2. COVID-19 vaccine (subunit). In: Lexi-Drugs. Lexicomp; 2023. Last updated October 19, 2023. https://online.lexi.com