COVID booster update: People 6 months and older encouraged to get the bivalent vaccine

On Dec. 9, the Centers for Disease Control and Prevention expanded the updated bivalent booster vaccine for children ages 6 months and older. These updated boosters are bivalent, meaning they offer protection against the latest omicron variants plus the original COVID-19 strain.

“There is concern that we may see another potential wave of COVID-19 infections,” says Kelly Cawcutt, MD, Nebraska Medicine infectious diseases specialist. “If we do, it may be related to several things at once: new variants, spending more time indoors as the weather gets colder, and the fact that we are heading into flu season.”

Getting the latest booster is highly recommended to protect you against severe disease, hospitalization and death. Viruses frequently change through mutation. Sometimes these mutations result in a new variant of the virus. BA.4 and BA.5 variants now account for about 62% of COVID-19 cases in the United States, and newer variants have appeared since, including omicron variants BF.7 and BQ.1.

Interested in the data? Use the CDC’s data tracker for daily updates with maps and charts.  You can also track new variants as the situation changes.

The bottom line: Everyone age 6 months and older can now get an updated bivalent booster

As long as you’ve completed a primary series, it doesn’t matter how many boosters you’ve had before.

Who can get an updated (bivalent) booster?

• Pfizer booster: Ages 6 months and up 
• Moderna booster: Ages 6 months and up
• Novavax doesn’t have a bivalent booster yet, but you can get one of the others even if your primary series was Novavax

Further recommendations:

As long as you've completed a primary COVID-19 series (two doses of Pfizer or Moderna or one dose of Johnson & Johnson), you can get one bivalent booster.  You should get your bivalent booster two months or longer after your last COVID-19 vaccine or booster.

Children 6 months and older should receive one updated (bivalent) booster if it has been at least two months since their last COVID-19 vaccine dose, whether that was:
•    Their final primary series dose, or
•    An original (monovalent) booster

Those who have received more than one original (monovalent) booster are also recommended to get an updated (bivalent) booster.

Stay current with the latest CDC booster recommendations for children and teens ages 6 months to 17 years and adults ages 18 years and older.

Can I still get the original (monovalent) COVID-19 mRNA vaccine?

The new bivalent boosters combine half the original mRNA vaccine targeting the Wuhan (original) strain and half the new mRNA vaccine targeting the BA.4 and BA.5 variants.

The original monovalent mRNA vaccines continue to be available for primary series vaccination (first two doses) and for boosters for children aged 5 to 11 years who have not previously received a booster.

With the decision to approve the new bivalent booster vaccines, the Food and Drug Administration specified that the original monovalent COVID-19 vaccines are no longer authorized for use as boosters in people 12 years and older.

What are booster recommendations for immunocompromised people?

See the complete bivalent booster recommendations for immunocompromised people from the CDC. You may get a bivalent booster at least two months after your primary series.

In addition, the CDC recommends:

• Everyone ages 6 months and older get an updated COVID-19 booster to help restore protection that has decreased since their last vaccine. One updated booster dose is recommended for all people ages 5 years and older, regardless of whether or not they are immunocompromised
• People that are moderately or severely immunocompromised get an extra primary series dose if receiving the Moderna or Pfizer-BioNTech series
• You can self-attest to your moderately or severely immunocompromised status, which means you do not need any documentation of your status to receive the COVID-19 vaccine doses you might be eligible to receive

Use CDC’s COVID-19 booster tool to learn if and when you can get boosters to stay up to date with your COVID-19 vaccines.

Can I get the updated bivalent booster with the flu shot? Yes.

For the best protection, get both the updated COVID-19 booster and the flu shot (influenza vaccine) now. Just like last year, you can get the COVID-19 booster at the same time as your flu shot.

Are vaccines working? Yes.

Vaccines still protect against severe outcomes from COVID-19. The data shows a significant decrease in deaths in those who have been vaccinated compared to those who have not been vaccinated. The data is even more encouraging for those who have received one or more booster doses.

Are the boosters safe? Available evidence says yes.

The COVID-19 vaccines have been rigorously tested and studied since early 2020. "We have been using mRNA COVID-19 vaccines for two years, and over 2 billion doses have been given worldwide. These vaccines have a good safety record," says infectious diseases expert James Lawler, MD, MPH. "As we face continued high rates of BA.5 infection, an updated booster gives you additional protection against severe disease, hospitalization, death and likely long COVID."

The data we have on the bivalent BA.4/BA.5 fall boosters is from studies of human serum and mice. Because they are slight variations on the previous monovalent mRNA vaccines (for which we have large amounts of safety data), the FDA has determined that we do not need extensive human clinical trials to ensure safety.

Similarly, it is the same process we follow for the influenza (flu) vaccine every year. The flu vaccine is updated yearly based on which strains are likely to be the most widespread. After the platform is thoroughly tested in human clinical trials for initial product approval, the flu shot variant is updated each year. The annual flu vaccine updates do not require additional human testing. If we did wait for human testing each year, we would not get protection from the vaccines while the flu spreads unchecked.
 
The FDA and CDC authorized the same approach for the COVID-19 updated booster. The COVID-19 vaccine platform remains the same, but the specific code is updated to match new variants.

Should I get vaccinated if I've had COVID-19? Yes.

COVID-19 vaccines are recommended if you've had COVID-19. During omicron, reinfections increased. Reinfections have increased even more with BA.5. Studies show that the best protection against reinfection, hospitalization, and death comes from previous infection and up-to-date vaccination.

If you've recently had COVID-19, the CDC and most experts recommend a dose of vaccine one to four weeks after resolution of symptoms (if you are eligible).

Do I have to get the same vaccine as my original type? No.

If you are 18 years or older, you may choose between Pfizer and Moderna as a bivalent booster dose. Some people may prefer the vaccine type that they originally received. Others may prefer to get a different type for their booster. CDC recommendations allow for this mix-and-match dosing for booster shots.