Theo Huot de Saint-Albin was a 9-year-old elementary school student when he first contracted COVID-19 in July 2020, near the start of the coronavirus pandemic.
Four years later, as much of the world has moved on from the pandemic and resumed normal life, Theo, now nearly a teenager, is still battling the effects of long COVID.
"What happened directly after COVID-19 was worse than my actual COVID-19," Theo, now in seventh grade, told "Good Morning America." For me, I have chronic migraines ... it doesn't mean the migraine is terrible every day. It's very unpredictable. It goes in waves. But it's always there. It never leaves."
Over the past four years, Theo has contracted COVID-19 a total of three times, and each case has been mild. It's what happens in the weeks and months after the COVID-19 diagnosis that he says has impacted his ability to learn, go to school and play with friends.
In addition to battling chronic migraines, Theo was also diagnosed with postural orthostatic tachycardia syndrome, or POTS, a blood circulation disorder that can cause dizziness, lightheadedness and a rapid heartbeat, according to the U.S. National Institute of Neurological Disorders and Stroke.
He said he also suffers from symptoms like muscle pain, extreme fatigue and brain fog, and takes around two dozen medications and supplements each day to help manage his symptoms.
"There's no real way to tell how I'm going to feel," Theo said, noting that some days he is able to go to school for only a half-day, while other days he feels closer to his pre-COVID-19 self, and still others he can't move beyond the couch all day.
"It's especially hard because it's 'invisible,'" Theo said of his long COVID diagnosis. "Sometimes it's hard to get people to believe you as well because they can empathize with something they know is there. 'Oh, you have a broken leg, I can see that. Wow, you can't walk. That must be tough.' But, your head hurts? 'I don't see a big bulge on your head. I don't see bandages wrapped around it.'"
While battling long COVID can seem lonely, Theo is far from alone, data shows.
An analysis published in February in the journal Pediatrics reported that as many as 5.8 million children in the United States have developed long COVID, or between 10% to 20% of children who have contracted COVID-19.
Figures from the Centers for Disease Control and Prevention show a smaller but still noteworthy estimate of 1.3% of children in the U.S. having had long COVID as of 2022.
Long COVID is diagnosed when patients still have symptoms at least four weeks after they have cleared the infection, according to the CDC. In some cases, like Theo's, symptoms can be present for months or years.
It's not clear if long COVID symptoms last a lifetime. Many people eventually recover, but scientists are still working to understand who is most affected, and why.
Symptoms vary and can include fatigue, difficulty breathing, headaches, dizziness brain fog, joint and muscle pain and continued loss of taste and smell, according to the CDC.
In kids, symptoms of long COVID can also include rashes, diarrhea, heart issues and diabetes, according to the research published in Pediatrics.
Part of the complication with long COVID is there is no single test or bloodwork to diagnose it. Instead, doctors have to rule out other conditions and rely on patients to describe and track their symptoms, which can be difficult with kids.
For Theo, it took nearly two years for him to be diagnosed with long COVID, according to his mom Meredith Eubanks.
Eubanks said she was told "no" by doctors when she would ask if her son might have long COVID, and faced misdiagnoses along the way, like Lyme disease. Both she and Theo struggled to answer when asked roughly how many doctors he had seen over the past four years.
In April 2022, Eubanks said Theo was diagnosed with long COVID by an infectious disease group at a local children's hospital in Atlanta, where the family lives. But the hospital, according to Eubanks, had no answer to her question of "Now what?" in terms of treatments and rehabilitation.
For that, the family traveled over 600 miles to Baltimore, where Dr. Laura Malone, a pediatric neurologist, had established the Pediatric Post-COVID-19 Rehabilitation Clinic at the Kennedy Krieger Institute, a pediatric-focused nonprofit health organization affiliated with Johns Hopkins Medicine.
"They were the first place we got to where they were like, 'Here's a list of symptoms, and did you have any pre-COVID, and what did you have post-COVID?'" Eubanks said, recalling how Theo checked nearly all of the symptoms on the list. "I just remember that was such relief. It was just like, 'Oh, you know, they're recognizing this and it's official, and Theo is not alone.'"
Malone said she and her team at the Kennedy Krieger Institute established the clinic in the summer of 2020 as they saw reports of adults developing long COVID. As the pandemic continued, demand began to grow.
"Everybody was, early in the pandemic, very focused on hospitalized cases, and the sequela after people get care in the ICU or are very critically ill with the acute infection, and that's not generally what we see in pediatrics," Malone said. "Most children can have a relatively mild infection and then go on to develop long-term sequela. So, that took a little bit of time to recognize and for patients to seek care, both from their primary care doctors and then also from clinics like us."
As long COVID became more recognized, Malone said the clinic has seen steady demand from pediatric patients across the country, while she said other patients may go undiagnosed.
"You have to look at a lot of behavioral changes, especially in younger children, to say, 'Something seems off'.' So I do think that [long COVID] is probably a little bit under-recognized still," Malone said. "We do see that there can be a lot of resiliency in children, and so despite them sometimes maybe having the symptoms, they may not always bring it up to family members or doctors but rather just try and manage the symptoms, and it's only when it gets to be intolerable that sometimes it will present to more medical care."
Along with there being no diagnostic test for long COVID, there is also no cure for the condition. Much of what can be done for patients is symptom management, according to Malone.
For kids, she said that means helping them manage their symptoms so they can, at least to some degree, return to school and social activities.
"Participation in life and all the activities, including education, that kids are designed to be participating in is really important," Malone said. "One of our big focuses is to try to provide accommodations to get kids back into school, but meet them where they are, because they may not be able to do a full course load, or they may not be able to make it through the full day of school, but there is still benefit if they can go for an hour, and gradually increase that over time to getting them back into that sort of routine, and getting them back into the social aspects of school and the educational aspects."
Patients at the clinic see not only medical doctors like Malone, but a team of experts including behavioral and neuropsychologists, social workers, pain specialists and physical therapists.
Ellen Henning, Ph.D., a pediatric psychologist at the Kennedy Krieger Institute, said patients often struggle with anxiety and depression due to long COVID. She said new research is also suggesting that long COVID itself could be influencing mental health symptoms due to factors like inflammation in the brain and lower levels of serotonin.
"We learn new things constantly and we adjust as we as we go," Henning said. "We try to provide the best supports that we can and then we all are always integrating new knowledge and adjusting things as we need to."
In October, the clinic received a $5 million grant from the Department of Health and Human Services that it is using to help train school nurses and other community health care providers to identify long COVID in students and provide accommodations for students already diagnosed with the condition.
"We have a lot of families and children that say that they have to educate, sometimes, their providers and tell their doctors at home about what's going on and about long COVID," Malone said. "That can just be really exhausting for kid, so that's a big thing that we've been working on, and we're really proud of that."
Theo said while his long COVID symptoms continue, he has felt more at ease since receiving his diagnosis and as the condition becomes more recognized.
With the help of Malone and the team at the Kennedy Krieger Institute, Theo is back in school for periods of time and working on catching up with his classmates.
"We have a lot of hope," he said. "I know I'm going to finish school at some point. Maybe a little later than most people, but who knows. And I think I'm going to get better. With all the research that's going to come out, hopefully, something will help me more than anything else."
While most people recognized that the pandemic was a catalyst for buying groceries online, few could fully anticipate the implications of that surge, said David Bishop, partner at Brick Meets Click. Now, four years after COVID-19 first impacted our everyday lives, eGrocery in the U.S. looks very different from both a contribution and growth perspective, and this will impact how grocers and others expand and drive profitability in their respective businesses moving forward.
From a contribution perspective, Pickup and Delivery share has grown at the expense of Ship-to-Home. Pickup, which accounted for less than one-third of eGrocery sales in 2019, quickly moved to the top spot when the pandemic started and it has stayed there ever since. Delivery, which represented one-quarter of all online sales in 2019, experienced an even larger jump in market share, to 39.1 percent.
Online grocery sales for March peaked in 2021 and have declined or been flat on a year-over-year basis since then. The ongoing research shows that the size of the online grocery customer pool has become more well-defined and that future growth will likely happen more gradually. In March 2024, the total eGrocery customer pool (which consists of active and lapsed or infrequent users), expanded to include 78.6 percent of all U.S. households. At the end of the first month of the pandemic in 2020, online grocery household penetration finished at 70.8 percent.
The overall eGrocery Monthly Active User base as a share of total households more than doubled at the start of COVID-19, finishing March 2020 at 57.5 percent, the share of MAUs since then has generally remained in the 50 percent range.
"Helping customers build their basket of goods by using tactics like personalized offers or targeted deals is not just key to growing sales but also to improving the chances that theyll come back again, said Mark Fairhurst, global chief growth officer at Mercatus. For todays grocers, keeping your online customers engaged is more important than ever as growth is now more likely derived from increased order frequency and/or spend per order.
Another challenge for most brick-and-mortar grocers is building a mobile app that assists customers as they shop, whether thats online or in-store. Mass retailers, like Walmart and Target, have already invested heavily in enhancing the perceived value from using their mobile apps and it shows.
The latest research found that 76 percent of households that primarily buy groceries from Walmart and who also buy groceries online completed one or more eGrocery orders with Walmart during March 2024. For the households that primarily shop at a supermarket and buy groceries online, only 60 percent of those households bought groceries online from a Supermarket.
This article has been reviewed according to ScienceX's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility:
by Mitochondria-Microbiota Task Force
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Long COVID-19, or post-acute sequelae of SARS-CoV-2 infection (PASC), is a global health phenomenon characterized by persistent symptoms following the acute phase of COVID-19.
Affecting millions worldwide, it leads to sustained health care needs and impacts workforce participation due to symptoms such as fatigue and cognitive impairments. The condition highlights the necessity for ongoing research, health care system adjustments, and the formulation of targeted treatments to address its prolonged effects on individuals and economies.
A recently published study in Clinics has shed light on significant metabolic changes in non-vaccinated individuals with long COVID-19, offering key insights into disease severity. This study was led by Marvin Edeas, MD, Ph.D., Universit de Paris, Institut Cochin, INSERM 1016, France, and a team of international researchers led by Jumana Saleh, Ph.D., Sultan Qaboos University Hospital, Oman.
Published under the title "Reduced HDL-cholesterol in long COVID-19: A Key Metabolic Risk Factor Tied to Disease Severity," the study examined 88 patients across varying degrees of initial disease severity (mild, moderate, and severe) compared to a control group comprising 29 healthy individuals.
Findings from the controlled study revealed major metabolic shifts, particularly a substantial reduction in HDL-cholesterol (HDL-C) levels, coupled with a twofold increase in ferritin levels and insulin resistance among severe long COVID-19 cases, compared to milder cases and the control group. These metabolic markers emerged as leading predictors of disease severity, offering novel understandings of long COVID-19 management and treatment.
Edeas explained, "Our research has, for the first time, established a direct correlation between HDL-C and ferritin levels and the severity of long COVID-19. The decline in HDL-C levels and the rise in ferritin levels observed in patients, influenced by the severity of the initial infection, could potentially play a role in the persistence and progression of long COVID-19 symptoms." This study is critical in understanding long COVID-19 and its long-term impacts on metabolic health.
The research findings suggest that HDL-C and ferritin levels could serve as crucial markers and therapeutic targets, opening new avenues for treatment strategies aimed at mitigating the long-term effects of the disease. By considering these metabolic markers, we can shape preventive strategies and significantly mitigate the long-term impacts of COVID-19 on patients' health.
The observed correlation between diminished levels of HDL-cholesterol (HDL-C), the severity of COVID-19, and its prolonged course might be explained by HDL-C's function as a modulator of the immune response. This includes its roles as an anti-inflammatory, antioxidant, and antiatherogenic agent, particularly vital during the heightened inflammatory response triggered by the virus. Investigating HDL-C's utility beyond its conventional role in cholesterol transport is crucial for a comprehensive understanding of COVID-19 and its secondary health effects, such as long-COVID.
Extensive research indicates that COVID-19 precipitates notable shifts in the host's lipid metabolism, leading to the accumulation of cellular lipid reserves. These alterations aid in the viral takeover of host cellular mechanisms, thus facilitating the progression of the infection. This theory gains support from laboratory evidence showing the cessation of viral replication upon the administration of small molecule lipid inhibitors, highlighting the critical dependence of the virus on host lipid resources for replication.
A notable aspect of the interplay between HDL-C functionality and iron homeostasis is the process of ferroptosis, induced by lipid peroxidation and disturbed iron balance, characterized by the buildup of iron and products of lipid oxidation. This leads to diminished antioxidant defense capabilities. HDL-C is influential in mitigating the detrimental effects associated with ferroptosis, underscoring the significance of maintaining balanced iron levels in COVID-19 management.
"Our findings highlight the exacerbating effect of impaired iron regulation on COVID-19 progression, further complicated by the disrupted protective functions of HDL-C," stated Saleh.
The outcome of the "war," between the host's metabolic defenses and viral invasion strategies, axes on the control over iron and lipid resources. The virus strategically targets these metabolic reserves to support its replication and spread. For Edeas, this battle underscores the complex interaction between host metabolic pathways and viral mechanisms, emphasizing the strategic importance of iron and lipid regulation in determining the course and outcome of COVID-19 infection.
How does the strategic alteration of iron and HDL-C levels by a virus contribute to its underlying aim of targeting mitochondria to disrupt host defense mechanisms? Edeas, founder of World Mitochondria Society, commented on the perspective of this study.
"In the intricate dance of viral infection, the virus employs a calculated strategy aimed directly at the heart of the host's cellular energy and defense systemsthe mitochondria. By subtly manipulating and altering the host's iron metabolism and HDL-C levels, the virus orchestrates a multifaceted attack designed to undermine mitochondrial integrity and function.
"This strategic disruption serves to weaken the mitochondria, a crucial step in the virus's broader aim to compromise the host's ability to mount an effective defense. Through this sophisticated mechanism of action, the virus ensures its survival and proliferation within the host, highlighting the importance of understanding these viral tactics for the development of targeted therapeutic interventions."
The implications of this study are broad, providing a new understanding of long COVID-19's impact on metabolic health and laying the foundation for future research and therapeutic interventions aimed at improving patient outcomes.
More information: Jamila Al-Zadjali et al, Reduced HDL-cholesterol in long COVID-19: A key metabolic risk factor tied to disease severity, Clinics (2024). DOI: 10.1016/j.clinsp.2024.100344
Provided by Mitochondria-Microbiota Task Force
A positive polymerase chain reaction (PCR) result for SARS-CoV-2 was not associated with a new asthma diagnosis in children, according to a retrospective cohort study.
In adjusted analyses, PCR positivity for SARS-CoV-2 had no significant effect on the hazard of a new asthma diagnosis over 18 months of follow-up (HR 0.96, 95% CI 0.73-1.27, P=0.79), reported David Hill, MD, PhD, of the Children's Hospital of Philadelphia, and co-authors in Pediatrics.
Previous longitudinal studies have shown associations between acute wheezing illnesses among infants secondary to rhinovirus or respiratory syncytial virus (RSV) and later progression to asthma in childhood and adolescence, the authors explained.
"Smaller studies have isolated coronavirus strains from nasopharyngeal aspirates of infants and children during acute wheezing episodes or asthma exacerbations," they added. "However, each of these studies identified aspirates containing human coronaviruses 229E and OC43, coronavirus strains with low pathogenicity and mostly responsible for benign upper respiratory tract infections."
The current study examined a cohort of over 27,000 kids ages 1 to 16 years who were tested for COVID-19 during the first year of the pandemic. In the primary analysis, 1.81% of SARS-CoV-2-positive patients were subsequently diagnosed with asthma compared with 2.13% of SARS-CoV-2-negative patients.
"This study further benefits from a relatively unique period in history in which there was more uniformity in and control over environmental risk factors for asthma development," Hill and team noted. "Principally, the prevalence of other respiratory viral illnesses (including RSV, influenza, and rhinovirus) plummeted during the first year of the pandemic."
"This fact provided a natural opportunity to isolate the effects of SARS-CoV-2 from other respiratory viral infections," they continued. "Additionally, global improvement in pollution trends and air quality, coupled with greater isolation indoors, may have helped minimize exposure to outdoor toxicants and allergens while also minimizing variability between urban and rural settings."
Michelle Mann, MD, of Texas Children's Hospital and Baylor College of Medicine in Houston, told MedPage Today in an email that cough, wheezing, and bronchial reactivity can be seen in children with acute COVID-19 infection with or without an asthma diagnosis.
"The data are reassuring when discussing the prognosis with patients and families with COVID-19 infection and respiratory symptoms," she said. "We have seen in practice that most children with prolonged respiratory symptoms after COVID-19 infection will improve with time. However, the time course for resolution of respiratory symptoms can be much longer than other respiratory viruses."
Theresa W. Guilbert, MD, of Cincinnati Children's Hospital Medical Center, highlighted the environmental factors present during the pandemic.
"It is possible that our appropriate public health response to the pandemic -- social distancing, temporary suspension of school and work -- may have led to less exposure to respiratory viruses and other risk factors associated with asthma," she told MedPage Today. "For example, 1) less exposure to respiratory viruses, which may or may not be protective against asthma, 2) less exposure to pollution, which may be protective against asthma, or 3) increased maternal stress, which may lead to increased risk of asthma."
In the study, factors that significantly increased the hazard of new asthma diagnosis were Black race (HR 1.49, 95% CI 1.13-1.95, P=0.004), food allergies (HR 1.26, 95% CI 1.03-1.55, P=0.025), and allergic rhinitis (HR 2.30, 95% CI 1.93-2.74, P<0.001).
For children younger than 5 years, preterm birth (HR 1.48, 95% CI 1.13-1.93, P=0.005) and body mass index (HR 1.13, 95% CI 1.07-1.19, P<0.001) also significantly increased the hazard of new asthma diagnosis.
On the other hand, older age (ages 5-11: HR 0.27, 95% CI 0.22-0.34; ages 12 and up: HR 0.16, 95% CI 0.12-0.22) was associated with a significantly lower hazard of new asthma diagnosis.
For this study, Hill and team enrolled 27,423 children within the Children's Hospital of Philadelphia Care Network who received PCR testing for SARS-CoV-2 from March 2020 through February 2021. More than half were boys (52%), 39% were ages 5-11, 37.3% were ages 1-4, and 23.7% were 12 and older. Most kids were white (60.7%), and 21.3% were Black.
About 11% were born preterm, 12.7% had atopic dermatitis, 15.7% had a food allergy, and 43.6% had allergic rhinitis.
During the follow-up period, 573 children received an asthma diagnosis. The primary analysis defined asthma diagnosis as the presence of at least one corresponding ICD code for asthma, along with a prescription of an asthma-related medication.
Rates were similar in the sensitivity analysis, which used the secondary asthma diagnosis definition that required a corresponding ICD code for asthma at two or more follow-up visits at least 6 months apart, as well as a prescription of an asthma-related medication, with 1.12% of positive patients and 1.59% of negative patients diagnosed with asthma.
Hill and colleagues pointed to several study limitations, including the fact that it took place at a single institution and it relied on PCR test results for a 1-year exposure window only. In addition, "the exposure window preceded the evolution of several SARS-CoV-2 variants," and "it is possible that these later SARS-CoV-2 strains may influence asthma risk differently," they wrote.
Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow
Disclosures
This study was supported by the National Institutes of Health and the Children's Hospital of Philadelphia Research Institute.
The study authors reported no conflicts of interest.
Mann and Guilbert reported no disclosures.
Primary Source
Pediatrics
Source Reference: Senter JP, et al "COVID-19 and asthma onset in children" Pediatrics 2024; DOI: 10.1542/peds.2023-064615.
(The Hill) A Centers for Disease Control and Prevention (CDC) study has found that mRNA vaccines for the COVID-19 virus are not linked to cardiac death in younger adults.
The study was conducted using Oregon death certificate data for people aged 16 to 30 who died from a heart condition between June 1, 2021 and Dec. 31, 2022. The study was done after cases of myocarditis, an inflammation of the heart muscle, were reported to the Vaccine Adverse Event Reporting System.
Of the 40 people who died who had a COVID vaccine dose, three died within 100 days of receiving their vaccination. Two were because the person had an underlying illness and one had an undetermined cause of death, the CDC said.
The data do not support an association of COVID-19 vaccination with sudden cardiac death among previously healthy young persons, the CDC said.
While the risk of dying due to myocarditis was higher for younger people during 2021, the CDC found that it remained an infrequent cause of death among the age group.
During the same time period, 30 Oregon residents in the same age group died from COVID and only three of the people who died had received any sort of COVID vaccine.
The CDC said the report cant exclude vaccine-related cardiac deaths after the 100-day mark, but published data indicate that potential adverse effects associated with vaccinations tend to occur within 42 days of vaccine receipt.
The study also noted that the small population size made it less likely to see a rare event such as sudden cardiac death among the age group.
The CDC maintains that a COVID vaccination is recommended for all people 6 months and older to prevent infection, complications and death.
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The drive-through event is being held in the parking lot of Friends of Indianapolis Dogs Outside at 1505 N. Sherman Drive.
INDIANAPOLIS One local animal non-profit organization is offering Hoosiers an opportunity to get their dogs vaccinated for free.
Indy's Parvo Prevention Project is hosting a free parvo vaccination clinic from 11 a.m. to 3 p.m. for local dogs April 13, and another one May 11.
Canine parvovirus is a highly contagious virus that spreads from dogs and can potentially be lethal.
Too many dogs arent getting the affordable and effective vaccinations for the highly lethal, expensive-to-treat Parvovirus, and the results are heartbreaking, said Robin Herman, the founder of LDR Rescue and organizer of the event.
Herman said the circumstance is especially regrettable, given the low cost of the vaccine.
When new puppy owners meet with most vets for the first time, they are confronted with packaged options that can run up to several hundred dollars, she said. If they do nothing else, they should ask for the Parvo vaccine, which can cost as little as $16.
Herman, who has rescued more than 1,400 dogs in her career, said the goal of Indys Parvo Prevention Project is to inoculate at least 500 dogs at the clinic.
The drive-through event is being held in the parking lot of Friends of Indianapolis Dogs Outsideat 1505 N. Sherman Dr.
For more information on the organizations and event, click here.
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There is no evidence that the vaccine is linked to heart disease, the agency says.
Author: 11alive.com
Published: 5:47 PM EDT April 12, 2024
Updated: 5:47 PM EDT April 12, 2024
Dear Savvy Senior,
My husband and I recently turned 65 and would like to find out which vaccines are recommended and covered by Medicare?
New beneficiaries
Dear New, All recommended vaccines for adults age 65 and older should be covered by either Medicare Part B or Part D, but there are some coverage challenges you should be aware of. Heres a rundown of which vaccines are recommended by the Centers for Disease Control and Prevention (CDC) and how Medicare covers them.
COVID-19: Even though COVID-19 is no longer a public health emergency, it can still cause severe illness, particularly in older adults. Because the COVID virus continues to mutate, new vaccines are being developed to keep pace, so the CDC recommends that all seniors stay up to date with the latest COVID vaccines, including booster shots.
All COVID-19 shots are covered 100 percent by Medicare Part B.
Flu: Considered an annual vaccination, most people of all ages receive flu shots in the fall when flu season begins. The CDC recommends seniors, 65 and older get a high-dose flu shot for extra protection beyond what a standard flu shot offers. The Fluzone High Dose Quadrivalent, FLUAD Quadrivalent and FluBlok Quadrivalent are your three options.
Annual flu shots are covered under Medicare Part B.
Pneumonia: These vaccines help protect against pneumococcal disease, which can cause pneumonia, meningitis and other infections. The CDC recommends everyone 65 and older get a pneumococcal vaccine. There are several different vaccine options available, so talk to your doctor or pharmacists to find out which is best for you or visit the CDCs Pneumococcal Vaccination webpage at CDC.gov/vaccines/vpd/pneumo/public/index.html.
Medicare Part B covers both single-dose and two-dose pneumococcal shots once in your lifetime.
Shingles: Caused by the same virus that causes chicken pox, shingles is a painful, blistering skin rash that affects more than 1 million Americans every year. All people over age 50 are recommended to get the two-dose Shingrix vaccine, which is given two to six months apart, even if you previously received Zostavax. In 2020, Shingrix replaced Zostavax, which is no longer available in the U.S.
All Medicare Part D prescription drug plans cover shingles vaccinations, but coverage amounts, and reimbursement rules vary depending on where the shot is given. Check your plan.
Tdap: Tetanus, diphtheria, and pertussis (whooping cough) are diseases caused by bacteria that can lead to serious illness and death. Therefore, a one-time dose of the Tdap vaccine is recommended for all adults. If youve already had a Tdap shot, you should get a tetanus-diphtheria (Td) booster shot every 10 years.
All Medicare Part D plans cover these vaccinations.
RSV: Respiratory syncytial virus (RSV) can lead to pneumonia or bronchiolitis and can worsen other chronic conditions common among older adults, such as asthma and chronic obstructive pulmonary disease (COPD). The CDC recommends all adults, age 60 and older, talk to their doctor about getting one of the RSV vaccines (either Arexvy or Abrysvo), usually in the fall and winter months when the virus is most prevalent.
Most Medicare Part D plans cover the RSV vaccine, but not all. If your plan doesnt cover it, you can ask for a coverage exception. You can also pay for the shot out of pocket and then follow-up with your plan to get reimbursed. If you pay for the shot upfront, your plan must pay you back.
There are other vaccines you may need depending on your health, lifestyle or travel plans. To help you get a handle on which ones are appropriate for you, take the CDCs What Vaccines Do You Need? quiz at www2.cdc.gov/nip/adultimmsched. Also, talk to your doctor during your next visit about what vaccinations you should get.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of The Savvy Senior book.
Despite the improved supply of COVID-19 vaccine starting by late 2021, coverage in the African Region increased slowly. Regional coverage with a primary series reached 32% in 2023, with 38% of the population receiving 1 dose. Among the subset of countries that reported coverage for high-risk groups, 48% of health care workers and 52% of older adults received a primary series. Variation in coverage among countries was substantial. Four (9%) of the 47 countries in the region achieved the WHO target of 70% primary series coverage in the total population in 2022 (Liberia, Mauritius, Rwanda, and Seychelles); 29 (62%) countries reported primary series total population coverage <40%. Eritrea has not introduced COVID-19 vaccines, and Burundi delayed introduction in the general population and focused on vaccination of health care workers.
Several reasons likely account for low coverage with COVID-19 vaccines, including limited political commitment, logistical challenges, low perceived risk of COVID-19 illness, and variation in vaccine confidence and demand (3). Country immunization program capacity varies widely across the African Region. Challenges include weak public health infrastructure, limited number of trained personnel, and lack of sustainable funding to implement vaccination programs, exacerbated by competing priorities, including other disease outbreaks and endemic diseases as well as economic and political instability. The total population for each country was used as the denominator for vaccination coverage calculations. However, the eligible population for COVID-19 vaccination differed among countries; most countries targeted persons aged 16 or 18 years, but some countries vaccinated persons aged 5 years. In countries with large populations aged <18 years, meeting coverage targets was not possible (7).
Vaccination of high-priority groups remains critical for optimizing the impact of COVID-19 vaccines (4). Morbidity and mortality are highest among older adults and those with comorbidities (5), yet only two countries in the African Region have achieved >70% coverage among older age groups. The low coverage emphasizes the importance of targeted approaches to generate demand and address population concerns and of new delivery strategies to reach high-priority groups.
In May 2023, the public health emergency of international concern was officially declared over by WHO (8). In October 2023, SAGE recommended using a simplified primary vaccination series of a single dose of any COVID-19 vaccine and updated recommendations on revaccination for high-priority groups (5). SAGE recommended the continued prioritization of high-risk groups as described in the updated SAGE roadmap (5). The recommendations also reinforced the need for sustainable programs and COVID-19 vaccination integration into primary health care and other relevant services. The aim was to optimize resources and build sustainable immunization delivery platforms throughout the life course in alignment with the Immunization Agenda 2030 goals (9).
In November 2023, the Regional Immunization Technical Advisory Group for the African Region endorsed the SAGE recommendations, encouraging countries to continue COVID-19 vaccination as aligned with national priorities (10). Many countries in the African Region are integrating COVID-19 vaccination into their routine health services and exploring new entry points for vaccinating high-priority populations as part of primary care and other relevant services, including through multiantigen periodic intensified routine immunization activities.
The findings in this report are subject to at least three limitations. First, immunization coverage estimates are based primarily on administrative data, which might contain inaccuracies resulting from errors in recording doses administered or in population estimates. Second, although reporting is highly encouraged, in 2023, many countries stopped reporting COVID-19 vaccination data because of competing priorities. In addition, fewer than one half of the countries are reporting doses administered among high-priority groups, including doses for health care workers and older persons. Finally, population estimates for high-priority groups are available only in some countries in the African Region, making assessing coverage challenging.
The African Region has low COVID-19 vaccination coverage. Community engagement is needed to better understand drivers of vaccine confidence and develop more targeted strategies to improve vaccine demand (4). Integration of COVID-19 vaccination into routine immunization and primary health care services would help build sustainability and support recovery of routine immunization services (9). Strengthening adult immunization platforms would contribute to pandemic preparedness and global disease prevention goals (4). To protect vulnerable populations and prevent additional COVID-19 morbidity and mortality in the African Region, progress must continue to be made in vaccination of priority populations at highest risk for disease.
