Suffolk County reported the following information related to COVID-19 on October 19, 2023
According to CDC, hospital admission rates and the percentage of COVID-19 deaths among all deaths are now the primary surveillance metrics.
COVID-19 Hospitalizations for the week ending October 14, 2023
Daily Hospitalization Summary for Suffolk County From October 19, 2023
NOTE: HOSPITALS ARE NO LONGER REPORTING DATA TO NYSDOH ON WEEKENDS OR HOLIDAYS.
Fatalities occurring in Suffolk County (Data showing fatalities by place of residence is archived as of 10/12/23 and is no longer being updated)
COVID-19 Case Tracker October 17, 2023
Note: As of May 11, 2023, COVID-19 Community Levels (CCLs) and COVID-19 Community Transmission Levels are no longer calculatable, according to the Centers for Disease Control and Prevention.
* As of 4/4/22, HHS no longer requires entities conducting COVID testing to report negative or indeterminate antigen test results. This may impact the number and interpretation of total test results reported to the state and also impacts calculation of test percent positivity. Because of this, as of 4/5/22, test percent positivity is calculated using PCR tests only. Reporting of total new daily cases (positive results) and cases per 100k will continue to include PCR and antigen tests.
COVID-19 Vaccination Information
Last updated 5/12/23
Vaccination Clinics
As of September 12, 2023, the Suffolk County Department of Health Services is not authorized to offer COVID-19 vaccines to ALL Suffolk County residents.
The department will offer the updated vaccine to only uninsured and underinsured patients through New York State's Vaccines for Children program and Vaccines for Adults program, also known as the Bridge Access Program.
Those with insurance that covers the COVID-19 vaccine are encouraged to receive their vaccines at their local pharmacies, health care providers offices, or local federally qualified health centers.
The department has ordered the updated COVID-19 vaccine and will announce when the vaccine becomes available.
FOR HEALTHCARE PROVIDERS
New York State Links
CDC COVID Data Tracker Rates of laboratory-confirmed COVID-19 hospitalizations by vaccination status
For additional information or explanation of data, click on the links provided in throughout this page.
Why do some people experience reactions to a vaccine while others dont? Everybodys immune system has unique characteristics, and that can influence how people may respond to a vaccine. What people are experiencing can be multifactorial. It can be a function of what else is going on in their lives. Maybe theyre more tired or stressed, or maybe they had another recent infection that their immune system is already responding to.
Age also can play a role. In larger COVID-19 vaccine studies, people below the age of 55 tended to have more reactions like fever, fatigue, headache, and muscle aches, and that may have to do with how vigorous the immune system is. As you get older, your immune system tends to quiet down a bit.
With this current vaccine, what we are hearing is that for the vast majority on a large population level, the side effects are on par with previous doses and people arent feeling any worse from the updated shot.
Its also important to remember that we are in flu season, along with other respiratory viruses circulating in addition to COVID-19. If symptoms last longer than a day or two, people may think the vaccine is the reason theyre getting sick or testing positive for COVID, but its likely a separate infection or theyre developing symptoms concurrently.
Do more vaccine symptoms mean more protection? Id caution against the idea that there is no protection if there is an absence of symptoms like pain, mild fever, or fatigue.
There are some studies that show that people have higher antibody levels when they have strong symptoms after vaccination, but the majority of people make antibodies after the vaccine. The differences that we see are not substantial enough to make us worry about lack of protection.
Should you take a pain reliever before the vaccine to prevent any symptoms? I dont recommend taking a pain reliever like ibuprofen or acetaminophen prior to the vaccine as a standard process, but would rather someone take one afterward if theyre feeling any pain or headache.
How can you treat COVID-19 vaccine side effects at home?
When should someone see a doctor if theyre experiencing any vaccine-related symptoms? Typically, someone can expect to experience symptoms for a day or two. But if the pain isnt going away or its getting worse after that time frame, get in touch with a healthcare provider.
Allergic reactions are very rare, but if someone has trouble breathing, persistent pain or pressure in their chest after getting the vaccine, they should contact their physician.
Although it hasnt felt much like fall around the desert just yet, the cooler temperatures will surface eventually. To prepare for the flu season, the Coachella Valley Unified School District is hosting their annual flu and COVID-19 vaccine clinic, open to the public.
According to the California Department of Public Health, the 2023-2024 flu season started on October 1st, and with COVID-19 still lingering around, CVUSD wants to make sure that all residents are prepared.
Well, we feel its important that everybodys safe during the flu season. The flu is expected to hit hard this year, so we want to offer this again to everybody so that they remain safe during the flu season. Lawrence Luna says, the Director of Risk Management for the Coachella Valley Unified School District.
The district is partnering with Desert Healthcare to help make this flu and COVID-19 vaccine clinic, free of charge, and open to all.
This is open to students, staff and the entire community. The flu is expected to hit hard this year, so we want to offer this again to everybody so that they remain safe during the flu season. Luna says.
The clinic takes place at the Thermal Senior Center, October 21st, from 9 a.m. to 12 p.m.
As far as what to bring to the clinic, They bring their insurance card if they have insurance, be there on time, please be patient. We do expect a good crowd for this, so if they come just bring your right or left arm and be ready to roll your sleeves up and get your vaccination. Luna adds.
Overall, CVUSD wants all Coachella Valley residents safe, this flu season.
We feel its extremely important for everybody to be vaccinated. We want to invite the entire community out here. Please come and get vaccinated in preparation for the flu season. We want everybody to be safe. We want our students in school, we want our staff in classrooms in front of the teacher, and we want our community safe as well. Luna says.
Again, everyone is welcome to the vaccine clinic at the Thermal Senior Center, with most services free for those without insurance.
Imran Mirza, a health specialist and global lead for UNICEFs COVID-19 Program, applauded the expedited vaccine rollout, but said the pandemic exposed many health systems weak infrastructure to handle patient overflow and mitigate burnout for health workers.
This is the time to build up those systems and whats required such as human resources, Mirza said, noting the world is still in a pandemic. We need to start thinking about this now. All the risk is not gone, its still there.
But the speedy arrival of COVID-19 vaccines, which were developed in less than one year, also holds lessons for future vaccine rollouts, the panelists noted. Wenhui Mao, Ph.D., assistant director of programs for the Duke Global Health Innovation Center, says the expediency of the vaccine allowed it to reach vulnerable populations much sooner. On average, some vaccines can remain in the research and development stage for up to a decade.
Imagine if we could reduce this time by years, she said. It could save lives and protect people. Lots of innovative practice was used to promote the COVID-19 vaccine.
Chizoba Wonodi, Ph.D., an associate scientist of global disease epidemiology and control at the Johns Hopkins Bloomberg School of Public Health, focused on where people received vaccine doses. In addition to hospitals, public health leaders turned facilities such as stadiums into vaccination sites and deployed mobile vaccination clinics to provide access for rural patients.
Fixed posts are important to get people to vaccination sites, Wonodi said, adding theres still room for flexibility in that area. Solutions for this can be more options for walk-in shots and arranging internet access [to make appointments] for those who need it.
Udayakumar highlighted the importance of discussing COVID-19 holistically, through all phases of testing, treatment and immunization, as a guide for how the world can respond to future health crises.
Understanding what happened from an end-to-end perspective will allow us to take some of these lessons to heart, he said. And be better in everything we do moving forward.
Moha El-Jaw / iStock
A new Centers for Disease Control and Prevention-led study finds that people with HIV (PWH) have higher COVID-19 reinfection rates than those without HIV (PWOH).
The study, published yesterday in Emerging Infectious Diseases, involved 453,587 adults in Chicago infected with SARS-CoV-2 from their first infection through May 2022. The investigators matched COVID-19 test results and vaccination data to Chicago's Enhanced HIV/AIDS Reporting System.
"HIV can compromise the immune system; persons with HIV (PWH), especially those not receiving antiretroviral therapy (ART), might be vulnerable to SARS-CoV-2 infection," the researchers wrote. "Understanding how COVID-19 affects PWH is important because approximately half of PWH are>50 years of age and have higher rates of medical comorbidities, compared with persons without HIV (PWOH)."
A total of 5.3% of the 453,587 COVID-positive residents were reinfected, including 192 of 2,886 (6.7%) PWH and 23,642 of 450,701 (5.2%) PWOH. Reinfection rates among PWH were 66 per 1,000 person-years, compared with 50 of 1,000 person-years among PWOH. PWH had a higher adjusted rate of COVID-19 reinfection (1.46 per 1,000 person-years) than PWOH.
Among reinfected residents, PWH were older (median age, 43 years) than PWOH (36 years). Relative to PWOH, PWH were more likely to be men (79.3% vs 40.9%) and Black (53.7% vs 27.0%) and to have received a primary COVID-19 vaccine series and booster (31.8% vs 22.1%). Of those reinfected, PWH were less likely than PWOH to be unvaccinated at their first infection (87.5% vs 91.0%).
PWH should follow the recommended COVID-19 vaccine schedule, including booster doses, to avoid SARS-CoV-2 reinfections.
Of 131,682 residents vaccinated before their first SARS-CoV-2 infection, 54.2% had completed a primary Pfizer/BioNTech vaccine series. Of 23,834 reinfected residents, 39.6% (9,444 of 23,834) had completed a primary series but had not received a booster before reinfection.
Regardless of variant wave and calendar quarter, PWH consistently had a higher rate of reinfection than PWOH. The highest incidence for PWH occurred during Omicron strain predominance (50 cases per 1,000 person-years). Overall, an excess of 16 reinfections per 1,000 person-years were reported among PWH.
"PWH should follow the recommended COVID-19 vaccine schedule, including booster doses, to avoid SARS-CoV-2 reinfections," the authors wrote.
Evidence suggests that protective antibodies against SARS-CoV-2 can pass from mother to fetus.
Evidence suggests that protective antibodies against SARS-CoV-2 can pass from mother to fetus.
In a study funded by the National Institute of Allergy and Infectious Diseases (NIAID), researchers found that people who received a primary COVID-19 vaccine dose or an additional booster dose while pregnant generated protective antibodies against SARS-CoV-2 in both their own blood and the umbilical cord blood, which suggests that the protective antibodies reached the fetus.
The Multisite Observational Maternal and Infant Study for COVID-19 (MOMI-VAX) launched in June 2021 to research how COVID-19 vaccination affects the immune systems of pregnant people. The study includes the results from 240 participants: 167 who received the two-dose primary series of an mRNA COVID-19 vaccine while pregnant and 73 who also received a booster dose. (At the time of the study, only one booster dose was recommended. The study closed in early 2022.)
To measure protective antibody levels, the researchers analyzed blood samples gathered before participants received the primary vaccine series or an additional booster, after the vaccination or booster, and at the time of delivery. A sample of umbilical cord blood was also gathered at delivery to measure antibodies that crossed the placenta.
The researchers found that pregnant people who received the COVID-19 vaccines generated antibodies against SARS-CoV-2 variants, including Omicron. Antibodies were also found in the cord blood, which suggests that the newborns also received protection against SARS-CoV-2. Study participants who received a booster dose had more antibodies in their blood and cord blood samples than those who received the primary series.
Research has shown that COVID-19 vaccination is safe and effective for pregnant people. Pregnant people are more likely to have severe COVID-19, and the disease increases their risk for preterm birth. Infants under 6 months of age are also at increased risk for severe COVID-19, and they are not eligible to get vaccinated.
This research supports COVID-19 vaccination, especially with booster doses, during pregnancy for the protection of pregnant parents and newborns. Future research can examine the best time during pregnancy to receive their first COVID-19 vaccine dose or a booster dose for the most protection.
More Evidence That COVID-19 Vaccination While Pregnant Likely Protects Children
COVID-19 Vaccination and Boosting During Pregnancy Benefits Pregnant People and Newborns
COVID-19 Vaccines While Pregnant or Breastfeeding
Munoz, F. M., Posavad, C. M., Richardson, B. A., Badell, M. L., Bunge, K. E., Mulligan, M. J., Parameswaran, L., Kelly, C. W., Olson-Chen, C., Novak, R. M., Brady, R. C., Pasetti, M. F., Defranco, E. A., Gerber, J. S., Shriver, M. C., Suthar, M. S., Coler, R. N., Berube, B. J., Kim, S. H., , & DMID 21-0004 Study Group. (2023). COVID-19 booster vaccination during pregnancy enhances maternal binding and neutralizing antibody responses and transplacental antibody transfer to the newborn. Vaccine, 41(36), 5296-5303. https://doi.org/10.1016/j.vaccine.2023.06.032
If your patients have been slow to get COVID-19 booster shots, here are some of the prevailing reasons why.
In a new study, researchers noted bivalent boosters were recommended for every aged 12 years and older since September 2022. That expanded to all people aged 6 months and older as of December last year.
But as of May 2023, fewer that 20% of eligible people had received updated boosters. Thats a critical public health challenge, study authors wrote in Understanding low COVID-19 booster uptake among US adults, published in the journal Vaccine.
In February and March 2023, researchers led by the University of Arizona Cancer Center surveyed 2196 adults who had received at least one dose of the COVID-19 vaccine.
The poll asked the question: Have you received the updated (bivalent, omicron) mRNA booster from Pfizer or Moderna?
Among them, 1637, or 74.5%, had received the booster, but 559 did not. To explain why, participants could select one or multiple answers, or write in their own. Responses fell into 3 groups:
Interventions to improve vaccination rates require a variety of approaches, the study said. A good start is to consider the top reasons why some participants opted not to get their COVID-19 booster.
Source: Jacobs ET, Cordova-Marks FM, Farland LV, et al. Understanding low COVID-19 booster uptake among US adults. Vaccine. 2023;41(6):6221-6226. doi:10.1016/j.vaccine.2023.08.080
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Refusal of COVID-19 vaccines has been a feature of the pandemic since the vaccines were first made available in late winter 2020 and early 2021.
In a new study in JAMA Network Open, authors review 28,000 interviews on vaccine uptake and hesitancy conducted in Hong Kong and Singapore from February 2020 through January 2022 to determine what was driving vaccine refusal.
Until the Omicron wave in late 2021 and early 2022, Hong Kong had one of the lowest COVID-19 prevalence rates across the globe. But with Omicron, death tolls in Hong Kong soared to 39.3 million people per day, the highest death toll in the world.
While Hong Kongs cumulative COVID-19 deaths per capita remain lower than the UK and US, it has far exceeded high-income economies in Asia-Pacific.
"While Hong Kongs cumulative COVID-19 deaths per capita remain lower than the UK and US, it has far exceeded high-income economies in Asia-Pacific," the authors said. This was likely linked to low vaccine uptake: 82.4% of adults in Hong Kong aged 80 years and older were unvaccinated or had received only one dose during the Omicron BA.2 variant phase of the pandemic, compared to just 9.0% of adults in in Singapore
The authors of the present study used 20 waves of questionnaires and data to understand the vaccine refusal and compared results to those seen in Singapore, which had one of the highest rates of vaccine uptake in Asia.
Participants came from the FAMILY Cohort, a prospective population-based cohort study in Hong Kong. The group was asked about vaccination in the decade before and during the pandemic. In total, 28,007 interviews were included.
In 2020, approximately two-thirds (65.3%; 95% confidence interval [CI], 61.7% to 68.6%) of adults in Hong Kong said they would be willing to vaccinate when a vaccine became available, the authors found. But vaccination willingness dropped to 55.0% when vaccines were procured from foreign nations.
Willingness dropped even further, to 43.6%, when adverse side effects were reported during the first weeks of vaccination in Hong Kong.
It took more than a year for vaccine confidence to recover. Low vaccine confidence was associated with vaccine refusal, the authors said.
Four factors, including mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views, accounted for 82.2% (95% CI, 62.3% to 100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2% to 91.4%) of vaccine refusal in adults aged 60 years and older.
Mandates, in the form of both workplace mandates and Hong Kong vaccine passes once the Omicron surge began to cause significant mortality, were related to great increases in uptake.
Workplace vaccine mandates were associated with a 62.2% (95% CI, 9.9% to 139.2%) increase in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9% to 204.6%) increases in daily COVID-19 vaccination appointments.
On October 10, 2023, this report was posted online as an MMWR Early Release.
Joanna J. Regan, MD1; Danielle L. Moulia, MPH1; Ruth Link-Gelles, PhD1; Monica Godfrey, MPH1; Josephine Mak, MPH1; Morgan Najdowski, MPH1,2; Hannah G. Rosenblum, MD1; Melisa M. Shah, MD1; Evelyn Twentyman, MD1; Sarah Meyer, MD1; Georgina Peacock, MD1; Natalie Thornburg, PhD1; Fiona P. Havers, MD1; Sharon Saydah, PhD1; Oliver Brooks, MD3; H. Keipp Talbot, MD4; Grace M. Lee, MD5; Beth P. Bell, MD6; Barbara E. Mahon, MD1; Matthew F. Daley, MD7; Katherine E. Fleming-Dutra, MD1; Megan Wallace, DrPH1 (View author affiliations)
What is already known about this topic?
Since September 2022, bivalent mRNA COVID-19 vaccines have been recommended in the United States, but the variants these vaccines were designed to protect against are no longer circulating widely. In September and October 2023, the Food and Drug Administration approved and authorized updated 20232024 Formula monovalent XBB.1.5 componentcontaining COVID-19 vaccines, formulated to target current variants more closely, specifically Omicron variant XBB.1.5, for persons aged 6 months.
What is added by this report?
On September 12, 2023, the Advisory Committee on Immunization Practices recommended vaccination with updated COVID-19 vaccines for all persons aged 6 months.
What are the implications for public health practice?
The updated COVID-19 vaccines are meant to broaden vaccine-induced immunity and provide protection against the currently circulating SARS-CoV-2 XBB-sublineage variants including against severe COVID-19associated illness and death.
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COVID-19 vaccines protect against severe COVID-19associated outcomes, including hospitalization and death. As SARS-CoV-2 has evolved, and waning vaccine effectiveness has been noted, vaccine formulations and policies have been updated to provide continued protection against severe illness and death from COVID-19. Since September 2022, bivalent mRNA COVID-19 vaccines have been recommended in the United States, but the variants these vaccines protect against are no longer circulating widely. On September 11, 2023, the Food and Drug Administration (FDA) approved the updated (20232024 Formula) COVID-19 mRNA vaccines by Moderna and Pfizer-BioNTech for persons aged 12 years and authorized these vaccines for persons aged 6 months11 years under Emergency Use Authorization (EUA). On October 3, 2023, FDA authorized the updated COVID-19 vaccine by Novavax for use in persons aged 12 years under EUA. The updated COVID-19 vaccines include a monovalent XBB.1.5 component, which is meant to broaden vaccine-induced immunity and provide protection against currently circulating SARS-CoV-2 XBB-sublineage variants including against severe COVID-19associated illness and death. On September 12, 2023, the Advisory Committee on Immunization Practices recommended vaccination with updated COVID-19 vaccines for all persons aged 6 months. These recommendations will be reviewed as new evidence becomes available or new vaccines are approved and might be updated.
By the end of 2022, COVID-19 vaccines had prevented 18.5 million COVID-19 hospitalizations and 3.2 million COVID-19 deaths in the United States (1). As SARS-CoV-2 has evolved, and waning vaccine effectiveness (VE) has been observed, vaccine formulations and policies have been updated to provide continued protection against severe COVID-19associated illness and death. On September 11, 2023, the Food and Drug Administration (FDA) authorized the updated (20232024 Formula) COVID-19 mRNA vaccines by Moderna and Pfizer-BioNTech for use in persons aged 6 months11 years under Emergency Use Authorization (EUA) and approved the updated Moderna and Pfizer-BioNTech COVID-19 vaccines for persons aged 12 years (2). On October 3, 2023, FDA authorized the updated Novavax COVID-19 vaccine for use in persons aged 12 years under EUA (2). The updated COVID-19 vaccines include a monovalent XBB.1.5 component and are meant to broaden vaccine-induced immunity and provide increased protection (compared with protection from earlier vaccines that might have waned) against currently circulating SARS-CoV-2 XBB-sublineage variants, which, by September 2, 2023, accounted for >99% of sequenced SARS-CoV-2 specimens in the United States.* As of September 11, 2023, bivalent mRNA COVID-19 vaccines (based on the ancestral SARS-CoV-2 strain and BA.4/BA.5 variants) are no longer authorized for use in the United States, and as of October 3, 2023, original monovalent Novavax COVID-19 vaccines (based on the ancestral SARS-CoV-2 strain) are no longer authorized for use in the United States. On September 12, 2023, the Advisory Committee on Immunization Practices (ACIP) recommended vaccination with the updated COVID-19 vaccine for all persons aged 6 months. These recommendations will be reviewed as new evidence becomes available or new vaccines are approved and might be updated.
Although severe COVID-19 is now less prevalent in the United States than during previous years, it continues to cause significant morbidity and mortality in this country. Currently, older adults (aged 65 years) and infants aged <6 months are at highest risk for COVID-19associated hospitalization. During January 1August 26, 2023, COVID-19associated hospitalization rates among adults aged 75 years were two to three times as high as those among the next youngest age group (adults aged 6574 years). Rates among infants aged <6 months are similar to those among adults aged 6574 years (3).
Nevertheless, persons aged 6 months64 years, including those with no underlying medical conditions, remain at risk for severe COVID-19. Rates of COVID-19associated hospitalization are currently lowest among children and adolescents aged 517 years. However, among persons in this age group who were hospitalized with COVID-19 during JanuaryJune 2023, 23% of those aged 511 years and 34% of those aged 1217 years had no underlying medical conditions. During January 2022June 2023, among children and adolescents aged 17 years who died during a COVID-19 hospitalization, 50% had no underlying condition. During January 1July 22, 2023, a total of 28,140 persons, including 26 aged <1 year, 18 aged 14 years, 36 aged 519 years, 463 aged 1544 years, 2,821 aged 4564 years, and 24,776 aged 65 years, died from COVID-19, as evidenced by COVID-19 being listed as the underlying cause of death on the death certificate.
PostCOVID-19 conditions contribute to COVID-19related morbidity among all age groups. The prevalence of ongoing symptoms 3 months after COVID-19 illness ranged from <1% among persons aged <18 years to 5% among those aged 3549 years. During June 719, 2023, approximately one in four adults with postCOVID-19 conditions reported significant activity limitations (4).
Members of racial and ethnic minority groups continue to be disproportionately affected by COVID-19associated hospitalization (5). Higher prevalences of underlying conditions in some racial and ethnic minority populations might increase their risk for severe COVID-19associated outcomes (6). As of May 10, 2023, only 17% of the U.S. population had received a bivalent COVID-19 vaccine dose, with lower coverage among some racial and ethnic minority populations, potentially driven by differences in vaccine access and acceptability (5,7).
After declining throughout the spring and early summer of 2023, COVID-19associated hospitalization rates began increasing in mid-July 2023. Further increases are anticipated during the fall and winter respiratory virus season (5).
Since June 2020, ACIP has convened 37 public meetings to review data relevant to the potential use of COVID-19 vaccines. The ACIP COVID-19 Vaccine Work Group, comprising experts in adult and pediatric medicine, obstetrics and gynecology, infectious diseases, vaccinology, vaccine safety, public health, and ethics, has met weekly to review COVID-19 surveillance data; evidence regarding immunogenicity, efficacy, effectiveness, and safety of COVID-19 vaccines; and implementation considerations. The Work Group conducted a systematic review of benefits and harms of vaccination, and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to assess the certainty of the evidence regarding benefits and harms associated with a bivalent vaccine administered in the United States during September 2022April 2023. The Work Group selected this population, intervention, and pandemic period of high seroprevalence to identify evidence most applicable to what can be anticipated from this years vaccine in the United States. The certainty of evidence was assessed separately for infants and children aged 6 months11 years, and adolescents and adults aged 12 years based on the difference in recommended vaccine dosage for these two age groups. The Work Group also reviewed additional CDC data on VE and safety, as well as data on the updated vaccines provided by manufacturers (810). To assess the evidence for benefits and harms associated with COVID-19 vaccine use, and to guide deliberations, ACIP uses the Evidence to Recommendations (EtR) Framework.** Within this framework, ACIP considered the importance of COVID-19 as a public health problem, including during the Omicron XBB-lineagepredominant era (January 2023September 2023), as well as issues of resource use, benefits and harms, patients values, acceptability, feasibility, and equity related to vaccine use. ACIP evaluated data related to all vaccines for which updated 20232024 formulations were anticipated (i.e., Moderna, Novavax, and Pfizer-BioNTech).
Published assessments of previous vaccine formulations VE and safety were evaluated using GRADE. GRADE is used to assess the confidence (high, moderate, low, or very low) that the true effect lies close to that of the estimated effect. Evidence that includes only randomized controlled trials begins at high certainty, whereas evidence that includes observational data begins at low certainty.
Among adolescents and adults, benefits of bivalent vaccination were assessed using pooled observational VE data for three outcomes: medically attended COVID-19, hospitalization attributed to COVID-19, and death attributed to COVID-19. Pooled VE against medically attended COVID-19 was 53% (95% CI=50%56%), and hospitalization attributed to COVID-19 was 48% (95% CI=30%61%). For both critical outcomes, the certainty assessment was low. Pooled VE against death attributed to COVID-19 was 61% (95% CI=41%74%), and the certainty assessment was very low because of serious concern for inconsistency. Among infants and children, insufficient observational data were identified for a systematic review of benefits, but benefits were indirectly inferred from adolescent and adult data. The certainty assessment was very low for all three outcomes because of serious concern for indirectness.
Studies from the Vaccine Safety Datalink (VSD), a postauthorization vaccine safety monitoring system, were used to assess rates of serious adverse events (i.e., myocarditis or pericarditis and anaphylaxis, which were the outcomes specified for GRADE) that have been associated with vaccination (myocarditis after receipt of COVID-19 vaccine has been reported primarily in adolescent and young adult males) (11), and the certainty assessment was low among adolescents and adults and very low among infants and children. Severe reactogenicity (grade 3*** local or systemic reactions) was assessed using pooled clinical trial data after any original monovalent primary series dose. Severe reactogenicity occurred more often in the vaccine than placebo study arms, and the certainty assessment for the clinical trial body of evidence was low because of very serious concern for indirectness in both age groups. The GRADE evidence profile is available at www.cdc.gov/vaccines/acip/recs/grade/covid-19-2023-2024-Monovalent.html.
Additional, updated CDC VE data were also reviewed, including data showing patterns of waning bivalent vaccineinduced immunity against infection and COVID-19associated hospitalization during a period with increased Omicron XBB sublineage circulation (12,13). During September 2022August 2023, VE against hospitalization among adults aged 65 years without an immunocompromising condition waned from 67% (95% CI=62%71%) at 759 days postvaccination to 28% (95% CI=18%36%) at 60119 days (13). VE of both the original monovalent and bivalent vaccines against critical outcomes (invasive mechanical ventilation, intensive care unit admission, or death) has remained more durable than VE against less severe outcomes among adults, including those with and without immunocompromising conditions (12,14). VE patterns were similar among children and adults, although available data were more limited in children (13,15). VE against emergency department and urgent care visits among persons aged 517 years ranged from 59%63% by age group 759 days after a bivalent dose, waning to 36%47% by age group 60119 days after a bivalent dose (13). VE has historically been lower and has waned more quickly among adults with immunocompromise than among immunocompetent adults, although bivalent VE trends are less clear (12,13).
Additional, updated data on COVID-19 vaccine safety from VSD were also reviewed. The risk for myocarditis or pericarditis after receipt of a bivalent vaccine dose is uncertain because myocarditis is a rare outcome, and bivalent vaccination coverage is relatively low, especially in adolescents and young adults. Myocarditis rates after booster doses in adolescent and young adult males are lower than rates after primary series vaccination, but estimates for monovalent booster and bivalent doses are limited by the lower numbers of doses administered in VSD in this group (16). A longer interval between doses has been associated with lower rates of myocarditis (17).
ACIP recommendations for the updated COVID-19 vaccines were also guided by data on immunogenicity provided by the vaccine manufacturers. Data from Moderna, Novavax, and Pfizer-BioNTech show that monovalent XBB componentcontaining COVID-19 vaccines increase the immune response against the currently circulating XBB-sublineage variants (810). The evidence used to guide EtR is available at https://www.cdc.gov/vaccines/acip/recs/grade/covid-19-2023-2024-Monovalent-etr.html.
COVID-19 vaccination is a cost-effective intervention, particularly in adults aged 65 years, among whom incidence is highest. For this age group, a dose of the vaccine is cost saving (at an assumed cost of $120 per dose). Among adults aged 5064 years, the incremental cost-effectiveness ratio of updated COVID-19 vaccines was estimated to be $25,787 per quality-adjusted life year, with estimates in those aged 50 years robust to input changes across plausible ranges (18). For adults aged 1849 years, the incremental cost-effectiveness ratio for updated COVID-19 vaccines was estimated to be $115,588 per quality-adjusted life year, although estimates in younger adults were more sensitive to changes in input, with higher VE or hospitalization rates increasing cost-effectiveness (18). Cost-effectiveness estimates are not yet available for pediatric populations (18).
On September 12, 2023, ACIP recommended vaccination with the updated (20232024 Formula) COVID-19 vaccine for all persons aged 6 months. The recommendation is inclusive of FDA-licensed or authorized updated monovalent XBB componentcontaining COVID-19 vaccines (i.e., Moderna, Novavax and Pfizer-BioNTech updated COVID-19 vaccines), consistent with the FDA-licensed indication or EUA. The recommendation for children aged 6 months11 years is an interim recommendation because the updated COVID-19 vaccines for this age group are currently authorized under EUA. In addition, the recommendation for the updated Novavax COVID-19 vaccine is an interim recommendation because the Novavax COVID-19 vaccine is currently authorized under EUA.
Infants and children aged 6 months4 years are recommended to receive a multidose initial series (previously referred to as the primary series) and at least 1 updated mRNA COVID-19 vaccine dose depending on vaccination history as defined herein. Infants and children aged 6 months4 years who are unvaccinated are recommended to receive either 2 updated Moderna COVID-19 vaccine doses or 3 updated Pfizer-BioNTech COVID-19 vaccine doses (Table 1). Infants and children aged 6 months4 years who previously received original monovalent or bivalent mRNA vaccine doses are recommended to receive 1 or 2 homologous (i.e., from the same manufacturer) updated COVID-19 mRNA vaccine doses, depending on vaccine manufacturer and the number of previous vaccine doses received. Infants and children aged 6 months4 years who completed the initial series with original monovalent or bivalent mRNA vaccine doses are recommended to receive 1 updated COVID-19 vaccine dose, at least 2 months after receipt of the last COVID-19 vaccine dose. Infants and children aged 6 months4 years may receive either the updated Moderna or Pfizer-BioNTech COVID-19 vaccine; however, all doses administered to an infant or child in this age group should be from the same manufacturer.
For those receiving updated mRNA COVID-19 vaccines, persons aged 5 years without immunocompromise are recommended to receive 1 updated COVID-19 vaccine dose, irrespective of previous COVID-19 vaccination history (Table 2). For those receiving updated Novavax COVID-19 vaccines, persons ages 12 years without immunocompromise are recommended to receive 2 updated COVID-19 vaccine doses if previously unvaccinated and 1 updated dose if previously vaccinated with any COVID-19 vaccine. For those who have received previous COVID-19 vaccines, the updated vaccine should be administered 2 months after receipt of the most recent dose.
Unvaccinated persons aged 6 months11 years who are moderately or severely immunocompromised are recommended to receive an initial vaccination series of 3 homologous updated (20232024 Formula) mRNA COVID-19 vaccine doses. Unvaccinated persons aged 12 years who are moderately or severely immunocompromised can complete an initial vaccination series with 3 homologous doses of updated mRNA or 2 doses of updated Novavax COVID-19 vaccine. Persons aged 6 months who are moderately or severely immunocompromised and previously received 1 or 2 original monovalent or bivalent mRNA vaccine doses are recommended to receive 1 or 2 homologous updated COVID-19 vaccine doses, depending on the number of previous vaccine doses. Persons aged 6 months who are moderately or severely immunocompromised who previously received 3 original monovalent or bivalent mRNA vaccine doses are recommended to receive 1 updated COVID-19 vaccine dose. Persons aged 12 years who are moderately or severely immunocompromised and who previously received original Novavax COVID-19 vaccine or Janssen (Johnson & Johnson) COVID-19 vaccine, including those who also received original monovalent or bivalent mRNA COVID-19 vaccine doses, are recommended to receive 1 updated COVID-19 vaccine dose from any FDA-authorized or approved manufacturer.
Persons who are moderately or severely immunocompromised, have completed an initial series, and have received 1 updated COVID-19 vaccine dose, may receive additional updated COVID-19 vaccine doses, guided by the clinical judgment of a health care provider and personal preference and circumstances. Any further additional doses should be administered 2 months after the last COVID-19 vaccine dose. Additional clinical considerations, including detailed schedules and tables by age and vaccination history for those who are and are not moderately or severely immunocompromised, are available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.
COVID-19 vaccines are transitioning from federal procurement and distribution into the commercial marketplace during fall 2023. Under the Affordable Care Act (ACA), ACIP recommendations for routine immunization that have been adopted by CDC and are listed on CDC Immunization Schedules are required to be covered by group health plans and health insurance issuers offering group or individual health insurance coverage without cost-sharing requirements. The Coronavirus Aid, Relief, and Economic Security (CARES) Act expedited coverage for COVID-19 vaccines; since January 5, 2021, ACA-covered insurers must cover, without cost sharing, any COVID-19 vaccine FDA authorized under an EUA or FDA approved under a Biologics License Application immediately upon authorization or approval of the vaccine (19). Thus, for U.S. residents with applicable ACA commercial medical insurance coverage, COVID-19 vaccines will be covered immediately. In addition, COVID-19 vaccines are covered under Medicare Part B, and nearly all Medicaid beneficiaries can receive COVID-19 vaccines without cost-sharing. COVID-19 vaccines are also included in the Vaccines for Children Program,**** which provides vaccines to approximately one half of U.S. persons aged <19 years at no cost. The Bridge Access Program for COVID-19 Vaccines is a public-private partnership serving as a temporary measure to maintain access to COVID-19 vaccines for adults who are uninsured or underinsured, working through both public health clinics and participating retail pharmacies. Before vaccination, providers should provide the EUA Fact Sheet, manufacturers package insert, or other written materials regarding the vaccine being administered and counsel vaccine recipients about expected systemic and local adverse reactions (reactogenicity).
Adverse events after vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS). Reporting is encouraged for any clinically significant adverse event even if it is uncertain whether the vaccine caused the event. Information on how to submit a report to VAERS is available at https://vaers.hhs.gov or by telephone at 1-800-822-7967.
Karen Broder, Mary Chamberland, Susan Goldstein, Andrew Leidner, Kadam Patel, Jamison Pike, Tom Shimabukuro, John Su, Christopher Taylor, Eric Weintraub, Melinda Wharton, Fangjun Zhou, CDC. Voting members of the Advisory Committee on Immunization Practices (in addition to listed authors): Lynn Bahta, Minnesota Department of Health; Wilbur Chen, University of Maryland School of Medicine; Sybil Cineas, Warren Alpert Medical School of Brown University; Camille Kotton, Harvard Medical School; James Loehr, Cayuga Family Medicine; Sarah Long, Drexel University College of Medicine; Veronica V. McNally, Franny Strong Foundation; Katherine A. Poehling, Wake Forest School of Medicine; Pablo J. Snchez, The Research Institute at Nationwide Childrens Hospital. Members of the Advisory Committee on Immunization Practices COVID-19 Vaccines Work Group: Edward Belongia, Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute; Henry Bernstein, Zucker School of Medicine at Hofstra/Northwell Cohen Childrens Medical Center; Dayna Bowen Matthew, George Washington University Law School; Uzo Chukwuma, Indian Health Service; Paul Cieslak, Christine Hahn, Council of State and Territorial Epidemiologists; Richard Dang, American Pharmacists Association; Jeffrey Duchin, Infectious Diseases Society of America; Kathy Edwards, Vanderbilt University Medical Center; Sandra Fryhofer, American Medical Association; Jason M. Goldman, American College of Physicians; Robert Hopkins, University of Arkansas for Medical Sciences; Michael Ison, Chris Roberts, National Institutes of Health; Lisa Jackson, Jennifer Nelson, Kaiser Permanente; Denise Jamieson, American College of Obstetricians and Gynecologists; Jeffery Kelman, Centers for Medicare & Medicaid Services; Kathy Kinlaw, Center for Ethics, Emory University; Alan Lam, U.S. Department of Defense; Lucia Lee, Anuga Rastogi, Rachel Zhang, Food and Drug Administration; Valerie Marshall, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services; Preeti Mehrotra, Society for Healthcare Epidemiology of America; Kathleen Neuzil, Center for Vaccine Development and Global Health, University of Maryland School of Medicine; Sean OLeary, American Academy of Pediatrics; Christine Oshansky, Biomedical Advanced Research and Development Authority; Stanley Perlman, Department of Microbiology and Immunology, University of Iowa; Marcus Plescia, Association of State and Territorial Health Officials; Rob Schechter, National Foundation for Infectious Diseases; Kenneth Schmader, American Geriatrics Society; Peter Szilagyi, University of California, Los Angeles; Jonathan Temte, American Academy of Family Physicians; Matthew Tunis, National Advisory Committee on Immunization Secretariat, Public Health Agency of Canada; Matt Zahn, National Association of County and City Health Officials. Nicola P. Klein, Kaiser Permanente Northern California; Cara B. Janusz, Lisa Posser, Angela Rose, University of Michigan.
1National Center for Immunization and Respiratory Diseases, CDC; 2Eagle Health Analytics, San Antonio, Texas; 3Watts Healthcare Corporation, Los Angeles, California; 4Vanderbilt University School of Medicine, Nashville, Tennessee; 5Stanford University School of Medicine, Stanford, California; 6University of Washington, Seattle, Washington; 7Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado,
Suggested citation for this article: Regan JJ, Moulia DL, Link-Gelles R, et al. Use of Updated COVID-19 Vaccines 20232024 Formula for Persons Aged 6 Months: Recommendations of the Advisory Committee on Immunization Practices United States, September 2023. MMWR Morb Mortal Wkly Rep 2023;72:11401146. DOI: http://dx.doi.org/10.15585/mmwr.mm7242e1.
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