Top 5 Takeaways

1. Additional Primary Dose for Immunocompromised: ACIP recommends an additional mRNA COVID-19 vaccine dose for moderately to severely immunocompromised individuals.
2. Booster Dose Recommendations: ACIP recommends a COVID-19 vaccine booster dose for specific groups, including those aged ≥65 years, residents of long-term care facilities, and individuals with certain underlying medical conditions.
3. Booster Dose Eligibility: Individuals aged 18-49 with underlying conditions and those aged 18-64 at increased risk due to occupational or institutional exposure may receive a booster dose based on individual benefits and risks.
4. Vaccine Effectiveness and Safety: Data indicate reduced vaccine effectiveness in immunocompromised individuals and waning immunity over time, supporting the need for additional and booster doses.
5. Global and Equitable Vaccine Coverage: ACIP emphasizes the importance of achieving high and equitable primary vaccination coverage and ensuring global access to COVID-19 vaccines.

Original Article Author and Citation

Corresponding Author

Sarah Mbaeyi, vif6@cdc.gov

Suggested Citation

Mbaeyi S, Oliver SE, Collins JP, et al. The Advisory Committee on Immunization Practices’ Interim Recommendations for Additional Primary and Booster Doses of COVID-19 Vaccines — United States, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1545–1552. DOI: http://dx.doi.org/10.15585/mmwr.mm7044e2

Summary

The Advisory Committee on Immunization Practices (ACIP) has issued interim recommendations for additional primary and booster doses of COVID-19 vaccines in the United States. These recommendations include an additional mRNA COVID-19 vaccine dose for immunocompromised individuals and booster doses for certain groups at increased risk of severe illness or exposure to SARS-CoV-2. The recommendations aim to enhance protection for vulnerable populations and address waning immunity over time.

Methods

ACIP used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence for benefits and harms of booster doses. The Evidence to Recommendations (EtR) Framework was also employed to evaluate factors such as resource use, benefits and harms, patient values, acceptability, feasibility, and equity.

Discussion

Data showed reduced vaccine effectiveness in immunocompromised individuals and waning immunity in the general population, particularly with the emergence of the Delta variant. Booster doses have been shown to increase neutralizing antibody titers and provide additional protection. Safety data indicate that adverse events after booster doses are similar or lower compared to the primary series, with no unexpected patterns of adverse events observed in national safety surveillance systems.

Conclusion

ACIP’s interim recommendations support the use of additional primary doses for immunocompromised individuals and booster doses for certain populations to enhance and restore protection against COVID-19. Ensuring high and equitable primary vaccination coverage remains a priority, along with global access to vaccines to mitigate the emergence of new variants.

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