What to tell patients and parents about COVID-19 boosters in early 2023

Canada’s National Advisory Committee on Immunization (NACI) recognizes that uncertainties continue regarding the evolution of the COVID-19 pandemic, including the need for and timing of additional booster doses. NACI continues to monitor COVID-19 activity and the duration of vaccine protection (particularly against severe outcomes) and plans to update COVID-19 vaccine recommendations when needed.1 In the interim, NACI has issued preliminary guidance on COVID-19 booster doses for early 2023, with NACI reinforcing its existing fall 2022 booster dose recommendations. Basically, this means that individuals who were recommended to receive a booster in the fall of 2022, but did not, are recommended to receive a booster dose now.1 NACI’s recommendations regarding booster doses are summarized as follows: Adults and adolescents at high risk of severe illness: At least one booster dose should be offered to all adults (≥ 18 years of age) and adolescents (12–17 years of age) who are at increased risk of severe illness from COVID-19. (Strong NACI recommendation) Those who have not yet received any booster dose should receive one now. All adults ≥ 65 years of age and individuals 5–64 years of age who are at increased risk of severe illness from COVID-19: These individuals should have received a booster dose since the start of fall 2022. For those who did not, a booster should be offered, as per the recommended interval. (Strong NACI recommendation) Individuals 5–64 years of age without risk factors for severe illness from COVID-19 may have been offered a booster dose since the start of fall 2022. Those who have not yet received a fall 2022 booster may still be offered one, as per the recommended interval. (Discretionary NACI recommendation) Preferred booster products: Bivalent Omicron-containing mRNA COVID-19 vaccines continue to be the preferred booster products for all individuals five years of age and older. Preferred dosing interval: When COVID-19 booster doses are offered, they should be provided at an interval of six or more months after the last COVID-19 vaccine dose or infection. More than 6 months since the fall booster dose: Based on the differences in fall 2022 booster program start dates across various Canadian jurisdictions, later this winter it will be more than six months since some individuals received their fall booster dose. Currently, NACI is not issuing guidance on an additional booster dose for these individuals. NACI will continue to monitor the evidence and evolving epidemiology and provide updated guidance in the coming months. For children 5–11 years of age, NACI is currently recommending only one booster dose after the primary series. At the discretion of a healthcare provider, a bivalent booster dose may be offered at the recommended interval to children considered at high risk of severe COVID-19 who have previously received a booster dose of the original Pfizer-BioNTech (Comirnaty) vaccine. Children 6 months up to 5 years of age: Currently, no booster dose products are authorized for children six months up to five years of age. NACI is not making any booster dose recommendations for this age group.1 NACI notes that COVID-19 hospitalizations, intensive care unit (ICU) admissions and deaths continue to occur at a higher frequency since the appearance of Omicron in late 2021 compared to the pre-Omicron period. Age continues to be the single greatest risk factor for severe outcomes of COVID-19. Hospitalizations, ICU admissions and death rates from COVID-19 are highest in those ≥ 80 years of age. The previously dominant BA.5.2 and BA.5.2.1 Omicron sublineages are declining, while more immune-evasive sublineages (e.g., BQ.1, BQ.1.1 and BF.7) are increasing. The duration of protection of new vaccine formulations against severe disease, particularly for more recent variants, is currently unknown and continues to be monitored.1 In the United States, the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee will be meeting on January 26th to discuss plans for future COVID-19 vaccinations. The FDA will also consider whether adjustments to the current vaccines are needed, including the strains in the primary and booster vaccines. This issue is important, as the US Centers for Disease Control and Prevention reports that more than 550 Americans are still dying each day from COVID-19 (as of the week ending Jan. 13) compared with 346 per day for the week ending December 28th. Uptake of the bivalent booster has been low in the United States, with just 15.9% of the population ≥ 5 years of age receiving it and only 39% of those age ≥ 65 years, who are in the age group most vulnerable to COVID-19.2 References 1. National Advisory Committee on Immunization (NACI). An Advisory Committee Statement (ACS). Guidance on COVID-19 vaccine booster doses: initial considerations for 2023. Published: January 20, 2023. https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/guidance-covid-19-vaccine-booster-doses-initial-considerations-2023.pdf (accessed January 24, 2023). 2. Doheny K. Is it time for yet another COVID booster? It's complicated. Medscape Pharmacists 2023; published online January 18, 2023. https://www.medscape.com/viewarticle/987132?src=WNL_trdalrt_pos1_ous_230120&uac=30288CV&impID=5099854 (accessed January 24, 2023).

What to tell patients and parents about COVID-19 boosters in early 2023

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