Individuals age 65 years of age and older and those who are immunocompromised may now receive one additional bivalent booster at least 4 months following their initial bivalent booster.
The language from the FDA and CDC here is notably much less strong in terms of recommending this additional booster than prior recommendations. I would summarize this language as “the option has now been provided,” and a gentle nudge toward receiving that second booster. I agree with this language.
On April 18th the FDA updated the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines to include this second bivalent booster for the groups listed above. The subsequent CDC guidance provided the next day used similar phrasing as the FDA’s language, including statements like “may receive” or “have the option to” receive an additional bivalent dose.2 The FDA press update goes on to state that a second bivalent dose is supported by data showing the waning of immunity in this population over time and its restoration by an additional dose.
Data presented in the CDC Morbidity and Mortality Weekly Report (MMWR) on February 10th including bivalent booster recipients in 24 US jurisdictions shows slightly higher protection against infection and significantly higher protection against death than was observed for monovalent booster recipients or unvaccinated persons, especially among older adults.3
It is not yet clear how much a second bivalent booster will decrease the risk of severe COVID for those who are most at risk, but if you are over age 65, immunocompromised or at risk of severe COVID disease, I do recommend considering that a second bivalent vaccine for optimal protection. Please consider getting this now, as we will likely see a new booster dose available in the fall that you will want to be eligible for.
If you are under age 65, you are well-protected with a single bivalent booster dose.
Jennifer Abrams, MD, May 8, 2023