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CDC director includes health care workers in COVID-19 vaccine boosters

September 24, 2021

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Health care workers and others exposed to COVID-19 due to their jobs will be eligible for boosters after the Centers for Disease Control and Prevention (CDC) director overruled a decision by the agency’s vaccine committee.

“As CDC Director, it is my job to recognize where our actions can have the greatest impact,” CDC Director Rochelle P. Walensky, M.D., M.P.H., said in a news release. “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.”

CDC Advisory Committee on Immunization Practices (ACIP) members who met for two days this week voted against boosters based on occupational exposure, but members were divided on that decision. Some said an extra dose for health care workers could help maintain staffing levels. Others felt the language was too broad and included people who don’t really need a boost. Dr. Walensky’s decision to break with the committee was rare and puts the CDC recommendations in line with those of the Food and Drug Administration (FDA).

“I believe we should abide by the recommendations of CDC, noting that it aligns closely with the FDA decision,” said Yvonne A. Maldonado, M.D., FAAP, chair of the AAP Committee on Infectious Diseases.

The group that is eligible based on occupation or institutional setting includes people ages 18-64 years who are frontline or non-frontline essential workers, paid and unpaid workers who interact closely with others, unpaid caregivers of frail or immunocompromised people and people living in a congregate setting such as a homeless shelter or correctional facility, according to the CDC. People in this group should weigh the risks and benefits of a booster.

Dr. Walensky agreed with the ACIP that boosters also should be available for people who are 65 years and older, people who live in long-term care facilities and people ages 18-64 years who have underlying medical conditions. Like the people with occupational exposure, those who are ages 18-49 years with underlying conditions should weigh the risks and benefits of a booster.

“With the Delta variant’s dominance as the circulating strain and cases of COVID-19 increasing significantly across the United States, a booster shot will help strengthen protection against severe disease in those populations who are at high-risk for exposure to COVID-19 or the complications from severe disease,” according to the CDC.

However, experts have been at odds as to whether there are enough data to justify the boosters, especially in younger populations.

Boosters can be given to eligible people six months after they complete their primary series. They only are available to people who received the Pfizer-BioNTech vaccine for their primary series. The same vaccine would be used for the booster. Dr. Walensky said recommendations for people who received Moderna or Johnson & Johnson vaccines will come as soon as more data are available.

People who don’t receive a booster still will be considered fully vaccinated two weeks after their second shot of the Pfizer-BioNTech or Moderna vaccines or a single dose of the Johnson & Johnson vaccine, according to the CDC. About 64% of people who are eligible are fully vaccinated.

“While today’s action was an initial step related to booster shots, it will not distract from our most important focus of primary vaccination in the United States and around the world,” Dr. Walensky said.

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