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Health officials are providing more clarity on when young children can get COVID-19 vaccines from two different brands and how to handle age transitions.
The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) discussed the guidance Thursday at a meeting in which it also approved speeding up publication of the 2024 immunization schedule for all routine vaccines.
COVID-19
Updated COVID-19 vaccines are available for everyone 6 months and older. Most people who are not immunocompromised need only one dose.
For children who need multiple doses including those ages 6 months through 4 years, doses should be from the same manufacturer except in the following circumstances outlined by the CDC Thursday:
- same vaccine is not available at the vaccination site at the time of the clinic visit,
- previous dose is unknown,
- person otherwise would not receive the recommended vaccine dose, or
- person starts but is unable to complete a vaccination series with the same COVID-19 vaccine due to a contraindication.
Providers do not need to report these vaccinations to the Vaccine Adverse Event Reporting System.
In addition, the CDC updated its interim clinical considerations regarding age transitions. Children who turn 5 years during the initial COVID-19 vaccination series and children who are moderately or severely immunocompromised and turn 12 years during their series should receive a dose based on their age on the day of vaccination. Previously, the dose remained the same throughout the series.
The new flexibility in vaccination comes amid low vaccination rates. Just 7% of adults and 2% of children and adolescents have received the updated 2023-’24 COVID-19 vaccine. A survey found about one-quarter of parents definitely will get their child vaccinated, while one-third said they probably would. About 38% probably or definitely will not.
ACIP members pointed to several possible factors for the low rates, including supply issues, high costs for providers to stock vaccines, lack of communication and misperception that children don’t get severe illness.
AAP Red Book Editor David W. Kimberlin, M.D., FAAP, a liaison to the committee, called for better communication strategies.
“Not additional adjustments to current recommendations but how are we trying to do better as a country to get those recommendations to the people that need to hear them in a way that they want to hear them, that they are receptive to being heard,” he said.
Sean T. O’Leary, M.D., M.P.H., FAAP, chair of the AAP Committee on Infectious Diseases and a liaison to ACIP, said primary care practices are dealing with staffing shortages and thin financial margins, making it difficult to stock the COVID-19 vaccines.
“I don’t know how the pricing is determined for these vaccines, but it’s really a lot to ask these clinicians to purchase these very expensive products for their cohort when they don’t even know if they are going to get paid back,” he said.
The CDC recently announced flexibilities in the Vaccines for Children program this season for COVID-19 vaccines. They include not being required to keep a private stock until March 31, 2024 if privately insured patients will not be vaccinated, allowing limited bidirectional borrowing of VFC and private stock with rules around repayment within 30 days and allowing certain types of providers like temporary vaccination clinics and pharmacies to offer a limited formulary of vaccines such as just COVID and influenza vaccines.
Immunization schedules
The 2024 immunization schedules will be published online in November, several months ahead of the usual timeline.
ACIP members voted 13-0 in favor of the updated schedules for children, adolescents and adults, which incorporate policies approved over the past year and tweaks to improve clarity and readability.
The updates to the child and adolescent schedules include immunization recommendations for COVID, respiratory syncytial virus, flu, poliovirus, meningococcal disease and pneumococcal disease.
Traditionally, ACIP approves the schedules in October, then partner organizations do so in November and December, and the schedules are published in February. For the 2024 schedules, partners will review over the next few weeks and schedules will be published online next month and in the Morbidity and Mortality Report in December or January.
Any changes ACIP approves to the schedule in the coming months will be added online as addenda to the 2024 schedule instead of waiting for publication of the 2025 schedule.
“We’re currently working on a transition to have a more responsive schedule, and we’re hoping to have that plan finalized in the next few months,” said A. Patricia Wodi, M.D., CDC co-lead of the immunization schedule work group.
Last month, the CDC announced plans to update the schedule more regularly as the timing impacts insurance payment and the ability of certain health care providers to administer immunizations in some states. The CDC also said health care providers referring to the schedule may not be aware of recommendations made after its publication.
The AAP and numerous other medical organizations have expressed support for updating the schedules more frequently.
Resources
- Information from the AAP on COVID-19 vaccines, including a dosing guide and information on payment
- CDC interim clinical guidance on COVID-19 vaccines
- COVID-19 vaccine checklist for children from HealthyChildren.org
