Updated CDC Immunization Guidelines for 2023-2024 Tripledemic Viruses
Immunization Awareness Month
CDC immunization recommendations for influenza, COVID-19, and RSV from the updated 2023 schedules are summarized in this Guideline Topline.
The immunization schedules issued by the Centers for Disease Control and Prevention (CDC) in February 2023 contain several important updates, including recommending COVID-19 primary and booster vaccine series for the general population and individuals who are moderately to severely immunocompromised.
In advance of the 2023-2024 respiratory virus season, this Guideline Topline slide show summarizes updates regarding the 3 top respiratory viruses that could work up a tripledemic this year or could be equally menacing each on its own: influenza, COVID-19, and respiratory syncytial virus.
Virus images ©Kateryna_Kon/shutterstock.com
At the time of initial vaccination against COVID-19, the number of bivalent COVID-19 doses will depend on age and vaccine product.
Initial vaccination for COVID-19 for immunocompromised individuals should be with 3 doses of bivalent mRNA vaccine.
The current bivalent COVID-19 vaccines were formulated against the original SARS-CoV-2 virus and the BA.4 and BA.5 variants.
No original monovalent COVID-19 vaccines are currently in use. For the 2023-2024 respiratory virus season, however, it is anticipated that a new monovalent shot will be available that targets the XBB 1.5 variant.
Per CDC Interim Clinical Considerations, updated May 12, 2023: Original monovalent formulations should no longer be used, including Janssen COVID-19 Vaccine which is no longer available in the US. Individuals 18 years and older who received the Janssen COVID-19 Vaccine primary series dose are recommended to receive 1 bivalent vaccine dose (Moderna or Pfizer-BioNTech) at least 2 months after the primary, or at least 2 months after the last monovalent booster dose.
Per FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC), updated June 15, 2023: There will be a return to monovalent in Fall 2023, but with different viral clade. Monovalent XBB 1.5 composition is recommended for Fall 2023.
Updates to recommendations for influenza vaccination include preference for high-dose, recombinant, and adjuvanted products noted above to be administered to adults aged ≥65 yrs.
Other important updates on influenza vaccination are removal of recommendations for extra safety measures after vaccine administration for patients who have egg allergy, per ACIP update in June 2023) and added guidance on patient selection to receive LAIV4.
A vaccine against respiratory syncytial virus (RSV) in older adults is newly available and recommended for some older adults based on shared clinical decision-making between patient and health care provider.
A decision to administer the RSV vaccine to an adult patient aged ≥60 yrs should take into consideration underlying health conditions,* potential costs to the patient and patient preference.
*Data on prevalent health conditions obtained from: RSV vaccine recommendations and ACIP meeting recap with Sandra Fryhofer, MD. Podcast transcript. American Medical Association. June 27, 2023. Accessed August 4, 2023. https://www.ama-assn.org/delivering-care/public-health/rsv-vaccine-recommendations-and-acip-meeting-recap-sandra-fryhofer-md
In addition to the CDC highlights, the summaries include recommendations from recent meetings of the CDC's Advisory Committee on Immunization Practices (ACIP) and the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC).All recommendations have been accepted by the CDC as official and either are, or will be posted in The Morbidity and Mortlity Weekly Report (MMWR).
