In a first, COVID vaccine is added to adult immunization schedule

For the first time, COVID-19 vaccines have been added to the list of routine immunizations recommended for adults—a further sign the virus is here to stay.

The addition is being made to the 2023 Recommended Adult Immunization Schedule, released Thursday by the Advisory Committee on Immunization Practice (ACIP), an expert panel that advises the U.S. federal government on vaccination recommendations for all Americans.

COVID vaccination has, of course, been recommended ever since the vaccines became available.

But its inclusion on the recommended vaccine schedule underscores the fact that COVID-19 is not going away, said Dr. Sandra Adamson Fryhofer, an Atlanta-based physician who serves as an ACIP liaison.

"This reiterates that COVID has gone from pandemic to endemic," Fryhofer said. "For now, it looks like it's here to stay."

"Endemic" means that a disease is spreading at a more stable frequency, versus the exponential growth seen during a pandemic.

At this point, most Americans have received the primary series of vaccines against COVID. However, few have gotten the updated "bivalent" boosters that target both the original strain of the virus that causes COVID and two Omicron subvariants.

It has been available since September, but only about 16% of Americans have gotten it, according to the U.S. Centers for Disease Control and Prevention.

That rate is higher among people age 65 and older, who are at increased risk of severe COVID. But at around 40%, it's still much lower than public health experts want to see.

Fryhofer put it bluntly: "Booster uptake has been sad."

It's not entirely clear why, but Fryhofer pointed to vaccine "fatigue" as one possible reason, along with the way COVID vaccination has been politicized.

Meanwhile, a CDC report released last month found signs of an education problem: Over 40% of Americans the agency surveyed were either unaware the updated COVID booster shots exist, or did not know they were eligible for them.

The CDC recommends one dose of the updated booster for everyone ages 5 and older, if they are at least two months out since their last dose.

Dr. Aaron Glatt is chief of infectious diseases at Mount Sinai South Nassau in Oceanside, N.Y. He agreed that the ACIP's inclusion of COVID vaccination is another indicator that the virus is expected to hang around.

But, Glatt said, "there's not really a clear scientific consensus on how important the [updated booster] is for different age groups."

Glatt said he focuses on boosters for relatively older people, starting at age 50. For a healthy younger adult, who would be at low risk of severe COVID, the benefits of getting another booster are less clear, he said.

Both Glatt and Fryhofer encouraged people to talk to their doctor about their personal situation. The new vaccine schedule includes links to CDC information that doctors and patients can use to make decisions about the updated COVID boosters.

At this point, it's not clear what COVID vaccination will look like going forward: Will it be a yearly immunization, like the flu shot, that is recommended for adults and kids?

"It's still evolving," Glatt said. "We'll have to wait and see."

For anyone wondering, it's not "too late" to get the updated booster, both doctors said. For the time being, there is no COVID "season," as there is for the flu.

But, Fryhofer noted, people might want to get the booster shots while they're still free. Once the Biden administration ends the COVID national health emergency declaration in May and the COVID vaccines the government still has left are gone, that will no longer be the case.

Other than the inclusion of COVID vaccination, most of the recommendations for adult immunizations remain the same. But there is one addition related to polio.

Most Americans were vaccinated against polio in childhood, and the risk of contracting the infection in the United States is "extremely low," according to the CDC.

But the 2023 recommendations say that certain adults at risk of poliovirus exposure may consider one lifetime polio booster. That includes people traveling to countries where polio is circulating.

There has been no sustained transmission of poliovirus in the United States for about 40 years, the CDC says. But the virus made headlines last summer after a case of paralytic polio was reported in New York State. It struck a young adult who had never received the polio vaccine.

The full vaccine schedule is being published simultaneously on Feb. 10 in both the Annals of Internal Medicine and the CDC's Morbidity and Mortality Weekly Report.

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