CDC Strengthens Second COVID-19 Booster Recommendation for Adults 50 and Over

The Centers for Disease Control and Prevention (CDC) issued new clinical guidance on May 20, 2022 recommending the second COVID-19 booster for all adults age 50 and over at least four months after their first booster. In addition, it updated in its clinical guidance the definition of “up to date” with COVID-19 vaccinations to include the second booster for adults age 50 and over who are at least four months beyond their first booster. LeadingAge National has learned from contacts at the CDC that it intends to apply this new definition to health care settings, even though the CDC web page on vaccinations for the general public has not been updated. This creates some ambiguity regarding the enforceability of the new "up to date" definition, but we anticipate that the inconsistency will be resolved shortly.

The definition of “up to date” is important for long term care and other providers because it affects the work exclusion periods of staff in any setting who are exposed to COVID-19, the quarantine requirements for residents and patients after an exposure, and the nursing home staff who are subject to routine COVID-19 testing. Under the new definition, adults age 50 and over who have not gotten a second booster once four months have elapsed since their first booster will be subject to more stringent requirements.

Work Exclusion for Staff in All Settings with a High-Risk Exposure

Staff who are not up to date under the new definition – that is, those age 50 and older who are eligible for and have not received a second booster – should be restricted from work according to CDC recommendations following a high-risk exposure to COVID-19.

Nursing Homes

Staff who are age 50 and older and eligible for a second booster, but have not received one, must participate in routine screening testing according to community transmission rates in accordance with Centers for Medicare and Medicaid Services (CMS) requirements. Residents who are not up to date with COVID-19 vaccination must be placed on transmission-based precautions (quarantine) following close contact exposure and upon admission or readmission to the nursing home. Even in counties with low to moderate transmission of COVID-19, residents who are not up to date should wear source control and physically distance from others when in communal areas of the facility. See CDC Interim Infection Prevention and Control Guidance for Nursing Homes and Interim Infection Prevention and Control Guidance for Healthcare Personnel.

Expanded Booster Eligibility for Children

In addition to strengthening its guidance on the second booster, the CDC expanded eligibility of COVID-19 vaccine booster doses to everyone 5 years of age and older. The CDC now recommends that children ages 5 through 11 years should receive a booster shot five months after their initial Pfizer-BioNTech vaccination series and that those 12 and older who are immunocompromised should receive a second booster at least four months after their first booster.

Updated DOH Clinical Vaccination Guidance

In conjunction with the new CDC clinical guidance, the Department of Health (DOH) updated its vaccination administration guidance documents for health care providers. The updated guidance documents are available here. DOH’s summary of the most recent changes to the guidance is set forth below:

The CDC recommends a single Pfizer-BioNTech COVID-19 vaccine booster dose for persons ages 5 through 11 years who are NOT moderately to severely immunocompromised at least five months after the primary series under the Food and Drug Administration's (FDA) Emergency Use Authorization (EUA).
The CDC recommends a single Pfizer-BioNTech COVID-19 vaccine booster dose for persons ages 5 through 11 years who ARE moderately to severely immunocompromised at least three months after the primary series under the FDA’s EUA.
CDC clinical considerations were amended to provide considerations for people who recently had SARS-CoV-2 infection to delay their primary series or booster dose by three months from symptom onset or positive test (if infection was asymptomatic).
Storage and handling requirements, including temperature monitoring and temperature excursion reporting requirements, for COVID-19 vaccination providers have been outlined.
The FDA has approved an amendment to the EUA for the Pfizer Pediatric Vaccine (orange cap for ages 5 through 11, with diluent), extending the shelf life of the Pfizer product formulation from 9 to 12 months.
The CDC has updated considerations for COVID-19 revaccination for patients who received one or more doses of COVID-19 vaccine during treatment with B-cell-depleting therapies (e.g., rituximab, ocrelizumab) that were administered over a limited period of time.
Updates were made regarding the considerations to initiate COVID-19 vaccination in children with a history of multisystem inflammatory syndrome in children (MIS-C).
Updates were made regarding individuals who were vaccinated outside the U.S. and individuals who were vaccinated as part of a clinical trial.
The link to New York State Wastage Guidance has been updated to reflect updated guidance.
The link to Redistribution Guidance has been updated to reflect updated guidance.