cdc.gov/coronavirus

Summary and Work Group 

Considerations

Megan Wallace, DrPH, MPH

ACIP Meeting

June 23, 2023
U.S. COVID-19 vaccine uptake among ages ≥12 years, 

August 2021-June 2023

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

Primary Series, Adolescents Ages 12-17 Primary Series, Adults Ages 18-49 Primary Series, Adults Ages 50-64 Primary Series, Adults Ages 65+

Booster, Adolescents Ages 12-17 Booster, Adults Ages 18-49 Booster, Adults Ages 50-64 Booster, Adults Ages 65+

Primary series authorization 

1

st booster authorization 

2

nd booster authorization 1st bivalent booster 

authorization 

2

nd bivalent 

booster 

Doses Administered

authorization 

Source: IZ Data Lake 
Coverage / Age (years) <2 2–4 5–11 12–17 18–24 24–49 50–64 >65

At least one dose† 8.9 10.9 40.0 72.2 82.3 85.5 95.0 95.0

At least one bivalent dose 0.6 0.6 4.8 7.8 7.4 12.1 21.7 43.3

Unvaccinated 91.1 89.1 60.0 27.8 17.7 14.5 —† —†

U.S. COVID-19 Vaccination Coverage (%) of Total Population by 

Age Group — May 10, 2023

†Note: Coverage is capped at 95%

Source: https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends Updated June 1, 2023 3
PI=Prediction Interval, VOC=Variants of Concern, VBM=Variants Being Monitored. https://covid.cdc.gov/covid-data-tracker/#variant-proportions Accessed June 1, 2023

Trends in weighted variant proportion estimates & Nowcast

United States, February 19, 2023–June 10, 2023

Collection date, week ending

4
Weekly population-based rates of COVID-19-associated hospitalizations 

by age group— COVID-NET, March 2020–May 2023

. 

https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalization-network Accessed June, 2023

Age Group

5
▪ COVID-19 during pregnancy is associated with severe maternal health outcomes and 

adverse pregnancy outcomes

▪ Risk of complications lower, but still elevated, during the Omicron predominant 

period compared to pre-Omicron period

– Possibly due to the impact of prior infection and vaccination

▪ Most hospitalized pregnant persons with a positive SARS-CoV-2 test were not up to 

date with vaccinations

COVID-19 in pregnant people

Summary

6
▪ COVID-19-associated hospitalization rates in infants ages 0 – 5 months increased in 

the Omicron period

– Hospitalization rates similar to those in adults ages 65 – 75 years

▪ Majority of infants ages 0 – 5 months hospitalized with a positive SARS-CoV-2 test 

were hospitalized with COVID-19-like symptoms

▪ Vaccination at any point in pregnancy appears to be beneficial to infants <6 months

COVID-19 in infants

Summary

7
▪ Pregnancy remains a risk factor for severe maternal disease and adverse pregnancy 

outcomes, even with new variants

▪ COVID-19 vaccination improves outcomes for pregnant people, their pregnancies and 

their infants

▪ Growing body of evidence that COVID-19 mRNA vaccines are safe during pregnancy1

▪ Current uptake of updated COVID-19 vaccine is low among pregnant people

– 23% of pregnant people received an updated dose2

▪ Work group emphasized that pregnant people should receive recommended COVID-19 

vaccine dose for protection of themselves and their infants

▪ Continue to review data and evaluate COVID-19 recommendations for pregnant 

people as needed

Work Group interpretation

COVID-19 in pregnant people and infants

1. https://www.cdc.gov/vaccinesafety/research/publications/index.html . COVID-19 Vaccine Safety Articles and Studies by Topic. Pregnancy. 

2. https://covid.cdc.gov/covid-data-tracker/#vaccinations-pregnant-women 8
▪ Hybrid immunity likely provides better protection than either infection or 

vaccination alone

▪ Protection likely influenced by cumulative number of vaccine doses, number of 

times infected, timing of most recent vaccination or infection, and how closely the 

circulating variant matches the vaccine or prior infection

▪ Protection can wane over time after both infection and vaccination

▪ Receipt of updated vaccine dose can provide additional protection beyond that 

received by prior doses or infection and restore protection after waning

Infection-induced and hybrid immunity

Summary

9
Current recommendations for mRNA COVID-19 vaccines

6 months – 4 years 5 years ≥6 years

2 doses 

bivalent 

Moderna

3 doses 

bivalent 

PfizerBioNTech

OR

2 doses 

bivalent 

Moderna

1 dose 

bivalent 

PfizerBioNTech

OR

1 dose 

bivalent 

Moderna

1 dose 

bivalent 

PfizerBioNTech

OR
Current recommendations for mRNA COVID-19 vaccines

6 – 23 months 2 – 4 years

Question discussed by the Work Group: 

Do children ages 2–4 years continue to 

need a multi-dose initial series, or could 

they also move to a single (annual?) dose 

like older populations 
Possible future recommendations for simplification 

mRNA COVID-19 vaccines

6–23 months ≥2 years

2 doses 

bivalent 

Moderna

3 doses 

bivalent 

PfizerBioNTech

OR

1 dose 

bivalent 

Moderna

1 dose 

bivalent 

PfizerBioNTech

OR
COVID-19-associated hospitalization rates in infants, children and adolescents aged 6 

months through <18 Years — COVID-NET, March 2020–May 2023

Source: COVID-NET: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covid-net/purpose-methods.html. Data March 1, 2020 through March 31, 2023. Pre-Delta: March 1, 2020 – June 

19, 2021; Delta: June 20–December 18, 2021; Omicron BA.1: December 19, 2021–March 19, 2022; Omicron BA.2: March 20–June 18, 2022; Omicron BA.5 (June 19, 2022–May 27, 2023)

Pre-Delta Delta

Omicron

BA.1

Omicron

BA.2 Omicron BA.5 and later

13

0

2

4

6

8

10

12

14

16

18

20

3/7/20204/7/20205/7/20206/7/20207/7/20208/7/20209/7/2020

10/7/202011/7/202012/7/2020

1/7/20212/7/20213/7/20214/7/20215/7/20216/7/20217/7/20218/7/20219/7/2021

10/7/202111/7/202112/7/2021

1/7/20222/7/20223/7/20224/7/20225/7/20226/7/20227/7/20228/7/20229/7/2022

10/7/202211/7/202212/7/2022

1/7/20232/7/20233/7/20234/7/20235/7/2023

Rate per 100,000

6 months <2 years 2-4 years 5-11 years 12-17 years
63

82

89

93

0

10

20

30

40

50

60

70

80

90

100

Mar-Apr May-Jun Jul-Aug Sep-Oct Nov-Dec

Seroprevalence (%)

Month

75

85

92

97

99

0

10

20

30

40

50

60

70

80

90

100

Mar-Apr May-Jun Jul-Aug Sep-Oct Nov-Dec

Seroprevalence (%)

Month

Pediatric infection-induced and combined (vaccine- and infection-induced) 

Seroprevalence from U.S. commercial laboratories — March–December 2022

Source: https://covid.cdc.gov/covid-data-tracker/#pediatric-seroprevalence and unpublished data (CDC) Data from repeat, cross-sectional study on blood specimens collected by commercial laboratories. 

Vaccine history is unknown in this study. Infection-induced seroprevalence estimated from blood specimens tested for anti-nucleocapsid antibodies: the number of specimens per 2-month collection 

period were, by age group: 6–11 months: 157; 12–23 months: 724; 2–4 years: 2,165; 5–11 years: 9,247; and 12–17 years: 14,570. Combined (vaccine- and infection-induced seroprevalence estimated 

from specimens tested for both spike and nucleocapsid antibodies: >99% of samples tested for anti-nucleocapsid antibodies were tested for anti-spike antibodies. 14

Infection-induced Combined (vaccine- and infection-induced) 
▪ Children ages 6 – 23 months have higher COVID-19 hospitalization rates; hospitalization 

rates among children ages 2 – 4 years similar to rates in children 5 – 17 years

▪ Children ages ≥2 years more likely to be seropositive and may have multiple exposures 

through either infection or vaccination

▪ However, no randomized, clinical trials compared efficacy or immunogenicity of single 

dose versus multiple dose in young pediatric population in the context of high 

seroprevalence 

Children ages 2–4 years

Multiple initial doses or single (annual?) dose

15
▪ COVID-19 vaccines effectively protect children from hospitalization and severe disease 

from COVID-19

– Uptake of COVID-19 vaccines in children remains low

▪ Work Group would be supportive of a move toward recommendation for a single 

(possibly annual) dose in ages 2 – 4 years based on hospitalization rates and rates of 

seropositivity in this age group

– Work Group did highlight differences in transition to a single dose series from a two-dose 

series, compared to a three-dose series

▪ Simple recommendations may lead to increased coverage

▪ Continue to review data and evaluate COVID-19 vaccine program in context of evolving 

epidemiology 

Work Group interpretation 

Multiple doses in children ages 2-4 years

16
▪ June 15, 2023 FDA’s Vaccines and Related Biological Products Advisory Committee 

(VRBPAC) met to discuss fall strain composition

▪ VRBPAC unanimously voted that the vaccine composition be updated to a 

monovalent COVID-19 vaccine with an XBB-lineage of the Omicron variant

▪ FDA advised manufacturers to develop vaccines with a monovalent XBB.1.5 

composition

▪ Anticipate updated vaccine doses will be broadly available in the fall 

▪ Following updated vaccine authorizations, ACIP will review evidence to inform 

updated recommendations

Steps toward recommendation of updated vaccine

https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-june-15-2023-meeting-announcement

https://www.fda.gov/vaccines-blood-biologics/updated-covid-19-vaccines-use-united-states-beginning-fall-2023 17
▪ COVID-19 vaccines and treatments will likely transition to the commercial 

marketplace in fall 2023

– CDC continues to partner closely with state, local, and interagency partners toward 

continued successful distribution of COVID-19 vaccines and treatments during this time, 

including clarification of processes for ordering, shipping and distribution

– Guidance for partners will be published in summer 2023, prior to the transition to the 

commercial marketplace

▪ Most Americans will continue to pay nothing out-of-pocket for the COVID-19 vaccine 

due to their insurance coverage

▪ However, approximately 25 million uninsured adults will lose access to affordable 

COVID-19 vaccines and treatments if no action were taken

▪ The Bridge Access Program for COVID-19 Vaccines and Treatment is a public-private 

partnership which serves as a temporary measure to prevent the loss of under- and 

uninsured adults' access to COVID-19 vaccines and treatments at no-cost after 

commercialization

Planning for Fall 2023

18
▪ COVID-19 continues to cause substantial morbidity and mortality across the population, 

particularly in groups like older adults and persons with immunocompromising conditions

▪ COVID-19 vaccines continue to be the most effective tool we have to prevent serious illness, 

hospitalization and death from COVID-19 

▪ COVID-19 vaccination is important for pregnant people for the protection of themselves and 

their infants

▪ Most of the population hasn’t received a bivalent vaccine dose

▪ Ongoing review of data to continue efforts toward simplification

– Work Group would be supportive of additional simplification for children ages 2 – 4 years in the future 

▪ FDA advised manufacturers to develop vaccines with a monovalent XBB.1.5 composition

▪ Anticipate benefits from updated vaccine prior to possible increases in cases over the winter; 

ACIP can discuss future vaccine recommendations at upcoming meetings following updated 

vaccine authorizations

Summary

19
▪ Sara Oliver

▪ Danielle Moulia

▪ Monica Godfrey

▪ Evelyn Twentyman

▪ Hannah Rosenblum

▪ Lauren Roper

▪ Katherine Fleming-Dutra

▪ Ruth Link-Gelles

▪ Amadea Britton

▪ Sarah Meyer

▪ Susan Goldstein

▪ Mary Chamberland

▪ Elisha Hall

▪ Valerie Morelli

▪ JoEllen Wolicki

▪ Fiona Havers

▪ Romeo Galang

▪ Sierra Scarbrough

▪ Jefferson Jones

▪ Aron Hall

▪ Barbara Mahon

▪ Coronavirus and other Respiratory Viruses Division

▪ National Center for Immunization and Respiratory 

Diseases

Acknowledgments
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.

Thank you