Health experts expect COVID-19 infections to rise this winter and in recent weeks we have begun to see increased cases. On December 9, 2022, the CDC expanded updated booster recommendations to include children 6 months through 5 years. The Lung Association recommends that everyone who is eligible stay up to date on the latest COVID-19 vaccination recommendations. The virus that causes COVID-19 continues to change over time, these are called variants. The most recent variants circulating are Omicron subvariants (BA.5 for example) and their sublineages such as BQ.1, BQ.1.1 and BF.7. The newest COVID-19 booster is expected to provide protection against all of these.

What is a bivalent COVID-19 vaccine?

The updated or bivalent COVID-19 booster are called bivalent because they boost immunity against the original virus that causes COVID-19 and they provide protection against Omicron BA.4 and BA.5 variants. Previously, boosters were called monovalent because they protected against only the original virus strain. While the monovalent boosters did provide some protection against Omicron, the updated or bivalent COVID-19 booster provides additional protection. Omicron has become the dominate strain circulating and accounts for nearly all COVID-19 cases in the United States.

Who is eligible?

Pfizer and Moderna both have developed updated (bivalent) COVID-19 boosters. Currently, the CDC recommends that people 6 months of age and older receive a bivalent COVID-19 vaccine when eligible. Updated COVID-19 boosters are recommended only to those who have completed their primary series first.

When should you get the booster?

You should get your updated COVID-19 booster at least two months after completion of your primary series or most recent booster dose regardless of whether the last COVID-19 vaccine you received was with Pfizer, Moderna, Novavax or Johnson & Johnson. If you recently had COVID-19, you may opt to delay your next vaccine dose by three months from the date your symptoms started or, if you did not have symptoms, when you first received a positive test. Bivalent vaccine recommendations differ slightly for children ages 6 months through 4 years.

Which booster should you get?

The new bivalent booster recommendations replaced the previous monovalent booster recommendations. As such:

  • Children 6 months-4 years who complete a Moderna primary series are recommended to receive a bivalent Moderna booster only.
  • Children 6 months-4 years completing their 3-dose Pfizer-BioNTech primary series receive the monovalent vaccine for the first and second dose, followed by the bivalent Pfizer-BioNTech vaccine for their third dose. There are no booster doses authorized for children in this age group who receive a Pfizer-BioNTech 3-dose primary series.
  • People 5 years and older can receive either Pfizer-BioNTech or Moderna updated booster.
  • There is a monovalent Novavax booster available for adults who are unable or unwilling to receive a Moderna or Pfizer updated booster. You must be 18+, have completed a COVID-19 primary series at least 6 months ago and have not received any other booster dose to be eligible.

Can you get the bivalent booster at the same time as the flu shot?

The CDC and American Lung Association strongly encourage everyone to receive annual flu vaccinations and to stay up to date on COVID-19 vaccinations. It is also safe to receive both vaccinations at the same time.

Are there any new side-effects?

The side effects for the bivalent booster are the same as those for previous COVID-19 vaccines. These include injection site tenderness, fatigue, headache, and muscle pain.

“The COVID-19 vaccines, including boosters, continue to save countless lives and prevent the most serious outcomes (hospitalization and death) of COVID-19,” said FDA Commissioner Robert M. Califf, M.D. “As we head into fall and begin to spend more time indoors, we strongly encourage anyone who is eligible to consider receiving a booster dose with a bivalent COVID-19 vaccine to provide better protection against currently circulating variants.”

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