New COVID-19 Vaccination Guidance for Older Adults & High-Risk Groups: A Conversation with NFID Medical Director Robert Hopkins, Jr, MD

As the SARS-CoV-2 virus that causes COVID-19 continues to evolve, scientists and medical experts are refining their knowledge and understanding of the increased risk of severe disease in older adults and the immunocompromised and of the durability of vaccine against the infection and the year-round circulation of the virus. National Foundation for Infectious Diseases medical director Robert Hopkins, Jr, MD, recently spoke with Patient Care^© about the most recent guidance on COVID-19 immunization from the Advisory Committee on Immunization Practices, which reflects the current data on these topics. He provides details in the short video above.

The following transcript has been lightly edited for clarity and length.

Patient Care: What are the recent changes to the ACIP recommendations for the monovalent COVID-19 vaccine booster?

Robert Hopkins, Jr, MD: There are two key updates regarding COVID-19 vaccine recommendations. First, adults aged 65 and older, as well as individuals with moderate or severe immune suppression, should receive 2 doses of the updated monovalent COVID-19, that is the 2024-2025 vaccine. These doses should be spaced approximately 6 months apart. Second, individuals with moderate or severe immune suppression may receive additional doses of the vaccine in consultation with their healthcare provider.

PC: For immunocompromised individuals, should additional doses also follow a 6-month interval?

Hopkins: The timing for additional doses in immunocompromised individuals is intentionally flexible. This is because the population with severe immune suppression is highly diverse.

For example, it includes people with hematologic malignancies like multiple myeloma or leukemia, solid organ transplant recipients, and those undergoing stem cell transplants. It also encompasses individuals taking medications that suppress immune function, such as B-cell depleting agents or chemotherapy for cancer, as well as patients with autoimmune diseases like lupus or rheumatoid arthritis.

This heterogeneity means that healthcare professionals need flexibility to tailor vaccine intervals to individual patient needs. For some, a 4-month interval may be appropriate instead of 6 months to ensure optimal protection.

Emerging data also indicate that vaccine responses may vary within these subgroups. While more refined recommendations may develop as new evidence becomes available, the current guidance aims to empower healthcare professionals to make decisions that maximize protection based on a patient’s specific circumstances.

Robert J Hopkins, Jr, MD, is the medical director of the National Foundation for Infectious Diseases and professor of internal medicine and pediatrics and director of the division of General Internal Medicine at the University of Arkansas for Medical Sciences, in Little Rock, AK.