01 HPV brooks 508

Introduction to the HPV Vaccines Work Group
Oliver Brooks, MD
Chair, HPV Vaccine Work Group
Advisory Committee on Immunization Practices
June 28, 2024
National Center for Immunization & Respiratory Diseases
2006      2011      2016    2019  Recommendation  for Females
Routine : 11 or 12 years ,
can be started at age 9
Catch -up: through  26 years
3-dose  scheduleEvolution  of HPV  vaccination  recommendations  –
United  States
2Recommendation  for Males
Routine : 11 or 12 years ,
can be started at age 9
Catch -up: through  21 years
3-dose  schedule2-dose  schedule
if first dose
age <15 yearsCatch -up: through  26
Shared  clinical  decision -
making : some  adults
27 through  45 years
2006      2011      2016    2019  Recommendation  for Females
Routine : 11 or 12 years ,
can be started at age 9
Catch -up: through  26 years
3-dose  scheduleEvolution  of HPV  vaccination  recommendations  –
United  States
3Recommendation  for Males
Routine : 11 or 12 years ,
can be started at age 9
Catch -up: through  21 years
3-dose  schedule2-dose  schedule
if first dose
age <15 yearsCatch -up: through  26
Shared  clinical  decision -
making : some  adults
27 through  45 years
Quadrivalent Vaccine
Bivalent VaccineVaccines
available
9-valent Vaccine
•Routine vaccination
-Age 11 or 12 years
-Can be started at age 9 years
•Catch -up vaccination
-Through age 26 years
•Shared clinical decision -making
-Age 27–45 yearsCurrent HPV vaccination recommendations,
United States
Recommendations of the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices
https://www.cdc.gov/vaccines/hcp/acip -recs/vacc -specific/hpv.html  Number of doses
2 doses  (0, 6 -12 months)
if starting series before 15th birthday
3 doses  (0,1-2, 6 months)
if starting series on or after 15th birthday or if
immunocompromising condition
4
•Number of doses in the recommended HPV vaccination series
•Wording of the age for routine vaccination
•Guidance regarding persons in the “shared clinical decision -making” age
range (27 –45 years)Topics to be considered by HPV Vaccines Work Group
5
•Number of doses in the recommended HPV vaccination series
-Accumulating evidence on efficacy of HPV vaccination with fewer doses
-In 2022, the World Health Organization recommended a two -dose schedule for
persons aged 9 years or older and, a s an off -label option, a single -dose schedule
can be used for those aged 9 –20 yearsTopics to be considered by HPV Vaccines Work Group
6
•Wording of the age for routine HPV vaccination
-Some stakeholders interested in starting vaccination at age 9 years
-Current ACIP recommendations are consistent with vaccination at age 9 years
-Modification of wording could allow more flexibility Topics to be considered by HPV Vaccines Work Group
7
•Guidance regarding persons in the “shared clinical decision -making” age
range (27 –45 years)
-Shared clinical decision -making recommendation made in 2019
-Interest in providing more guidance for subgroups in this age rangeTopics to be considered by HPV Vaccines Work Group
8
•July 2024 – first meeting of Work Group
•October 2024 – presentation of general issues to full ACIP
-Number of doses in the HPV vaccination schedule
-Routine age recommendation wordingACIP HPV Vaccines Work Group initial timeline
9
ACIP HPV Vaccines Work Group
Chair
•Oliver Brooks
CDC Co -Leads
•Lauri Markowitz
•Carla DeSistoWork Group Members
•Pending
10

Summary: Introduction to the HPV Vaccines Work Group Oliver Brooks, MD Chair, HPV Vaccine Work Group Advisory Committee on Immunization Practices June 28, 2024 National Center for Immunization & Respiratory Diseases 2006      2011      2016    2019  Recommendation  for Females Routine : 11 or 12 years ,  can be started at age 9  Catch -up: through  26 years  3-dose  scheduleEvolution  of HPV  vaccination  recommendations  –  United  States 2Recommendation  for Males  Routine : 11 or 12 years ,  can be…


01 COVID Daley 508

Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.
ACIP COVID- 19 Vaccines Work Group
Dr. Matthew F. Daley, Work Group Chair
February 28, 2024
ACIP met September 12, 2023 to review the available evidence for updated (2023- 2024 Formula) COVID-
19 vaccines.
ACIP recommended updated COVID- 19 vaccines as authorized under EUA or approved by BLA in persons
aged ≥6 months.
–Moderna COVID -19 vaccine in persons ≥6 months
–Pfizer -BioNTech COVID- 19 vaccine in persons ≥6 months
–Novavax COVID -19 vaccine in persons ≥ 12 years*
Everyone aged 5 years and older should get 1 dose of an updated COVID- 19 vaccine to protect against
serious illness from COVID -19.
Children aged 6 months –4 years need multiple doses of COVID -19 vaccines to be up to date, including at
least 1 dose of updated COVID- 19 vaccine.
People who are moderately or severely immunocompromised may get additional doses of updated
COVID -19 vaccine.COVID- 19 vaccine policy
Note: Updated (2023 – 2024 Formula) COVID -19 vaccines are monovalent vaccines containing an XBB.1.5 component
Abbreviations – EUA: Emergency Use Authorization, BLA: Biologics License Application
*People aged 12 years and older who have not previously gotten any COVID -19 vaccine doses and choose to get Novavax should get 2  doses of updated Novavax vaccine to be
up to date.
Reviewed and discussed:
COVID -19 vaccine implementation
COVID -19 policy updatesACIP COVID- 19 Meeting Review: October 2023
COVID -19 hospitalizations – COVID -NET   Dr. Christopher Taylor
COVID -19 vaccine coverage    Dr. Kevin Chatham -Stephens
COVID -19 vaccine effectiveness     Dr. Ruth Link -Gelles
Economic analysis of additional dose    Dr. Lisa Prosser
Evidence to Recommendations     Dr. Megan Wallace
Next steps for COVID -19 vaccine program    Dr. Lakshmi Panagiotakopoulos
Vote: Additional Dose of COVID -19 Vaccine   Dr. Megan WallaceAgenda
February 28, 2024
Work Group members
ACIP members
Matthew Daley (chair)
Oliver Brooks
Ex-officio/government members
FDA: Rachel Zhang, Lucia Lee, Anuja Rastogi,
      Adam Spanier
NIH: Chris Roberts, Michael Ison
IHS: Uzo Chukwuma
CMS: Jeff Kelman
BARDA: Christine Oshansky
HHS: Valerie Marshall
CDC: Alan Lam
CDC co- Leads
Megan Wallace
Lakshmi Panagiotakopoulos
5Liaisons
AAFP: Jonathan Temte
AAP: Sean O’Leary
ACOG: Denise Jamieson (primary),
Laura Riley (alternate)
ACP: Jason Goldman
AGS: Ken Schmader
AMA: Sandra Fryhofer
ANA: Ruth Francis
APhA : Richard Dang
ASTHO: Marcus Plescia
CSTE: Paul Cieslak, Christine Hahn
IDSA: Jeff Duchin (primary)Liaisons, cont’d
NACCHO: Matt Zahn (primary), Jeff Duchin (alternate)
NACI: Matthew Tunis (primary),    Eva Wong (alternate)
NFID: Rob Schechter  (primary),
Bill Schaffner  (alternate)
NMA: Patricia Whitley -Williams
SHEA:  Preeti Mehrotra,
Marci Drees (alternate)

Consultants
Beth Bell
Ed Belongia
Hank Bernstein
Kathy Edwards
Robert Hopkins
Lisa Jackson
Kathy KinlawGrace Lee
Dayna Matthew
Jennifer Nelson
Kathleen Neuzil
Stanley Perlman
Peter Szilagyi
Keipp Talbot
Sarah Meyer
Elisha Hall
Danielle Moulia
Monica Godfrey
Hannah Rosenblum
Katherine Fleming -Dutra
Ruth Link -Gelles
Lauren Roper
Mary Chamberland
Susan Goldstein
Stephen Hadler
JoEllen Wolicki
Melinda Wharton
Jessica MacNeil
Amanda Cohn
Latifa Boyce
Amadea BrittonCDC participants
6Karen Broder
Carolyn Bridges
Allison Ciesla
Nicole Dowling
Daniel Drapeau
Tarayn Fairlie
Kristen Folsom
Ashley Fowlkes
Jarrett Gartin
Julianne Gee
Samuel Graitcer
Elizabeth Greene
Lisa Grohskopf
Aron Hall
Demorah Hayes
Rita Helfand
Terri Hyde
 Melisa Shah
Tom Shimabukuro
Jordan Singleton
Laura Steinhardt
John Su
Natalie Thornburg
Evelyn Twentyman
Dennis Wang
Raigan Wheeler
Ryan Wiegand
Trang Wisard
Patricia Yu
Yon YuJefferson Jones
Andrew Kroger
Josephine Mak
Lauri Markowitz
Michael McNeil
Michael Melgar
Noelle -Angelique Molinari
Morgan Najdowski
Kristen Nordlund
Ismael Ortega -Sanchez
Manisha Patel
Pragna Patel
Amanda Payne
Georgina Peacock
Jamison Pike
Derrell Powers
Sierra Scarbrough
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.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.
Thank you

Summary: Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation  use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences. ACIP COVID- 19 Vaccines Work Group Dr. Matthew F. Daley, Work Group Chair February 28, 2024 ACIP met September 12, 2023 to review the available evidence for updated…


02 COVID Taylor 508

Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.
COVID- 19–Associated Hospitalizations among
Adults — COVID- NET, 2023 –2024
Advisory Committee on Immunization Practices (ACIP)
February 28, 2024
Christopher A. Taylor, PhD
RESP- NET Hospitalization Surveillance Team
Surveillance and Prevention Branch
Coronavirus and Other Respiratory Viruses Division
RESP -NET: COVID -NET, RSV -NET, FluSurv -NET
>300 acute -care hospitals
98 counties in 13 states
In 9 of 10 HHS regions
~10% of U.S. population
Positive SARS-CoV -2 within 14 days of or
during hospitalization
Screening or clinician-driven testing
Clinical data: representative sample of
COVID -NET patientsCOVID -NET: A RESP -NET population -based hospitalization
surveillance platform

Epidemiology of COVID -19–associated
hospitalizations among adults
Weekly Population -Based Rates of COVID -19-Associated
Hospitalizations — COVID -NET, March 2020– January 2024
020406080100120140
3/7/2020
5/7/2020
7/7/2020
9/7/2020
11/7/2020
1/7/2021
3/7/2021
5/7/2021
7/7/2021
9/7/2021
11/7/2021
1/7/2022
3/7/2022
5/7/2022
7/7/2022
9/7/2022
11/7/2022
1/7/2023
3/7/2023
5/7/2023
7/7/2023
9/7/2023
11/7/2023
1/7/2024Rate per 100,000 population
Week Ending DateMarch 1, 2020 –January 27, 2024
18–49 years 50–64 years 65–74 years ≥75 years020406080100120140
10/7/2023 11/7/2023 12/7/2023 1/7/2024Rate per 100,000 population
Week Ending DateOctober 2023 –January 2024
Gray boxes indicate potential reporting delays. Interpretation of trends should be excluded from these weeks. Rates highest in adults ages ≥75 years.
Percent of Weekly Hospitalizations by Age Group —
COVID -NET, March 2020– January 2024
0%10%20%30%40%50%60%70%80%90%100%
3/7/2020
4/11/2020
5/16/2020
6/20/2020
7/25/2020
8/29/2020
10/3/2020
11/7/2020
12/12/2020
1/16/2021
2/20/2021
3/27/2021
5/1/2021
6/5/2021
7/10/2021
8/14/2021
9/18/2021
10/23/2021
11/27/2021
1/1/20222/5/2022
3/12/20224/16/20225/21/20226/25/2022
7/30/2022
9/3/2022
10/8/2022
11/12/202212/17/2022
1/21/20232/25/2023
4/1/2023
5/6/2023
6/10/2023
7/15/2023
8/19/2023
9/23/2023
10/28/2023
12/2/2023
1/6/2024Percent of COVID -19-associated hospitalizations
Week ending date
≤17 years 18–49 years 50–64 years 65–74 years 75–84 years ≥85 years≥65: 67%  of COVID -19
hospitalizations October
2023– January 2024
<65: 33%  of COVID -19
hospitalizations October 2023– January 2024≥75: 46%  of COVID -19
hospitalizations October 2023–January 2024
05101520253035
October
2022November
2022December
2022January
2023February
2023March 2023 April 2023 May 2023 June 2023 July 2023 August 2023 September
2023October
2023November
2023Weighted % of COVID -19-Associated HospitalizationsAmong adults ages ≥75 years during October 2022–November 2023, 25% of
COVID -19-associated hospitalizations were residents of a long -term care
facility.
01234567
18–49 years 50–64 years 65–74 years ≥75 years All AdultsWeighted % of Hospitalizations1.4%,
N=383.3%,
N=555.5%,
N=70
4.0%,
N=853.8%,
N=238Percent of COVID -19-Associated Hospitalizations Resulting in In -Hospital
Death, by Age Group — COVID -NET, October 2022 –November 2023
An examination of death certificate data from March 2020 –April 2022 found that among all deaths in adults with COVID -19-associat ed hospitalization,
67% occurred in -hospital and 33% occurred ≤30 days post -discharge. Among adults ages ≥65
years who died in -hospital,
28%  were residents of
long -term care facilities.
Percent of COVID-19 -Associated Hospitalizations with
Immunocompromising Conditions*, by Age Group —
COVID -NET, October 2022 –November 2023
121921
1316
051015202530
18–49 years 50–64 years 65–74 years ≥75 years All AdultsWeighted % of hospitalizations
* Immunocompromising conditions include AIDS or CD4 count<200, complement deficiency, graft vs host disease, HIV, immunoglobu lin deficiency, receipt of immunosuppressive therapy,
leukemia, lymphoma, solid organ malignancy, bone marrow transplant, metastatic cancer, multiple myeloma, steroid therapy, solid organ transplant, and other conditions adjudicated by
RESP -NET physicians to be immunocompromising in nature.
Percent of COVID -19-Associated Hospitalizations with Immunocompromising
Conditions among All Adults Ages ≥18 Years, Overall and by Outcome — COVID -NET,
October 2022– November 2023
16% 17%28%
0%10%20%30%40%50%60%70%80%90%100%
All Hospitalizations ICU Admissions In-Hospital DeathsWeighted % of Hospitalizations
Immunocompromised Not Immunocompromised
* Immunocompromising conditions include AIDS or CD4 count<200, complement deficiency, graft vs host disease, HIV, immunoglobu lin deficiency, receipt of immunosuppressive therapy,
leukemia, lymphoma, solid organ malignancy, bone marrow transplant, metastatic cancer, multiple myeloma, steroid therapy, solid organ transplant, and other conditions adjudicated by
RESP -NET physicians to be immunocompromising in nature.N=75
(of 251
deaths)N=206
(of 1,035 ICU
admissions)
Percent of Hospitalizations among Adults Ages ≥18 Years with Underlying Medical Conditions
by Age Group, with Top 4 Conditions Highlighted — COVID -NET, October 2022 –November 2023
Condition 18–49 yrs 50–64 yrs 65–74 yrs ≥75 yrs
Chronic lung disease 23 36 45 34
Asthma 19 17 14 9
COPD/Bronchitis 3 16 24 16
Cardiovascular disease 20 47 61 67
CAD/CABG/MI 5 17 27 27
CHF/Cardiomyopathy 6 18 25 25
Stroke/TIA 3 13 15 20
Diabetes 21 40 44 37
Immunocompromising condition 12 19 21 13
Neurologic condition 18 26 30 42
Dementia 0 1 6 29
Renal Disease 8 21 24 31
Obesity 42 43 39 23
COVID -19 Vaccination Status by Age Group among Adults Ages ≥18 Years
Hospitalized with COVID -19 — COVID -NET, October –November 2023 (Preliminary)
No record of bivalent or updated monovalent dose : No recorded doses of COVID -19 bivalent or updated 2023 -2024monovalent dose. Bivalent booster, but no updated monovalent doses :
Received COVID -19 bivalent booster vaccination but no record of receiving updated 2023 -2024 monovalent booster dose. Updated monovalent dose: Received updated 2023- 2024 monovalent
dose  Persons with unknown vaccination status are excluded  87
73677012
2528252 2 5 4
0%10%20%30%40%50%60%70%80%90%100%
18–49 years 50–64 years ≥65 years All Adults, ≥18 yearsWeighted percent of hospitalizations
No record of  bivalent or updated monovalent dose Bivalent booster, but no updated monovalent dose Updated monovalent dose
Coronavirus and Other Respiratory
Viruses Division
Fiona Havers
Huong Pham
Kadam Patel
Michael Whitaker
RESP -NET Site investigators and staffAcknowledgements
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.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.

Summary: Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation  use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences. COVID- 19–Associated Hospitalizations among Adults — COVID- NET, 2023 –2024 Advisory Committee on Immunization Practices (ACIP) February 28, 2024 Christopher A. Taylor,…


03 COVID Chatham Stevens 508

National Center for Immunization & Respiratory Diseases
An update on COVID- 19 vaccination coverage
CDR Kevin Chatham -Stephens, MD, MPH, FAAP
Readiness and Response Lead
Immunization Services DivisionNational Center for Immunizations and Respiratory Diseases (NCIRD)
COVID -19 vaccination coverage
Percent of adults and children up- to-date with 2023– 24
COVID -19 Vaccine
National Immunization Survey -Adult COVID Module (NIS -ACM) and - Child COVID Module (NIS -CCM)
0.010.020.030.040.050.0
9/30/23
10/7/23
10/14/23
10/21/23
10/28/23
11/4/23
11/11/23
11/18/23
11/25/23
12/2/23
12/9/23
12/16/23
12/23/2312/30/23
1/6/24
1/13/241/20/24
1/27/24
2/3/24Vaccinated with 2023 -24 COVID -19 vaccine (%)
Week end dateAll children 6m-17y
12-17y
5-11y
6m-4y
0.010.020.030.040.050.0
9/30/23
10/7/23
10/14/23
10/21/2310/28/23
11/4/23
11/11/23
11/18/23
11/25/23
12/2/2312/9/23
12/16/2312/23/2312/30/23
1/6/24
1/13/241/20/24
1/27/24
2/3/24Vaccinated with 2023 -24 COVID- 19 vaccine (%)
Week end dateAll adults 18+
75+
65-74
50-64
40-49
30-39
18-29COVID -19 Vaccination Coverage with 2023- 24 Vaccine
Among Adults ≥18 Years, NIS -ACMCOVID -19 Vaccination Coverage with 2023- 24 Vaccine
Among Children 6 Months -17 Years, NIS -CCM
COVID -19 vaccination status among adults ≥18 years by jurisdiction*
National Immunization Survey-Adult COVID Module (NIS -ACM)
Across jurisdictions, range of
vaccination coverage among adults 18 and older:
•Lowest jurisdiction: Puerto Rico
9.5% (95% CI: 8.0- 11.0)
•Lowest state: Mississippi 10.5%
(95% CI: 8.4- 12.5)
•Highest jurisdiction: District of
Columbia 41.9% (95% CI: 37.0-46.8)
*As of week ending 2/3/24
COVID -19 vaccination status and intent among adults ≥18 years
National Immunization Survey -Adult COVID Module (NIS -ACM)*
Probably or definitely will not get vaccinated
Probably will get vaccinated or unsureDefinitely will get vaccinatedVaccinated with 2023 -24 COVID -19 vaccine
3.0 4.0 6.1 8.2 9.5 11.9 13.2 14.5 14.8 17.1 17.9 18.2 18.6 18.9 20.6 21.0 21.4 21.7 21.928.2 27.2 24.924.2 19.718.6 18.1 15.1 14.714.6 14.2 12.0 13.1 13.314.3 12.7 11.7 11.4 11.331.7 31.9 31.0 29.329.230.1 28.8 30.1 31.230.3 27.2 29.4 28.9 28.227.6 28.2 28.2 28.1 28.537.1 36.8 38.0 38.241.6 39.4 39.9 40.3 39.3 38.0 40.7 40.4 39.5 39.6 37.5 38.1 38.7 38.8 38.3
0255075100Weighted %
*Sample size = 257,352

COVID -19 vaccination status and intent among adults ≥18 years
National Immunization Survey -Adult COVID Module (NIS -ACM)*
Probably or definitely will not get vaccinated
Probably will get vaccinated or unsureDefinitely will get vaccinatedVaccinated with 2023 -24 COVID -19 vaccine
3.0 4.0 6.1 8.2 9.5 11.9 13.2 14.5 14.8 17.1 17.9 18.2 18.6 18.9 20.6 21.0 21.4 21.7 21.928.2 27.2 24.924.2 19.718.6 18.1 15.1 14.714.6 14.2 12.0 13.1 13.314.3 12.7 11.7 11.4 11.331.7 31.9 31.0 29.329.230.1 28.8 30.1 31.230.3 27.2 29.4 28.9 28.227.6 28.2 28.2 28.1 28.537.1 36.8 38.0 38.241.6 39.4 39.9 40.3 39.3 38.0 40.7 40.4 39.5 39.6 37.5 38.1 38.7 38.8 38.3
0255075100Weighted %
*Sample size = 257,352Note: The analysis of coverage
by demographics on the
following slides is based on
survey responses from the time
period December 31, 2023-
January 27, 2024

COVID -19 vaccination status among adults ≥18 years, January 2024
National Immunization Survey -Adult COVID Module (NIS -ACM)*
24.419.216.419.413.314.111.423.218.620.9
0.0 20.0 40.0 60.0 80.0 100.0WhiteAsianBlackMulti/OtherHispanicNH/OPIAI/ANFemaleMaleOverall 18+
Weighted % (95% CI)•Among adults ≥18 years responding to the
NIS-ACM during 12/31/23 –1/27/24:
•20.9% (95% CI: 20.3- 21.6) reported that they
have received an updated 2023 -24 COVID -19
vaccine.
•By demographics:
•Vaccination coverage was significantly higher
among females (23%).
•Vaccination coverage was highest among White non-Hispanic adults (24%) and lowest among
AI/AN (11%), NH/OPI (14%), and Hispanic (13%) adults.
*Sample size = 60,840
COVID -19 vaccination status among adults ≥18 years, January 2024
National Immunization Survey -Adult COVID Module (NIS -ACM)*
21.020.618.726.119.412.76.922.716.821.321.9
0.0 20.0 40.0 60.0 80.0 100.0Disability: noneDisability: anyIncome unknownAbove poverty, >=$75KAbove poverty, <$75KBelow povertyUninsuredInsuredRuralSuburbanUrban
Weighted % (95% CI)•By urbanicity:
•COVID -19 vaccination coverage was lowest in
rural areas (17%).
•By health insurance status:
•Adults with health insurance had significantly
higher vaccination coverage (23%) than adults without insurance (7%).
•By household income:
•Vaccination coverage increased with increasing household income; highest among those with
income ≥$75k (26%).
*Sample size = 60,840
Percent of pregnant persons 18 –49 years vaccinated with 2023–24
COVID -19 Vaccine (Vaccine Safety Datalink)
•Among pregnant
persons ages 18 –49
years, 12.5% have received an
updated 2023- 24
COVID -19 vaccine
as of 1/27/24.
•Coverage varies by
race/ethnicity; ranges from 4.8%
(Black non-
Hispanic) to 21.3%
(Asian).

Attitudes and experiences regarding COVID -
19 vaccination
Most frequent COVID-19 vaccination concerns among adults ≥18
years by vaccination status/intent (Omnibus Surveys January 5 –29, 2024*)
10.1%
6.4%
6.3%
5.9%
74.1%
0 25 50 75 100Mild side
effects
Impact of side effects
on work/school
Unknown serious
side effects
Effectiveness
No concerns
Weighted % (95% confidence interval)Received/definitely will get
(N=1,296)
15.5%
12.7%
12.3%
11.8%
40.7%
0 25 50 75 100Unknown serious
side effects
Too busy or
kept forgetting
Effectiveness
Mild side
effects
No concerns
Weighted % (95% confidence interval)Probably will get/unsure
(N=1,003)
47.0%
39.0%
37.2%
33.2%
32.9%
0 25 50 75 100Unknown serious
side effects
Not enough studies
(human trials)
Do not trust
gov. or pharma
Heart- related
issues
Effectiveness
Weighted % (95% confidence interval)Probably/definitely will NOT get
(N=1,861)
*Sample size = 4,160
Most frequent COVID-19 vaccination concerns among adults ≥18
years by vaccination status/intent (Omnibus Surveys January 5 –29, 2024*)
10.1%
6.4%
6.3%
5.9%
74.1%
0 25 50 75 100Mild side
effects
Impact of side effects
on work/school
Unknown serious
side effects
Effectiveness
No concerns
Weighted % (95% confidence interval)Received/definitely will get
(N=1,296)
15.5%
12.7%
12.3%
11.8%
40.7%
0 25 50 75 100Unknown serious
side effects
Too busy or
kept forgetting
Effectiveness
Mild side
effects
No concerns
Weighted % (95% confidence interval)Probably will get/unsure
(N=1,003)
47.0%
39.0%
37.2%
33.2%
32.9%
0 25 50 75 100Unknown serious
side effects
Not enough studies
(human trials)
Do not trust
gov. or pharma
Heart- related
issues
Effectiveness
Weighted % (95% confidence interval)Probably/definitely will NOT get
(N=1,861)
*Sample size = 4,160
Most frequent COVID-19 vaccination concerns among adults ≥18
years by vaccination status/intent (Omnibus Surveys January 5 –29, 2024*)
10.1%
6.4%
6.3%
5.9%
74.1%
0 25 50 75 100Mild side
effects
Impact of side effects
on work/school
Unknown serious
side effects
Effectiveness
No concerns
Weighted % (95% confidence interval)Received/definitely will get
(N=1,296)
15.5%
12.7%
12.3%
11.8%
40.7%
0 25 50 75 100Unknown serious
side effects
Too busy or
kept forgetting
Effectiveness
Mild side
effects
No concerns
Weighted % (95% confidence interval)Probably will get/unsure
(N=1,003)
47.0%
39.0%
37.2%
33.2%
32.9%
0 25 50 75 100Unknown serious
side effects
Not enough studies
(human trials)
Do not trust
gov. or pharma
Heart- related
issues
Effectiveness
Weighted % (95% confidence interval)Probably/definitely will NOT get
(N=1,861)
*Sample size = 4,160
Most frequent COVID-19 vaccination concerns among adults ≥18
years by vaccination status/intent (Omnibus Surveys January 5 –29, 2024*)
10.1%
6.4%
6.3%
5.9%
74.1%
0 25 50 75 100Mild side
effects
Impact of side effects
on work/school
Unknown serious
side effects
Effectiveness
No concerns
Weighted % (95% confidence interval)Received/definitely will get
(N=1,296)
15.5%
12.7%
12.3%
11.8%
40.7%
0 25 50 75 100Unknown serious
side effects
Too busy or
kept forgetting
Effectiveness
Mild side
effects
No concerns
Weighted % (95% confidence interval)Probably will get/unsure
(N=1,003)
47.0%
39.0%
37.2%
33.2%
32.9%
0 25 50 75 100Unknown serious
side effects
Not enough studies
(human trials)
Do not trust
gov. or pharma
Heart- related
issues
Effectiveness
Weighted % (95% confidence interval)Probably/definitely will NOT get
(N=1,861)
*Sample size = 4,160
Most frequent COVID-19 vaccination concerns among adults ≥18
years by vaccination status/intent (Omnibus Surveys January 5 –29, 2024*)
10.1%
6.4%
6.3%
5.9%
74.1%
0 25 50 75 100Mild side
effects
Impact of side effects
on work/school
Unknown serious
side effects
Effectiveness
No concerns
Weighted % (95% confidence interval)Received/definitely will get
(N=1,296)
15.5%
12.7%
12.3%
11.8%
40.7%
0 25 50 75 100Unknown serious
side effects
Too busy or
kept forgetting
Effectiveness
Mild side
effects
No concerns
Weighted % (95% confidence interval)Probably will get/unsure
(N=1,003)
47.0%
39.0%
37.2%
33.2%
32.9%
0 25 50 75 100Unknown serious
side effects
Not enough studies
(human trials)
Do not trust
gov. or pharma
Heart- related
issues
Effectiveness
Weighted % (95% confidence interval)Probably/definitely will NOT get
(N=1,861)
*Sample size = 4,160
Specific concerns about effectiveness of updated COVID -19 Vaccines
among adults ≥18 years who reported effectiveness as a concern
Omnibus Surveys, January 5 -29, 2024*
*Sample size = 798

How people think and feel about COVID -19 vaccines has changed since 2022
National Immunization Survey -Adult COVID Module (NIS -ACM)
Disease risk perception has also changed ,
as reflected in the percentage of Americans
moderately/very concerned about getting COVID -19.
While most Americans still consider
COVID -19 vaccines to be safe and important,
vaccine confidence has declined.
Percent of Adults 18+ years of age that
think that a COVID- 19 vaccine  is
very/completely safePercent of Adults 18+ years of age that
think that a COVID- 19
vaccine is somewhat/very importantPercent of Adults 18+ years of age that are
moderately/very concerned about getting
COVID -19
55.0%
32.7%
2022 January 2024 January83.9%
69.6%
2022 January 2024 January67.3%
55.6%
2022 January 2024 January
How people think and feel about COVID -19 vaccines has changed since 2022
National Immunization Survey -Adult COVID Module (NIS -ACM)
Disease risk perception has also changed ,
as reflected in the percentage of Americans
moderately/very concerned about getting COVID -19.
While most Americans still consider
COVID -19 vaccines to be safe and important,
vaccine confidence has declined.
Percent of Adults 18+ years of age that
think that a COVID- 19 vaccine  is
very/completely safePercent of Adults 18+ years of age that
think that a COVID- 19
vaccine is somewhat/very importantPercent of Adults 18+ years of age that are
moderately/very concerned about getting
COVID -19
55.0%
32.7%
2022 January 2024 January83.9%
69.6%
2022 January 2024 January67.3%
55.6%
2022 January 2024 January
How people think and feel about COVID -19 vaccines has changed since 2022
National Immunization Survey -Adult COVID Module (NIS -ACM)
Disease risk perception has also changed ,
as reflected in the percentage of Americans
moderately/very concerned about getting COVID -19.
While most Americans still consider
COVID -19 vaccines to be safe and important,
vaccine confidence has declined.
Percent of Adults 18+ years of age that
think that a COVID- 19 vaccine  is
very/completely safePercent of Adults 18+ years of age that
think that a COVID- 19
vaccine is somewhat/very importantPercent of Adults 18+ years of age that are
moderately/very concerned about getting
COVID -19
55.0%
32.7%
2022 January 2024 January83.9%
69.6%
2022 January 2024 January67.3%
55.6%
2022 January 2024 January
How people think and feel about COVID -19 vaccines has changed since 2022
National Immunization Survey -Adult COVID Module (NIS -ACM)
Disease risk perception has also changed ,
as reflected in the percentage of Americans
moderately/very concerned about getting COVID -19.
While most Americans still consider
COVID -19 vaccines to be safe and important,
vaccine confidence has declined.
Percent of Adults 18+ years of age that
think that a COVID- 19 vaccine  is
very/completely safePercent of Adults 18+ years of age that
think that a COVID- 19
vaccine is somewhat/very importantPercent of Adults 18+ years of age that are
moderately/very concerned about getting
COVID -19
55.0%
32.7%
2022 January 2024 January83.9%
69.6%
2022 January 2024 January67.3%
55.6%
2022 January 2024 January
Healthcare provider COVID -19 vaccine recommendations
Relative to 2021, adults
reported fewer providers are
recommending COVID -19
vaccines
(National Immunization Survey -Adult
COVID Module [NIS -ACM])
Percent of adults whose healthcare
provider recommends COVID -19 vaccine
Most physicians reported always
recommending bivalent boosters
(CDC/RAND/Univ of Iowa Survey)
65.4%77.2%80.9%
Patients 18-49 years Patients 50-64 years Patients aged ≥65 yearsPercent of physicians who reported always recommending on -
site bivalent COVID- 19 vaccine to eligible patients — Feb 2023
36.1%
20.4%
2021 May
(4 mo. after vaccine
available)2024 January
(4 mo. after updated
vaccine available)
Reasons healthcare providers reported for NOT recommending COVID -19
bivalent boosters to eligible adult patients (CDC/RAND/Univ of Iowa Survey — February 2023)
Response options receiving <5% for at least one provider group not presented 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Medical reason for not getting vaccinated
Patient will refuse booster vaccination
Patients tired of hearing about COVID-19 vaccines
High level of vaccine resistance in community
Other
Won't have severe COVID-19 symptoms
Bivalent vaccine doesn't provide enough additional protection
Not enough time during visit to discuss vaccines
Vaccine unnecessary if they have had COVID-19
Not enough time during visit to give vaccine
Bivalent vaccine doesn't reduce COVID-19 severity in this age group% of respondents selecting response option (n=744)
Physicians
Nurses
Pharmacists
•Perceived low interest for COVID -19 vaccination in the patient population
•Cost of the COVID -19 vaccine and other associated vaccination costs
•Healthcare system decided to not stock the COVID- 19 vaccines
•Availability of the COVID -19 vaccines elsewhere in the community (e.g., pharmacies)Potential reasons for primary care providers to not stock
COVID -19 vaccines
Accessibility of COVID -19 vaccines
National Immunization Survey -Adult COVID Module (NIS -ACM)
Most Americans reported little to no difficulty in getting a COVID- 19
vaccine, across income ranges , in October 2023.
Fewer Americans report
difficulty getting COVID -19
vaccines in 2024.
88.9%93.4%92.8% 93.3%94.9%96.1%
95.3% 95.6%
6065707580859095100
Less than
$5,000$5,001-
$10,000$10,001-
$20,000$20,001-
$40,000$40,001-
$60,000$60,001-
$75,000$75,001-
$150,000$150,001
or morePercent of adults that reported not at all/a little difficult getting a COVID -19
vaccine, by income
80.5%95.0%
2021 May 2024 JanuaryPercent of adults that reported not at all/a little
difficult getting a COVID -19 vaccine
Acceptability of getting the Flu, COVID -19, and/or RSV vaccines
in the same visit among adults ≥18 years
Omnibus Surveys, November 30 -December 21, 2023*
*Sample size = 1,951

Acknowledgements
•Carla Black (CDC)
•Kayla Calhoun (CDC)
•Courtney Gidengil (RAND)
•Elisha Hall (CDC)
•Jennifer Kriss (CDC)
•Megan Lindley (CDC)•Sarah Meyer (CDC)
•Lakshmi Panagiotakopoulos (CDC)
•Megan Wallace (CDC)
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.

Summary: National Center for Immunization & Respiratory Diseases An update on COVID- 19 vaccination coverage  CDR Kevin Chatham -Stephens, MD, MPH, FAAP Readiness and Response Lead Immunization Services DivisionNational Center for Immunizations and Respiratory Diseases (NCIRD) COVID -19 vaccination coverage Percent of adults and children up- to-date with 2023– 24  COVID -19 Vaccine National Immunization Survey -Adult COVID Module (NIS -ACM) and - Child COVID Module (NIS -CCM) 0.010.020.030.040.050.0…


04 COVID Link Gelles 508

1
Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.
Vaccine effectiveness of
updated (2023 -2024) COVID -19 vaccines
February 2024
Ruth Link- Gelles, PhD, MPH
CDR, US Public Health Service
Vaccine Effectiveness Program LeadCoronavirus and Other Respiratory Viruses Division
2VE refresher
Context for interpretation of VE
VE against:
–Symptomatic SARS -CoV -2, Increasing Community Access to Testing (ICATT) program
–COVID -19-associated emergency department/urgent care encounters, VISION Network
–COVID -19-associated hospitalizations , VISION and IVY NetworksAgenda: vaccine effectiveness (VE) of updated  2023 -24
COVID -19 vaccines
33Test
negative
design
Vaccine effectiveness = (1 – adjusted odds ratio)*100%
Odds of vaccination in cases
Odds of vaccination in controlswhere odds ratio = CaseControl
Slide adapted from Amadea Britton.Person with
COVID -19-like illness
SARS -CoV-2 test
COVID -19
vaccinationstatus
44•Benefits
•Reduces bias from health- care seeking behavior by including
cases and controls who presented to care and received
testing (usually at the same facility)
•Efficient use of an existing surveillance system
•Considerations
•Dependent on sensitivity and specificity of diagnostic testing
•Controls + for another vaccine preventable disease can bias results. Sensitivity analyses dropping RSV+ and flu+ positive controls can be helpful.Test
negative
design
Slide adapted from Amadea Britton.
5Efficacy and effectiveness are population level  estimates.
Adapted from: https://www.who.int/news -room/feature- stories/detail/vaccine -efficacy -effectiveness -and -protection
If a vaccine has an
effectiveness of 80 percent:
66Context for interpreting VE across age groups
* Internal CDC data. Data on persons aged ≥16 years is from a longitudinal, national cohort of >35,000 blood donors.High rates of SARS -CoV- 2 infection- induced immunity by July –August 2023.*
VE findings should be interpreted as the incremental benefit  provided by COVID- 19 vaccination in a
population with a high prevalence of infection- induced immunity.89%
89%
84%
72%16-29 years
30-49 years
50-64 years
≥65 years
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent with infection- induced immunityPercent of persons with infection -induced immunity,
based on anti -nucleocapsid results from blood donors
7Previously for COVID- 19 VE :
–Absolute VE: comparing the frequency of health outcomes in vaccinated and unvaccinated
people
•Example: comparing outcomes in people vaccinated with an updated  (2023 -24)  dose versus  no COVID -19
vaccine received ever
–Relative VE : comparing the frequency of health outcomes in people who received one type of
vaccine to people who received a different vaccine or by comparing people who received more
vaccine doses to those who received fewer doses
•Example: comparing outcomes in people vaccinated with an updated  (2023 -24)  dose versus no updated (2023 -
24) dose
Analyses presented today:
–Vaccinated group: received updated (2023 -24) dose
–Comparison group: eligible for, but did not receive, an updated (2023 -24)  dose , regardless of past vaccination
historyMeasuring updated (2023- 2024) COVID- 19 VE
8
Updates to vaccine effectiveness
against symptomatic infection
Increasing Community Access to Testing (ICATT) program
Data updated from MMWR published February 1, 2024:
Link -Gelles R, Ciesla AA, Mak J, et al. Early Estimates of Updated 2023 –2024 (Monovalent XBB.1.5) COVID -19 Vaccine
Effectiveness Against Symptomatic SARS -CoV -2 Infection Attributable to Co -Circulating Omicron Variants Among
Immunocompetent Adults — Increasing Community Access to Testing Program, United States, September 2023 –January
2024. MMWR Morb  Mortal Wkly  Rep 2024;73:77 –83. DOI: http://dx.doi.org/10.15585/mmwr.mm7304a2
9Nationwide community -based drive- through SARS- CoV-2 testing via pharmacies
Self-reported vaccine history at time of registration for SARS- CoV-2 testing*
Design : Test -negative analysis**
Population : Adults ≥18 years with ≥1 COVID -like symptom and nucleic acid amplification testing (NAAT)
Major exclusion criteria: Individuals with immunocompromising conditions, reported a positive SARS-
CoV-2 test in preceding 90 days***
Periods for analysis:
•Full analysis included tests from September 21, 2023 – February 18, 2024
•Sub- analysis using SGTF**** included tests from October 27, 2023 – February 15, 2024Increasing Community Access to Testing: VE from national pharmacy testing
data
*At 5% of testing encounters, COVID -19 vaccination status is collected by clinician interview
**Odds ratios were calculated using multivariable logistic regression, adjusting for single year of age, gender, race/ethnici ty, SVI of the testing location (<0.5 versus ≥0.5), pharmacy contractor, underlying conditions (presence versus
absence), U.S. Department of Health and Human Services region of testing location, and date of testing
***Additional exclusion criteria: 1) reported receiving Novavax as their most recent dose and reported receiving <2 total COV ID-19 vaccine doses; 2) reported receiving a Janssen (Johnson & Johnson) COVID -19 vaccine dose after May
12, 2023; 3) received most recent dose <7 days prior to the date of testing or during September 1 -12, 2023; or 4) registered for  testing with a version of the questionnaire that only reported month and year of the most recent vaccine
dose rather than calendar date.**** Results of spike gene (S -gene) amplification in real -time reverse transcription –polymerase chain reaction (RT -PCR) can be u sed to distinguish certain SARS -CoV-2 lineages over time (2). S -gene target presence (SGTP) was
detected in most lineages that circulated in 2023, including XBB lineages, whereas S -gene target failure (SGTF) is detected in J N.1 and other BA.2.86 lineages
Link-Gelles, et al. MMWR 2024: http://dx.doi.org/10.15585/mmwr.mm7304a2
 (Results updated with additional month of data since publication.)
1010ICATT: VE of 2023 -2024 COVID -19 vaccine against symptomatic infection
among adults aged ≥18 years, by age group and time since dose
September 2023 – February 2024
COVID- 19 dosage pattern/age groupTotal
testsSARS -CoV -2-
test -positive,
N (%)Median interval
since last dose among
vaccinated among those
vaccinated, days (IQR)Adjusted VE
(95% CI)
≥18 years
No updated (2023 -2024) monovalent dose (ref) 10,829 4,080 (38) 676 (427 to 859) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 1,537 408 (27) 61 (33 to 86) 49 (42 –  55)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 735 170 (23) 32 (20 to 46) 55 (46 –  62)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 720 214 (30) 82 (71 to 95) 43 (33 –  52)
18-49 years
No updated (2023 -2024) monovalent dose (ref) 8,676 3,152 (36) 691 (439 to 877) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 943 229 (24) 61 (34 to 85) 50 (41 –  58)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 452 87 (19) 32 (19 to 46) 61 (50 –  69)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 445 130 (29) 81 (70 to 94) 39 (24 –  51)
≥50 years
No updated (2023 -2024) monovalent dose (ref) 2,153 928 (43) 593 (400 to 800) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 594 179 (30) 62 (32 to 89) 45 (32 –  55)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 283 83 (29) 32 (21 to 44) 43 (24 –  57)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 275 84 (31) 84 (72 to 98) 47 (29 –  60)
0 20 40 60 80 100
Vaccine  Effectiveness (%)Link-Gelles, et al. MMWR 2024: http://dx.doi.org/10.15585/mmwr.mm7304a2  (Results updated with additional month of data since publication.)

11Trends in estimated proportions of SARS -CoV -2 S-gene target presence
and variant proportions and Nowcast projections from genomic
surveillance
S-gene = spike gene; SGTF = S -gene target failure; SGTP = S -gene target presence Specimen collection date (2 -week period ending)

1212ICATT: VE of 2023 -2024 COVID -19 vaccine against symptomatic infection among
adults aged ≥18 years, by S- gene target (SGT) result and time since dose
October 2023 –  February  2024
COVID- 19 dosage pattern/age groupTotal
testsSARS -CoV -2 negative SARS -CoV -2 positive
Adjusted VE
(95% CI)No.
(row %)Median interval
since last dose
among vaccinated,
days (IQR) N (row %)Median interval
since last dose
among vaccinated,
days (IQR)
SGT presence (likely non- JN.1)
No updated (2023 -2024) monovalent dose (ref) 2,497 1,705 (68) 659 (403 to 820) 422 (17) 671 (405 to 801) Ref
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 329 252 (77) 84 (72 to 98) 25 (8) 73 (69 to 83) 60 (36 to 74)
SGT failure (likely JN.1)
No updated (2023 -2024) monovalent dose (ref) 2,497 1,705 (68) 659 (403 to 820) 370 (15) 682 (426 to 822) Ref
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 329 252 (77) 84 (72 to 98) 52 (16) 86 (72 to 95) 45 (22 to 62)
0 20 40 60 80 100
Vaccine  Effectiveness (%)
Link-Gelles, et al. MMWR 2024: http://dx.doi.org/10.15585/mmwr.mm7304a2  (Results updated with additional month of data since publication.)

13
VISION ED/UC
Joint VISION/IVY MMWR to be published February 29, 2024
1414VISION Multi -Site Network of Electronic Health Records
369 emergency rooms and urgent cares/229 hospitals
Design: Test-negative analysis
Population: Adults visiting a participating
emergency department or urgent care
(ED/UC) or hospitalized with COVID -19-like
illness (CLI) with a SARS- CoV -2 NAAT test
result within 10 days before or 72 hours after encounter
−Cases : CLI with positive  NAAT for SARS -CoV -2 and
no positive NAAT for RSV or influenza
–Controls : CLI with negative  NAAT for SARS -CoV-2
and no positive NAAT for influenza
Vaccination data: Documented by electronic health records and state
and city registries
1515VISION: VE of 2023 -2024 vaccine against ED/UC encounters among
immunocompetent adults aged ≥18 years, by age group
September 2023 – January 2024
VE estimates adjusted for age, sex, race and ethnicity, geographic region, and calendar time. MMWR to be published February 2 9, 2024COVID- 19 dosage pattern/age groupCOVID- 19
case -
patients
N (Col %)COVID- 19
control -
patients
N (Col %)Median interval
since last dose among
vaccinated among those
vaccinated, days (IQR)Adjusted VE
(95% CI)
≥18 years
No updated (2023 -2024) monovalent dose (ref) 15,932 (92) 98,218 (88) 669 (403- 792) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 1,297 (8) 13,378 (12) 44 (26- 64) 47 (44- 50)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 825 (5) 9,372 (8) 33 (20- 46) 51 (47- 54)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 472 (3) 4,006 (4) 74 (66- 83) 39 (33- 45)
18-64 years
No updated (2023 -2024) monovalent dose (ref) 10,582 (97) 69,423 (94) 697 (480- 832) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 377 (3) 4,739 (6) 42 (24- 62) 50 (44- 55)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 259 (2) 3,457 (5) 31 (19- 45) 52 (45- 58)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 118 (1) 1,282 (2) 73 (66- 83) 45 (34- 55)
≥65 years
No updated (2023 -2024) monovalent dose (ref) 5,350 (85) 28,795 (77) 509 (362- 733) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 920 (15) 8,639 (23) 46 (27- 66) 45 (41- 49)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 566 (9) 5,915 (16) 33 (21- 46) 49 (44- 54)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 354 (6) 2,724 (7) 74 (66- 83) 37 (29- 44)
0 20 40 60 80 100
Vaccine  Effectiveness (%)
16
VISION/IVY Hospitalization
Joint VISION/IVY MMWR to be published February 29
1717VISION: VE of 2023 -2024 vaccine against hospitalization among
immunocompetent adults aged ≥18 years, by age group
September 2023 – January 2024
VE estimates adjusted for age, sex, race and ethnicity, geographic region, and calendar time. MMWR to be published February 2 9, 2024
*Some estimates are imprecise, which might be due to a relatively small number of persons in each level of vaccination or case  status. This imprecision indicates that the actual
VE could be substantially different from the point estimate shown, and estimates should therefore be interpreted with caution. A dditional data accrual could increase precision
and allow more precise interpretation.COVID- 19 dosage pattern/age groupCOVID- 19
case -
patients
N (Col %)COVID- 19
control -
patients
N (Col %)Median interval
since last dose among
vaccinated among those
vaccinated, days (IQR)Adjusted VE
(95% CI)
≥18 years
No updated (2023 -2024) monovalent dose (ref) 4,194 (91) 28,715 (87) 627 (383- 765) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 395 (9) 4,199 (13) 42 (24- 62) 52 (47- 57)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 270 (6) 3,056 (9) 32 (19- 45) 53 (46- 59)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 125 (3) 1,143 (3) 73 (66- 81) 50 (40- 59)
18-64 years
No updated (2023 -2024) monovalent dose (ref) 938 (96) 11,342 (95) 685 (447- 829) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 38 (4) 657 (5) 38 (22- 58) 43 (20- 59)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 28 (3) 503 (4) 30 (19- 44) 42 (14- 61)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 10 (1) 154 (1) 74 (67- 81) 45 (-6-71)*
≥65 years
No updated (2023 -2024) monovalent dose (ref) 3,256 (90) 17,373 (83) 549 (370- 745) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 357 (10) 3,542 (17) 43 (25- 62) 53 (47- 58)
Updated (2023- 2024) monovalent dose, 7 -59 days earlier 242 (7) 2,553 (12) 32 (19- 46) 54 (47- 60)
Updated (2023- 2024) monovalent dose, 60- 119 days earlier 115 (3) 989 (5) 73 (66- 81) 50 (39- 59)
0 20 40 60 80 100
Vaccine  Effectiveness (%)
1818IVY Network —  26 hospitals, 20 U.S. States
Design : Case -control, prospective enrollment
Population: Adults  aged  ≥18 years  hospitalized with
Acute respiratory illness (ARI)*
–Cases: ARI and test  positive  for SARS -CoV-2 by NAAT or
antigen test within 10 days of illness and not positive for
influenza or RSV
–Controls : ARI and test negative  for SARS -CoV-2 and influenza
by NAAT within 10 days of illness
Vaccination data: Electronic medical records (EMR),
state and city registries, and self -report
Specimens: Upper respiratory specimens obtained
for central RT -qPCR testing and sequencing
*ARI is defined as presence of any one of the following: fever, cough, shortness of breath, chest imaging consistent with pne umo nia, hypoxemia
1919IVY: VE of 2023 -2024 vaccine against hospitalization among
immunocompetent adults aged ≥18 years, by age group
September 2023 – January 2024
September 2023 – January 2024
VE estimates adjusted for age, sex, race and ethnicity, geographic region, and calendar time. MMWR to be published February 2 9, 2024COVID- 19 dosage pattern/age groupCOVID- 19
case -
patients
N (Col %)COVID- 19
control -
patients
N (Col %)Median interval
since last dose among
vaccinated among those
vaccinated, days (IQR)Adjusted VE
(95% CI)
≥18 years
No updated (2023 -2024) monovalent dose (ref) 1100 (92) 2570 (88) 645 (387- 781) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 94 (8) 353 (12) 47 (25- 71) 43 (27 to 56)
≥65 years
No updated (2023 -2024) monovalent dose (ref) 747 (91) 1284 (84) 573 (375- 752) Ref
Updated (2023- 2024) monovalent dose, ≥7 days 76 (9) 245 (16) 48 (26- 72) 48 (31 to 61)
0 20 40 60 80 100
Vaccine  Effectiveness (%)
20Updated (2023 -2024) COVID -19 vaccination provided increased protection against
symptomatic SARS- CoV -2 infection and COVID -19-associated ED/UC visits and
hospitalizations compared to no updated vaccine dose.
Receipt of updated (2023- 2024) COVID -19 vaccine provides protection against JN.1
and other circulating variants
These are relatively early estimates from all 3 VE studies with no substantial waning;
however, waning is expected,  and CDC will continue monitoring VEConclusions
21CDC COVID -19 Vaccine Effectiveness
and Policy Team
Amadea Britton
Allison Ciesla
Monica Godfrey
Eric Griggs
Katherine Fleming-Dutra
Dani Moulia
Morgan Najdowski
Erica OkwuaziAnd others, including:
Sarah Ball
Jennifer DeCuir
Monica Dickerson
Margaret Dunne
Shikha Garg
Jefferson Jones
Anastasia Lambrou
Patrick Mitchell
Clint Paden
Palak Patel
And many more!!!Acknowledgements
Caitlin Ray
Sarah Reese
Elizabeth Rowley
Philip Shirk
Benjamin Silk
Zach Smith
Diya Surie
Mark Tenforde
Zack Weber
VISION and IVY site investigatorsJosephine Mak
Amanda Payne
Lauren Roper
Ami Shah
Megan Wallace
Ryan Wiegand

Summary: 1 Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation  use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences. Vaccine effectiveness of updated (2023 -2024) COVID -19 vaccines February 2024 Ruth Link- Gelles, PhD, MPH CDR, US Public Health Service Vaccine Effectiveness Program…


05 COVID Prosser 508

Economic analysis of an
additional dose of COVID -19 vaccine
University of Michigan
COVID -19 Vaccination Modeling Team
Model updates & additional analysis
February 2024
1
Study team
University of Michigan
•Lisa A. Prosser, PhD, Principal Investigator
•David W. Hutton, PhD, Co -Investigator
•Acham Gebremariam, MS, Programmer/Analyst
•Angela Rose, MS, MPH, Project Manager
•Kerra Mercon, MS, Research Assistant
Wake Forest University
•Cara Janusz, PhD
Additional contributors to 2021 Covid Vaccination Model:
Marisa Eisenberg, Emily Martin, Grace Chung, Janamarie
Perroud, Ellen Kim Deluca, Chris Cadham, Huey -Fen Chen,
Anton L.V. Avancena, Tran Doan, David SuhCenters for Disease Control and Prevention
•Jamie Pike, PhD, Health Economist, Project officer
•Megan Wallace, DrPH, Epidemiologist
•Ismael Ortega -Sanchez, PhD, Senior Economist
•Andrew Leidner, PhD, Economist
•Fangjun Zhou, PhD, Health Scientist
•Melisa Shah, MD, MPH, Medical Epidemiologist
•Danielle Moulia, MPH, Health Scientist
•Ruth Link -Gelles, PhD, Epidemiologist
•Sharon Saydah, PhD, Epidemiologist
2
Conflict of interest statement
3Authors have no known conflicts of interest.
Objectives
•Original aims*:
oEstimate annual disease burden and healthcare utilization associated with COVID -19
illness and COVID -19 booster vaccination, including cases of symptomatic illness,
hospitalizations, deaths, adverse events, costs, and quality -adjusted life years
oProject cost -effectiveness of an updated mRNA booster against COVID -19-associated
illness in persons ages ≥18 years
•Update s to the current version of the model:
oProbability of hospitalization: Oct 2022 -Sept 2023
oAdjusted vaccine impact: seasonality
o2-dose strategy (an additional mid -year dose)
4* An earlier analysis from this model was presented to ACIP on September 12, 2023: Prosser, Lisa A. (2023). Economic Analysis o f Vaccination with mRNA Booster Dose
against COVID -19 Among Adults.
Weekly rates of COVID -19 associated
hospitalizations by season, all ages
5
2021 -2022
Annual probability of hospitalization, by age
Updated to COVID -NET data from Oct 2022 -Sept 2023 (table)
Age group Base caseRange
Low High*
18-49 y 44 10 204
50-64 y 155 41 479
65+ y 790 245 2090
Source: COVID -NET05001000150020002500
18-49 years 50-64 years 65+ yearsAnnual hospitalizations per 100,000
Sept 2023 model Updated Feb 2024 model
6*Adjusted to include upper limit from Oct 22 -Mar 23
Note: Table provides values for updated February 2024 model,
reflects rates for patients hospitalized due to COVID -19 as a
primary diagnosis
Seasonality -adjusted vaccine impact, 1 -dose strategy
61%
46%
22%
0%20%40%60%80%100%
0 73 146 219 292 365Vaccine Efficacy Against Hospitalization1st dose
020406080100120140
1 2 3 4 5 6 7 8 9 10 11 12Hospitalizations per 100,0001st dose
Oct    Nov    Dec    Jan    Feb     Mar    Apr    May     Jun     Jul      Aug     Sep Oct    Nov    Dec    Jan    Feb     Mar    Apr    May     Jun     Jul      Aug     Sep All adults (18+ y) 65+ y only
7Source: COVID -NET, VISION, and IVY
02468101214161820
1 2 3 4 5 6 7 8 9 10 11 12Critical illness
per 100,000
020406080100120140
1 2 3 4 5 6 7 8 9 10 11 12Hospitalizations
per 100,000Seasonality -adjusted vaccine impact, 1 -dose strategy,
65+ y
8
1st dose
1st doseHospitalizations                 Critical illness
Oct    Nov    Dec    Jan     Feb    Mar    Apr    May    Jun    Jul     Aug     Sep Oct    Nov    Dec    Jan     Feb    Mar    Apr    May    Jun    Jul     Aug     Sep
Source: COVID -NET, VISION, and IVY
Seasonality -adjusted vaccine impact, 2 -dose strategy,
65+ y
02468101214161820
1 2 3 4 5 6 7 8 9 10 11 12Critical illness
per 100,0002nd
dose1st
dose
9020406080100120140
1 2 3 4 5 6 7 8 9 10 11 12Hospitalizations
per 100,0002nd
dose1st
dose
Oct    Nov    Dec    Jan     Feb    Mar    Apr    May    Jun    Jul     Aug     Sep Hospitalizations      Critical illness
Oct    Nov    Dec    Jan     Feb    Mar    Apr    May    Jun    Jul     Aug     Sep
Source: COVID -NET, VISION, and IVY
Updated VE and seasonality -adjusted vaccine impact
Health outcomesSeptember 2023 analysis
VEFebruary 2024 analysis*
Seasonality -adjusted vaccine
impact
AgeBase
caseLow High AgeBase
caseLow High
1-dose
strategy•Symptomatic illness (non -
hospitalized)
•Hospitalization, uncomplicatedPooled
18+ y 0.269 0.088 0.418 65+ y 0.347 0.134 0.468
•Critical illness**
•DeathPooled
18+ y 0.403 0.191 0.671 65+ y 0.451 0.272 0.666
2-dose
strategy•Symptomatic illness (non -
hospitalized)
•Hospitalization, uncomplicatedPooled
18+ y 0.428 0.176 0.505 65+ y 0.434 0.179 0.509
•Critical illness**
•DeathPooled
18+ y 0.552 0.382 0.672 65+ y 0.549 0.386 0.669
Source: COVID -NET, VISION, and IVY* Updated hospitalization rates Oct 22 - Sept 23, seasonality -adjusted vaccine impact
**Hospitalization requiring ICU and/or ventilator assistance
10
Additional assumptions: 2 -dose strategy
•Adverse events: Twice the number of the 1 -dose strategy
•Costs of vaccination: Twice the cost of the 1 -dose strategy
•See supplementary slides 32 -33
11
Analysis Plan
•Updated analysis : Calculate incremental cost -effectiveness ratios comparing
updated mRNA booster (1 -dose strategy) to no booster, using updated
hospitalization and seasonality -adjusted vaccine impact
•Second dose : Conduct base case and uncertainty analyses (one -way sensitivity
and scenario analyses) comparing no booster, 1 -dose, and 2 -dose strategies
•Project disaggregated outcomes stratified by intervention strategy and by age
subgroups (18 -49y, 50 -64y, 65+y) – supplemental slides
oCases
oHospitalizations
oDeaths
oCosts
oQALYs
oAdverse events
***This presentation reports preliminary results from the second phase of an ongoing analysis***
12
Results
13
Incremental cost -effectiveness ratios (ICERs),
comparison to September 2023 analysis, societal
perspective, preliminary results
Age Intervention strategyICER
($/QALY)
September 2023 analysisICER
($/QALY)
February 2024 analysis
18-49 yNo updated COVID -19 vax - -
Updated COVID -19 vax, 1 -dose strategy $115,588 $163,255
50-64 yNo updated COVID -19 vax - -
Updated COVID -19 vax, 1 -dose strategy $25,787 $80,427
65+ yNo updated COVID -19 vax - -
Updated COVID -19 vax, 1 -dose strategy Cost -saving $11,936
14QALY = quality -adjusted life year
Incremental cost -effectiveness ratios (ICERs),
adding a 2 -dose strategy, societal perspective,
preliminary results
Age group Intervention strategyICER
($/QALY)
18-49 yNo updated vax -
Updated Covid -19 vax, 1 -dose strategy $163,255
Updated Covid -19 vax, 2 -dose strategy $1,317,714
50-64yNo updated vax -
Updated Covid -19 vax, 1 -dose strategy $80,427
Updated Covid -19 vax, 2 -dose strategy $777,612
65+ yNo updated vax -
Updated Covid -19 vax, 1 -dose strategy $11,936
Updated Covid -19 vax, 2 -dose strategy $255,122
15QALY = quality -adjusted life year
ICERs, 1 -way sensitivity analysis,
probability of hospitalization, societal perspective,
preliminary results
*Probability of hospitalization inputs, base case (range):  18-49 y: 0.000443 (0.000101 - 0.00204); 50 -64 y: 0.00155 (0.000413 - 0.00479);
65+ y: 0.0079 (0.00245 - 0.0209)
ICER = incremental cost -effectiveness ratio; QALY = quality -adjusted life yearAge
groupStrategyICER ($/QALY)
Base case Lower bound Upper bound
18-49 yUpdated Covid -19 vax, 1 -dose strategy $163,255 $195,442 $69,538
Updated Covid -19 vax, 2 -dose strategy $1,317,714 $1,507,831 $807,114
50-64 yUpdated Covid -19 vax, 1 -dose strategy $80,427 $161,605 Cost saving
Updated Covid -19 vax, 2 -dose strategy $777,612 $1,193,501 $349,971
65+ yUpdated Covid -19 vax, 1 -dose strategy $11,936 $81,544 Cost saving
Updated Covid -19 vax, 2 -dose strategy $255,122 $566,141 $80,182
16
Alternative season scenarios
17050100150200250300
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
June
July
Aug
SeptHospitalizations per 100,000
18-49 50-64 65+050100150200250300
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
June
July
Aug
SeptHospitalizations per 100,000
18-49 50-64 65+Alternative season #2
(spring peak)
050100150200250300
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
SepHospitalizations per 100,000
18-49 50-64 65+Alternative season #1
(winter peak)Base case
050100150200250300
1 2 3 4 5 6 7 8 9 10 11 12Hospitalizations
per 100,0001st doseSeasonality -adjusted vaccine impact:
alternative season scenario #1 (winter peak)
Health outcomes Age groupSeasonality -adjusted vaccine impact, alternative scenario #1 (winter peak)
1-dose 2-dose
Base Lower Upper Base Lower Upper
Symptomatic illness and
hospitalization65+ years0.334 0.121 0.460 0.443 0.181 0.516
Critical care and death 0.432 0.229 0.657 0.540 0.379 0.660
18
2nd dose
Oct Nov Dec Jan Feb Mar  Apr  May  Jun  Jul Aug Sep

050100150200250300
1 2 3 4 5 6 7 8 9 10 11 12Hospitalizations
per 100,0001st doseSeasonality -adjusted vaccine impact:
alternative season scenario #2 (spring peak)
Health outcomes Age groupSeasonality -adjusted vaccine impact, alternative scenario #2 (spring peak)
1-dose 2-dose
Base Low High Base Low High
Symptomatic illness and
hospitalization65+ years0.269 0.070 0.401 0.439 0.194 0.514
Critical care and death 0.444 0.190 0.670 0.571 0.410 0.688
19050100150200250300
Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept
18-49 50-64 65+
2nd dose
Oct Nov Dec Jan Feb Mar Apr  May Jun  Jul  Aug  Sep

ICERs, scenario analysis varying seasonality, societal
perspective, preliminary results
20Age
groupIntervention strategyBase case ICER
$/QALYAlternative season #1
(winter peak)
ICER ($/QALY)Alternative season #2
(spring peak)
ICER ($/QALY)
65+ yUpdated Covid -19 vax, 1 -dose strategy $11,936 $14,788 $25,126
Updated Covid -19 vax, 2 -dose strategy $255,122 $198,802 $115,650
ICER = incremental cost -effectiveness ratio; QALY = quality -adjusted life year
ICER, scenario analysis varying probability of
hospitalization*, age 65+, societal perspective,
preliminary results
21Intervention strategyICER ($/QALY)
¼ base case
(198 per 100,000)½ base case
(395 per 100,000)Base case
(790 per 100,000)2x base case
(1580 per 100,000)3x base case
(2370 per 100,000)4x base case
(3160 per 100,000)
Updated Covid -19 vax, 1 -dose $93,904 $52,541 $11,936 Cost saving Cost saving Cost saving
Updated Covid -19 vax, 2 -dose $624,028 $433,533 $255,122 $120,341 $64,599 $34,133
*Adjusted risk of hospitalization by underlying condition: chronic obstructive pulmonary disease: 0.9, history of stroke: 0.9 , coronary artery
disease: 1.3, asthma: 1.4, hypertension: 2.8, obesity: 2.9, diabetes: 3.2, chronic kidney disease: 4.0, severe obesity: 4.4. Ko et al 2021.
ICER = incremental cost -effectiveness ratio; QALY = quality -adjusted life year
ICER, scenario analyses varying vaccination costs,
age 65+, societal perspective, preliminary results
Intervention strategyICER ($/QALY)
$20 $60 Base case $120
Updated Covid -19 vax, 1 -dose strategy Cost saving Cost saving $11,936
Updated Covid -19 vax, 2 -dose strategy $72,240 $145,393 $255,122
Intervention strategyICER ($/QALY)
All lower Base case All upper
Updated Covid -19 vax, 1 -dose strategy Cost saving $11,936 $53,251
Updated Covid -19 vax, 2 -dose strategy $50,768 $255,122 $443,059Varying vaccine dose cost only
Varying all vaccination -related costs*
22*Multi -way sensitivity analysis varying vaccine dose cost, vaccine administration cost, time costs of vaccination, and cost of
vaccine -associated adverse events to lower and upper bounds. See supplementary slides 32 -33 for input data.
ICER = incremental  cost-effectiveness ratio; QALY = quality -adjusted life year
Limitations
•Unpublished data used to derive key parameters in the model: vaccine effectiveness,
symptomatic illness, probabilities of hospitalization and critical illness
•Data sources vary in representativeness, generalizability
•VE estimates derived from data on bivalent booster
•Few seasons to date to estimate seasonality
•MarketScan  data for ages 65+ only includes those with supplemental insurance
•Evidence base for long covid is especially scarce
•Model does not include reduced transmission (conservative approach)
23
Summary
•1-dose strategy, updated inputs (hospitalization, seasonality -adjusted VE)
➢Vaccination averts substantial morbidity and mortality as demonstrated through
estimated disaggregated outcomes (supplementary slides)
➢ICERs for 50 -64y and 65+ age groups remain robust to changes in parameter inputs
across plausible ranges (with a few exceptions)
➢ICERs for 18 -49y remain sensitive to changes in parameter inputs; more favorable for
higher VE, higher risk of hospitalization, and critical illness
•2-dose strategy
➢Not economically favorable for 18 -49y or 50 -64y across plausible parameter ranges
➢For 65+ years, ICERs are sensitive to probability of hospitalization, costs, and
seasonality
➢ICERs are more favorable in scenarios with higher risk of hospitalization, lower costs,
and alternate seasonality
24

Summary: Economic analysis of an  additional dose of COVID -19 vaccine University of Michigan  COVID -19 Vaccination Modeling Team Model updates & additional analysis February 2024 1 Study team University of Michigan •Lisa A. Prosser, PhD, Principal Investigator •David W. Hutton, PhD, Co -Investigator •Acham Gebremariam, MS, Programmer/Analyst •Angela Rose, MS, MPH, Project Manager •Kerra Mercon, MS, Research Assistant Wake Forest University •Cara Janusz, PhD Additional contributors to 2021 Covid…