I read the CDC’s guidelines on COVID vaccines so you don’t have to

It was as much fun as you'd expect, and, yet, interesting

The basic information written for the general public about covid is, at times, tough to find and/or understand. I have summarized the CDC’s recommendations here.

I have simplified this document by not including any of the CDC’s recommendations for people who have not been vaccinated at all or who have been minimally vaccinated. I figure those folks are unlikely to care about these recommendations anyway. If you are looking for that information, you will not find it in this article. 

Also, I did not include much information about children. I’m a doctor for adults.

Let me be clear here. These are the CDC’s recommendations. This is not personal medical advice, nor is it my opinion or that of my employer. What follows is what the CDC says as I understand it. Occasionally, I will add an experience from a patient or my own thought, and I have made it clear when I do that.

WHAT

There are three 2024-5 vaccines available. 

Spikevax - Moderna mRNA vaccine

Comirnaty  - Pfizer-Bio-NTech mRNA vaccine

Novavax - protein based vaccine with an adjuvant**

I was confused by some of the information on the web, because the adult (ages 12 and up) vaccine schedule had these three: Spikevax, Comirnaty, and Novavax and the child vaccine schedule had these two: Pfizer-BioNTech COVID-19 vaccine and Moderna COVID-19 vaccine. For a while, I wondered if there were five vaccines. I was encouraged in this mis-conception by AI which confidently told me, yes, there were 5. There are not. There are three. 

I think the resolution of the confusion is that the adult dose is called by either the generic or tradename and the child dosage is only called by the generic name, but I am not positive.  Novavax has the same trade, generic and company name. AI listed the generic and trade names as though they were different for Pfizer-Bio-NTech and Moderna. 

All three vaccines target proteins of the omicron variant of covid. The protein based vaccine (Novavax) targets a protein associated with the JN.1 version of the virus. The original formulation of Spikevax and Comirnaty targeted proteins from JN.1, but the FDA asked them to target a descendant of JN.1, KP.2. The manufacturers were able to pivot to that protein. I do not know how different these proteins are. You may recall that a problem with the old style vaccines is that they cannot respond as quickly to changes in the circulating virus as the mRNA style vaccines can. Novavax could not move to the new covid variant as quickly as mRNA vaccines could.

As I write this, the circulating version of covid is KP.3.1.1 . It is felt that all three vaccines will be a good match against this version. I wonder if JN.1 will be a worse match, but there is no readily available information on that. I also wonder when covid mutates to its next form which will be a better match, but that, of course, is unknowable.

During the  summer of 2024, some of my patients felt pressured by their pharmacies to take the 2023-4 vaccine. I discouraged them from taking it. The CDC says not to use the 2023-4 vaccine now that the 2024-5 one is available.

WHO

The CDC’s advice for covid vaccines is everyone aged 6 months to 12 years should get either the Pfizer or Moderna mRNA vaccine and everyone over 12 years should get one of those or the Novavax protein subunit vaccine.

According to the CDC, people who are over 65, at high risk for severe covid, or have never had a covid vaccine should especially get the covid vaccine.

The only people that the CDC recommends not get a covid vaccine are people who have had a severe allergic reaction to the vaccine or a component of it in the past. If you have covid actively, you should not get vaccinated so that you avoid exposing the vaccinator to your covid, but there seems to be no medical reason to avoid it. If you have had covid recently, the CDC says that you can delay your vaccines by three months, but you do not have to. Note: the old advice was to delay by four months. I do not know why this advice has changed. 

WHEN

The covid vaccine is felt to last for “a few months.” If you wish to get the vaccine, you would want to time it so that your body is ready to go as covid is starting to spread in your community. Current thought is that it takes your body “a few weeks” to build an effective immunity against covid after being vaccinated. If you were vaccinated now, roughly Halloween, 2024, the vaccine would be working well before Thanksgiving and would probably be less effective around Valentine’s Day.

You can get a booster 8 weeks or more after your first vaccine. The CDC does not appear to encourage or discourage it at this point. 

People who are moderately to severely immunocompromised should get two doses of covid vaccine and may have more according to the CDC. I cannot find the definition the CDC is using of moderately to severely immunocompromised with respect to covid vaccination, but in previous years it has been defined as immunosuppression, roughly equivalent to 20 mg / day of prednisone. There are expansions of what immunocompromised means on the CDC’s website, related to other topics. Of note, none of the covid vaccines are live vaccines. 

HOW

The vaccines are given as a jab in the arm. Many pharmacies have them. The CDC notes that HRSA clinics have them, but I work for a HRSA clinic and we have not had covid shots since the first wave.

The CDC website states that one can get the flu and covid vaccines at the same time.

WHY

From the CDC website: Getting a COVID-19 vaccine is a safer, more reliable way to build protection than getting sick with COVID-19. COVID-19 vaccination helps protect people by creating an immune response without the potentially severe illness or post-COVID conditions that can be associated with COVID-19 infection.

This seems an odd statement to me. “The vaccine is a better way to build protection against getting sick with COVID than getting sick with COVID.” Strictly speaking, what the CDC has said is not wrong, but I think it’s a funny way of saying it. I think most people would say they want the vaccine to decrease their chances of getting COVID. We can all agree that getting COVID is not a very effective way to decrease one’s chances of getting COVID. I think the CDC is trying to address the fact that many people don’t care about getting COVID per se, but want to avoid consequences of getting COVID such as long COVID or giving COVID to their elderly relatives. Getting the vaccines furthers those goals, too. It is surprising to me that the CDC spends a whole lot of effort on every last little detail of how many shots a 16 month old needs, depending on what shots they’ve had previously and just one tortured sentence on why anyone would want to get the vaccine.

Stayed tuned. I’ll see what I can sort out about the why. Hopefully, I won’t lose any friends or patients in the process. Maybe I’ll take a detour to writing that article about why, for the benefit of our health, we should all be paying less attention to politics and internet attempts at inflammation.

**An adjuvant is a substance added to a vaccine to bring it to the immune system’s attention. Novavax’s adjuvant is from the Chilean Soapbark tree