The Advisory Committee on Immunization Practices (ACIP) met on April 19, 2023, to review FDA’s April 18 amendments to the emergency use authorizations (EUAs) for use of bivalent mRNA COVID-19 vaccines. The amendments further simplify U.S. COVID-19 vaccine recommendations and provide additional flexibility for people at higher risk of COVID-19 complications. No votes were taken, but members were generally supportive of the changes. After the meeting, CDC released a media statement recommending use of these vaccines as authorized by FDA.

CDC’s statement enacts the following changes to COVID-19 vaccine recommendations:

• Bivalent mRNA COVID-19 vaccines are authorized for all recommended doses for people age 6 months and older
• Monovalent mRNA vaccines are no longer authorized for use in the United States
• Previously unvaccinated people age 6 years and older, and those in that age group who have not received a bivalent mRNA COVID-19 vaccine, are considered fully vaccinated following a single bivalent dose
• Children age 6 months through 5 years should receive a primary series of at least two doses (with at least one bivalent dose), but the total number of doses needed is determined by the formulation used and the number of previous doses. CDC is developing support materials to assist providers with these determinations.
• Adults age 65 years and older who have received a bivalent mRNA vaccine dose have the option to receive a second bivalent mRNA dose at least 4 months after their most recent dose
• Individuals with immunocompromise who received a bivalent mRNA vaccine dose have the option to receive a second bivalent mRNA vaccine dose at least 2 months after their most recent dose, and subsequent doses at the discretion of their healthcare provider
  • Due to lack of data, FDA did not extend this authorization to children younger than age 5 who received Pfizer-BioNTech COVID-19 vaccination
• No changes were made to the recommendations for use of monovalent Novavax and Janssen (Johnson & Johnson) COVID-19 vaccines

During the meeting, ACIP also received COVID-19 vaccine program updates, discussed vaccine safety and efficacy, and reviewed implementation issues related to the updated bivalent vaccine authorizations. Presentation slides are available online. The sections below outline additional key points.

Next steps for implementation of revised CDC guidance

• The elimination of monovalent mRNA vaccine options reduces the number of mRNA COVID-19 vaccine products from 11 to 5
• Clinicians should download and use the four new FDA EUA Fact Sheets that reflect these changes
• CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States should be reviewed for specific guidance
• CDC will issue additional clinic tools to assist providers in coming weeks, especially for children age 6 months through 5 years, whose new interim recommendations are particularly complex
• CDC will host a Clinician Outreach and Communication Activity (COCA) webinar on these changes on May 11

Current vaccine uptake and safety

• The bivalent vaccines demonstrate very good effectiveness against severe disease outcomes
• Only 16.7% of eligible people in the United States have received a bivalent vaccine
• CDC continues to monitor the statistical signal suggesting a possible increased risk for ischemic stroke following receipt of Pfizer-BioNTech COVID-19 bivalent vaccine. The signal has diminished over time, which is reassuring. Recommendations for use of the vaccine are unchanged.

End of the Public Health Emergency (PHE) for COVID-19

• The COVID-19 PHE ends on May 11, 2023
• All government-purchased COVID-19 vaccine doses will continue to be distributed and administered free of charge at least through summer 2023
• After COVID-19 vaccines become commercially available in the fall, most recipients will have access to vaccination with no out-of-pocket costs. The Vaccines for Children program, commercial insurance, Medicaid, and Medicare will cover the cost of these vaccines.
• A new federal “Bridge Access Program” is intended to maintain COVID-19 vaccine access for uninsured adults
• The Public Readiness and Emergency Preparedness (PREP) Act providing immunity from liability for medical countermeasures against COVID-19 will be extended through December 2024. This revised declaration will provide liability protection for pharmacy professionals to administer COVID-19 and seasonal influenza vaccines to people age 3 years or older.

Future recommendations

• In June 2023, the virus strain or strains to be included in COVID-19 vaccine anticipated to be distributed in fall 2023 will be selected
• ACIP members and CDC staff highlighted the need for further changes to recommendations for younger children, including immunocompromised children, and the need to consider recommending vaccination during each pregnancy

The next scheduled ACIP meeting will be held on June 21–22, 2023, although additional emergency meetings may be announced before that time. Information about past and future ACIP meetings may be found on the ACIP website.

Related Links

• ACIP main page for content from previous meetings, as well as information about future settings
• CDC: ACIP Presentation Slides: April 19 Meeting web page
• FDA: Fact Sheets for Bivalent COVID-19 mRNA Vaccine
  • Pfizer-BioNTech
    • Healthcare providers (4/18/2023)
    • Recipients and caregivers (4/18/2023)
  • Moderna
    • Healthcare providers (4/18/2023)
    • Recipients and caregivers (4/18/2023)
• CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States
• CDC: (media statement) CDC Simplifies COVID-19 Vaccine Recommendations, Allows Older Adults and Immunocompromised Adults to Get Second Dose of the Updated Vaccine
• HHS: Fact Sheet: HHS Announces Intent to Amend the Declaration under the PREP Act for Medical Countermeasures against COVID-19

CDC published The Association of Reported Experiences of Racial and Ethnic Discrimination in Health Care with COVID-19 Vaccination Status and Intent—United States, April 22, 2021–November 26, 2022 in the April 21 issue of MMWR. A portion of the summary appears below.

Adults reporting experiences of racial and ethnic discrimination in health care had a significantly higher prevalence of being unvaccinated against COVID-19 overall and among most racial and ethnic groups. . . .

Strategies to address inequitable experiences (discrimination) include increasing awareness by health care providers of patients’ potential negative health care experiences and known historical mistreatment and incorporating this sensitivity into their patient interactions. This action might foster patient trust, improve adherence to recommended health interventions, and reduce some COVID-19–related health disparities.



Access the MMWR article in HTML or PDF.

Related Link

• MMWR's main page provides access to MMWR Weekly and its companion publications

National Infant Immunization Week (NIIW), April 24–30, highlights the importance of protecting infants from vaccine-preventable diseases and celebrates the achievements of immunization partners. Completing the recommended vaccinations by age 2 years is the best way to protect young children from 15 potentially life-threatening diseases. After the disruptions of three pandemic years, these messages are more important than ever for families to hear.

Before this week is over, use CDC's 2023 NIIW Digital Media Toolkit for your NIIW activities. The toolkit includes updated English and Spanish logos, sample social media content, social graphics, and key messages. Please share your posts using the hashtag #ivax2protect.

Related Links

• CDC: National Infant Immunization Week main page
• CDC: 2023 NIIW Digital Media Toolkit main page
• Immunize.org: Parent Handouts main page

In this week’s Spotlight, we summarize resources at Immunize.org that focus on the history of vaccines.

Vaccine Timeline main page lists historic dates and events related to vaccines and immunization. From Edward Jenner’s first smallpox vaccination in 1796 to COVID-19 vaccines, this chart highlights scientific discoveries and technologies that led to rapid advances in virology, molecular biology, and vaccinology.

Immunize.org YouTube channel contains public service announcements encouraging vaccination. Compiled by vaccine expert Capt. William L. Atkinson, MD, MPH, USPHS (retired), this collection spans more than 50 years.

History through Film main page highlights Protecting Health: Saving Lives, the documentary that covers the history of the Immunization Action Coalition (now Immunize.org) from 1990 to 2020. Hosted by Sam Waterston, the 30-minute film was produced by Visionaries, Inc. for broadcast on more than 100 local PBS stations nationwide.

Publications Archive links to past issues of Immunize.org publications, describing the contemporary vaccine-practice issues of the time: Needle Tips, Vaccinate Adults!, Vaccinate Women, and IZ Express (formerly IAC Express).

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.

• STAT: RSV Vaccine Approval Should Be a Top Priority for the FDA (Opinion) (4/19/23)
• Washington Post: Why Reports of Period Weirdness after COVID Shots Were Ignored (Opinion) (4/18/23)
• New York Times: Biden Administration Will Fund Program to Keep COVID Vaccines Free for the Uninsured (4/18/23)
• Reuters: U.S. Spending $5 Billion to Speed Up Development of New COVID Vaccines (4/11/23)

Immunize.org updated its chart for healthcare providers, Meningococcal B Vaccine Recommendations by Age and Risk Factor. Minor text changes enhance comprehension. A QR code now links to the online version of the document.



Test Yourself: A 10-year-old patient with sickle cell disease presents for vaccination. You give MenB today. Based on the brand of MenB available in your setting, when would you schedule the second dose? Find the right answer in this chart.

Related Links

• Immunize.org: Handouts: Q&As: Diseases and Vaccines web page
• Immunize.org: Handouts: Meningococcal B web page
• Immunize.org: Handouts for Patients and Staff web page, where you can sort materials by topic, vaccine, or language
• Immunize.org: Educational Materials for Patients and Staff—an alphabetical list of more than 300 ready-to-print staff educational materials and patient handouts

Immunize.org updated its Talking about Vaccines: Responding to Parents main page. This page leads to many resources from Immunize.org, CDC, and others to help healthcare professionals communicate with parents and patients about important vaccine topics. Changes include updated CDC, AAP, and other resources.

Related Link

• Immunize.org: Talking about Vaccines main page

The Meningitis B Action Project, a joint initiative by the Kimberly Coffey Foundation and the Emily Stillman Foundation, offers a wide range of MenB educational materials and videos for parents, students, and healthcare professionals, including recently added Spanish translations.

Meningitis B Action Project co-founders, Patti Wukovits and Alicia Stillman, recently joined the Ambiguously Blind podcast, hosted by bacterial meningitis survivor John Grimes. In the podcast, they discuss their experience with meningitis advocacy in honor and memory of each of their daughters, Kimberly Coffey and Emily Stillman, who lost their lives to meningitis B before the MenB vaccine was available in the United States.

The work of the Meningitis B Action Project was recently highlighted in Contemporary Pediatrics. The article emphasized the role pediatric and adolescent practitioners play in preventing meningococcal meningitis.

Related Links

• Meningitis B Action Project web page
• Immunize.org: Handouts: Meningococcal B web page
• Immunze.org: Ask the Experts: Meningococcal B web page

Immunize.org's laminated versions of the 2023 U.S. child and adolescent immunization schedule and the 2023 U.S. adult immunization schedule are in stock, but supplies are getting low. Order while supplies last.

While the schedules are available online from CDC at no cost, Immunize.org’s laminated schedules are ideal for use in any busy healthcare setting. Their tough coating can be wiped down, and they’re durable enough to stand up to a year of use.

• Length: Each schedule with appendices is 12 pages
• Size: Standard 8.5” X 11” booklet format
• Full Color: With color coding for easy reading, our laminated schedules replicate the original CDC formatting, including the essential tables and notes
• Bonus: The adult schedule includes Immunize.org’s popular 1-page handout summarizing the dose, route, and needle length recommendations for all vaccines and recipients

Pricing for Each Schedule
$10.00: 1 copy
$9.50 each: 2–4 copies
$8.50 each: 5–19 copies
$7.50 each: 20–99 copies
$6.00 each: 100–499 copies
$5.00 each: 500–999 copies
$4.00 each: 1,000–1,999 copies
$3.25 each: 2,000+ copies

Visit Shop Immunize.org: Laminated Schedules to view images of each page and order today!

For additional information, call 651-647-9009 or email admininfo@immunize.org.

Related Links

• Immunize.org: Laminated Child and Adolescent Immunization Schedules (0–18 years) web page
• Immunize.org: Laminated Adult Immunization Schedules (19 and older) web page
• Immunize.org: Shop Immunize.org main page
• CDC: Immunization Schedules

Immunize.org’s elegantly designed “Vaccines Save Lives” pins are meaningful gifts for people who care about vaccination. The pin makes a refined statement in hard black enamel with gold lettering and edges, measuring 1.125" x 0.75".


The pin features a stick-through-post with the back covered by a round rubber cap that holds the pin securely. A gold metal spring-lock clasp is also provided.

Wear these pins on clothing, uniforms, and white coats to show that you value vaccines.



Click here for "Vaccines Save Lives" pin pricing and ordering information.

The National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM) released a collection of materials to help organizations supporting refugee, immigrant and migrant (RIM) communities before and after the end of the COVID-19 public health emergency.

• Materials for communities include fact sheets, social media assets, a cost table, and descriptions of promising practices to improve health in RIM communities
• Many of these materials are customizable; organizations may add their own logos
• Resources were translated into Amharic, Arabic, Burmese, Dari, French, Karen, Kinyarwanda, Nepali, Pashto, Portuguese, Rohingya, Russian, Spanish, Somali, Swahili (Congolese), Swahili (East Africa), Tigrinya, and Ukrainian
• Audio resources in Dari, Pashto, and Rohingya are coming soon

Related Links

• NRC-RIM main page
• NRC-RIM: End of the Public Health Emergency web page

In the April 2023 issue, Children's Health and COVID-19 published Advisory Committee Statement: Summary of the National Advisory Committee on Immunization (NACI) Statement—Recommendation on Repeated Seasonal Influenza Vaccination. NACI addressed the question of whether annual influenza vaccination might result in diminished benefits over time. They concluded that evidence supports the benefit of annual influenza immunization. NACI is the Canadian counterpart of the CDC’s ACIP. The conclusions section appears below.

Overall, NACI concluded that there is evidence to recommend annual influenza vaccination, irrespective of whether an individual received the seasonal influenza vaccine in previous seasons. It is neither currently feasible nor warranted to modify existing annual influenza vaccination programs to account for potential negative or positive interference. NACI continues to strongly recommend that seasonal influenza vaccine should be offered annually to everyone six months of age and older who does not have contraindications to the vaccine, irrespective of previous seasons' influenza vaccination status.

The American College Health Association (ACHA) is offering a free, five-part webinar series, Facts or Fakes? Promoting Health Literacy Skills with Your Students. This five-part webinar series provides tools to help students and others navigate misinformation, disinformation, and the infodemic. Webinars include:

• January 10 – "Health Literacy 101" (available on-demand)
• February 21 – "Digital Wellbeing and Mental Health: Helping Me Is Helping We" (available on-demand)
• March 7 – "Debunking Fake News" (available on-demand)
• April 18 – "Confronting Misinformation in Our Circles of Influence" (available on-demand)
• May 9 – "Managing the Infodemic: Getting Started"

The May 9 session airs 12:00–1:00 p.m. (ET). Up to 5 hours of credit are available for CNE, CME, and CHES, and 1.0 CE is available for counselors for session 2.

Register for the free webinars.