ACIP recommends Pfizer booster for adolescents aged 12 to 17 years

The CDC’s vaccine advisory committee voted Wednesday to recommend that adolescents aged 12 to 17 years receive a booster dose of the Pfizer-BioNTech COVID-19 vaccine.

Members of the Advisory Committee on Immunization Practices (ACIP) voted 13-1 to recommend that children in this age group receive a booster shot at least 5 months after their primary series and CDC Director Rochelle P. Walensky, MD, MPH, later endorsed the recommendation.

The vote came 2 days after the FDA amended an emergency use authorization for the vaccine to add a booster dose for children aged 12 to 15 years, shorten the interval between a primary two-shot series and a booster dose from 6 to 5 months, and to say that moderately or severely immunocompromised children aged 5 to 11 years should receive a third primary series dose of the vaccine 28 days after their second shot.

On Tuesday, the CDC backed the last two parts of the amended EUA, but not the component allowing for booster shots of the vaccine for children aged 12 to 15 years, preferring to hear first from the ACIP.

The language that the ACIP voted on Wednesday specified that adolescents “should” receive a booster dose of the vaccine. The vote applied not only to children aged 12 to 15 years, but also to those aged 16 and 17 years.

That older age group has been eligible for a third shot of the vaccine since last month, but the ACIP’s prior recommendation for them specified that they “may” received a booster of the vaccine. The ACIP added them to Wednesday’s vote so the language for all adolescents — “should” is a stronger recommendation — matched.

Helen “Keipp” Talbot, MD, MPH, an associate professor of medicine at Vanderbilt University Medical Center, was the only voting ACIP member to vote against the recommendation, citing the risk for myocarditis as the prime reason.

"I want children vaccinated, but I don't think that risking 12- to 17-year-olds to myocarditis again is worth the risk," Talbot said.

Members debated whether to use “should” or “may” in the guidance.

“We're right in the midst of this new phase where children are affected in large numbers,” Sarah S. Long, MD, a professor of pediatrics at Drexel University College of Medicine, said before the vote. “And we know until we get this piece in favor of boosting that this will help us understand this group over time.”

Although most wanted the recommendation to say “should,” others argued for a less forceful “may,” including Michael D. Hogue, PharmD, FAPhA, FNAP, dean of Loma Linda University School of Pharmacy and a liaison representative to the ACIP, not a voting member.

Sara Oliver MD, MSPH, who leads the ACIP work group on COVID-19 vaccines, said during a presentation prior to the vote that around 50% of the 16.7 million children aged 12 to 15 years in the United States have completed a primary series with the Pfizer-BioNTech vaccine.

“We've been watching for months and have continued to see that [vaccine efficacy] is high,” Oliver said.