Answers to Tough Questions about Public Health
Children and COVID-19
Talking Points
- The CDC now recommends that children and adolescents age 6 months and older get a Pfizer or Moderna COVID-19 vaccine. Children age 5 and older who receive the Pfizer vaccine should get a booster at least 5 months after their second shot.
- COVID-19 has become one of the top 10 causes of pediatric death, and tens of thousands of children and teens have been hospitalized because of the virus. While children and adolescents are typically at lower risk than adults of becoming severely ill or hospitalized from COVID-19, the effects of the virus are unpredictable. Vaccination is the best way to protect children from COVID-19.
- The COVID-19 vaccine is safe and effective. Before it was authorized for children across age groups, scientists and medical experts reviewed safety and effectiveness data from clinical trials involving thousands of children.
Pediatric vaccines
The CDC recommends that children and adolescents age 6 months and older get a Pfizer or Moderna COVID-19 vaccine, and advises children and adolescents age 5 and older who receive the Pfizer vaccine to get a booster dose at least 5 months after their second shot.
As of December 9, 2022, the CDC expanded the use of the updated (bivalent) COVID-19 vaccine for children ages 6 months through 5 years. The updated Pfizer vaccine will be used as the third dose in the primary series for children age 6 months through 4 years old. Children ages 6 months through 5 years who previously completed a Moderna primary series are eligible to receive the updated Moderna booster 2 months after their primary series. (See: Booster Doses)
The dose and series authorized for children is informed by clinical trials on safety and effectiveness of the Pfizer and Moderna vaccine in these age groups.
Pfizer COVID-19 Vaccine Authorization
- Children age 6 months through 4 years old receive a three-shot series, with two doses spaced three weeks apart and followed by a third at least two months later. The dosage is one-tenth the adult dosage. The third dose in the series is the updated (bivalent) COVID-19 vaccine.
- Children age 5 to 11 receive a two-shot series spaced three weeks apart. The dosage is one-third the adult dosage. This age group should also get a booster dose at least five months after their second shot. This age group should also get an updated booster dose at least two months after their second shot.
- Children age 12 to 17 receive a two-shot series spaced three weeks apart. The dosage is the same as the adult dosage. This age group should also get an updated booster dose at least two months after their second shot.
Moderna COVID-19 Vaccine Authorization
- Children age 6 months through 5 years old receive a two-shot series, with two doses spaced four weeks apart. The dosage is one-quarter of the adult dosage. This age group is also eligible to receive a Moderna bivalent booster dose 2 months after their primary series.
- Children age 6 to 11 receive a two-shot series, with two doses spaced four weeks apart. The dosage is half the adult dosage. This age group should also receive a Moderna bivalent booster dose 2 months after their primary series.
- Children age 12 to 17 receive a two-shot series, with two doses spaced four weeks apart. The dosage is the same as the dosage for adults. This age group should also receive a Moderna bivalent booster dose 2 months after their primary series.
The CDC recommends that children and adolescents age 6 months to 17 years who are moderately or severely immunocompromised should receive a three-shot series of the Pfizer or Moderna vaccine. For more information on COVID-19 vaccine recommendations for immunocompromised children and adolescents, follow the CDC’s guidelines here.
Medical and public health experts, including the CDC and the American Academy of Pediatrics, recommend that children and adolescents age 6 months and older get a COVID-19 vaccine to help protect them from contracting and spreading the virus.
The vaccine is the best way to protect children from becoming severely ill or having long-lasting health impacts due to COVID-19. While children and adolescents are typically at lower risk than adults of becoming severely ill or hospitalized from COVID-19, it is still possible. COVID-19 has become one of the top 10 causes of pediatric death, and tens of thousands of children and teens have been hospitalized with COVID-19.
Another important reason for children to get the COVID-19 vaccine is to protect their friends, family, and the broader community from the spread of the virus. The higher the vaccination rates, the lower the chances that the coronavirus will mutate into additional variants.
Yes. Scientists and medical experts have worked to ensure the vaccine is safe for children and adolescents ages 6 months to 17 years old. Before being authorized for children, these experts completed their review of safety and effectiveness data from clinical trials involving thousands of children. What’s more, 22 million children and adolescents, ages 5-17 have already received the COVID-19 vaccine. As of June 18, the Pfizer and Moderna vaccines are also authorized for children as young as 6 months.
Data from trials will continue to be collected for two years after each vaccine is first administered to ensure that they are safe for the long term. As with all vaccines, there will be ongoing monitoring among people who are vaccinated.
Yes, it is safe for children and adolescents to get a COVID-19 vaccine and other routine vaccines, including the flu shot and other routine pediatric immunizations, during the same visit. The CDC recommends that all children and adolescents age 6 months and older remain up to date with routine vaccinations, and to receive the COVID-19 vaccine when eligible.
All the COVID-19 vaccines have undergone a rigorous review process before being authorized for a given age group. The FDA’s evaluation of vaccines for young kids has been part of this overall thorough review process. Clinical trials were not started in children until after the trials in adults showed safety and efficacy of the vaccines. Additionally, part of what made the review process longer for young kids is that experts were determining what dosage and series would be safe and effective for children under five. After reviewing initial data on the effectiveness of the vaccine in young kids, the FDA waited to receive additional findings from clinical trials to ensure that its recommendation was based on a substantial amount of clinical data.
Side effects to the COVID-19 vaccines are typically mild and subside in one to two days — like soreness in the arm, fatigue, headaches, or a slight fever.
The risk of a child having a serious adverse reaction to the COVID-19 vaccine is very low. One rare complication that has been linked to the COVID-19 vaccine is myocarditis (inflammation of the heart), and data demonstrate a higher risk for such inflammation among younger males. However, reports of these complications are rare. The risk of developing myocarditis after a COVID-19 infection is much higher than the risk of developing myocarditis after the vaccine.
If you have questions about how to protect your children from COVID-19, about the vaccines, or about myocarditis, speak to your health care provider or pediatrician.
Schools and in-person learning
In-person learning is critical for the educational and social development of students of all ages. Ensuring that schools open and operate in a manner that prioritizes the health and safety of students, teachers, school staff, their families, and the community is a national priority.
In addition to following local and school requirements and getting vaccinated if eligible, children can protect themselves and others from contracting and spreading COVID-19 by wearing a well-fitting mask, washing their hands, social distancing, staying home if they are feeling sick, and getting tested if they were exposed to the virus or are symptomatic.
The CDC recommends that all students, teachers, and staff at K-12 schools wear masks to protect children and the community against the spread of COVID-19. Along with COVID-19 vaccination, mask-wearing can play an important role in ending the pandemic. Especially in schools where children under 12 can’t yet get vaccinated, masks are a critical line of defense against the spread of COVID-19.
Data show that wearing masks in schools is effective in preventing COVID-19 outbreaks and keeping children safe. A CDC study found that schools without mask requirements were 3.5 times more likely to have COVID-19 outbreaks than schools that started the fall 2021 school year with mask requirements. In another analysis of 520 U.S. counties, the CDC found that in places where schools did not have mask requirements, pediatric COVID-19 cases rose at a higher rate than in counties where schools do require masks.
School policies, including COVID-19 guidance, are made at the state, local, district, and school levels. The CDC continues to recommend universal masking in K-12 schools, vaccination, distancing, ventilation, and other prevention strategies, and that additional measures be based on local vaccination and infection rates.
Mask Guidance
Talking Points
- Wearing a high-quality, well-fitting mask helps prevent the spread of COVID-19. Alongside vaccination and boosting, testing, staying home when you’re sick, and washing your hands, masks are an important tool you can use to protect yourself and others from getting sick.
- High-quality, well-fitting masks are effective at reducing the transmission of COVID-19. Studies also show that high-quality, well-fitting masks are likely effective at reducing the transmission of flu and RSV. Scientists continue to study the use of masks, including what kinds of masks work best and which viruses can be prevented from spreading to others by wearing masks.
- You should wear a mask indoors if you’re in an area with a high COVID-19 Community Level. You should also consider wearing a mask indoors if you’re at high risk for severe COVID-19, or if flu or RSV are circulating at high levels in your community. Even if you’re not in an area with high virus transmission, you may also choose to wear a mask based on your own personal preference and risk assessment.
- The type of mask you wear matters. While all masks provide some level of protection, properly-fitted high filtration masks such as N95s, KN95s and KN94s provide the best protection.
Mask usage
Face masks help prevent the spread of COVID-19 when worn consistently and correctly. Here are considerations to help you choose a mask and ensure you get the best protection from it.
- Filtration. While all masks provide some level of protection, properly fitted high filtration masks such as N95s, KN95s, and KF94s offer the best protection. In absence of a high filtration mask, people can improve the protection of their masks by wearing two masks (a cloth mask over a disposable mask).
- Fit. A poorly fitting or uncomfortable mask may be less effective if it is worn improperly or taken off frequently. If you are wearing a high filtration mask, ensure that it seals tightly to your face, which facial hair can interfere with. Masks should fit snugly over your nose and mouth with no gaps. Fit can be improved by combining a cloth mask or disposable mask with a fitter or brace, knotting and tucking ear loops of your mask, or wearing a mask that is secured behind the head instead of with ear loops.
- Comfort. Some masks are more protective than others, and some are harder to tolerate than others. High filtration masks, such as N95s, KN95s and KF94s are recommended. People can get the best protection from COVID-19 by wearing the most protective mask you can that fits well and that you will wear consistently.
As the science and the virus evolves, so do the policies and recommendations. While all masks provide some level of protection, the CDC now recommends using the most protective mask you are able to because the Omicron variant is even more infectious than earlier variants.
The CDC also updated recommendations on N95s based on supply. When there was limited nationwide supply, CDC recommended prioritizing N95 respirators for healthcare workers, but now N95s and KN95s are widely available.
When to Wear a Mask
With COVID-19, flu, and RSV cases and hospitalizations spiking in many parts of the country, some public health officials are revisiting mask guidance and are again recommending mask wearing, particularly in indoor public spaces.
Data show that high-quality, well-fitting masks are effective at reducing the transmission of COVID-19. Studies also show that high-quality, well-fitting masks are likely effective at reducing the transmission of flu and RSV. Scientists continue to study the use of masks, including what kinds of masks work best and which viruses can be prevented from spreading by wearing masks.
When making mask recommendations, local public health authorities typically consider transmission rates of COVID-19, flu, and RSV, along with hospitalizations and hospital capacity. The CDC continues to recommend that you should wear a mask indoors if your COVID-19 Community Level is high. If your COVID-19 Community Level is medium, you should consider wearing a mask if you’re at high risk for severe COVID-19.
Regardless of COVID-19 Community Level or current local mask guidance, anyone can wear a mask as an additional precaution to protect themselves and their families from respiratory infections during the holiday season.
The CDC COVID-19 Community Level is a measure that takes into consideration COVID-19 cases, hospitalizations, and hospital capacity within a community. When the level is higher, more prevention measures, like masking, are recommended to keep people healthy and limit strain on the local healthcare system.
CDC’s masking recommendations based on COVID-19 community level are:
- Low: Mask use is based on personal preference and risk assessment.
- Medium: People who are at high risk for severe health impacts if infected with COVID-19, or who regularly interact with someone at high risk, should strongly consider wearing a mask in indoor public settings for additional protection from COVID-19.
- High: People should wear masks in indoor public settings, including in schools and workplaces.
There are also some situations where people should wear a mask, regardless of Community Level—such as if they have symptoms, have tested positive for COVID-19, or have been exposed to COVID-19. (See Quarantine and Isolation).
Depending on where you live, state or local elected officials typically have the authority to create or lift mask requirements and issue mask recommendations. As respiratory illnesses are spiking in many parts of the country, and based on CDC’s COVID-19 Community Level framework, some state and local officials are revisiting their indoor mask guidance. While the COVID-19 Community Level doesn’t currently take into account flu or RSV levels, data show that masks can also be effective in reducing the transmission of flu and RSV.
Questions that may help you make a decision about whether to wear a mask include:
- What is your COVID-19 Community Level?
- What health risks do you and your family members have? For example, are you or anyone in your family an older adult or have an underlying health condition, such as diabetes or heart disease?
- Do you have young children in your household who are not yet eligible to be vaccinated?
- Are you up to date on your vaccinations (fully vaccinated and boosted if eligible)?
- Are other respiratory illnesses circulating at high levels in your community?
Regardless of Community Level or whether your state, county, or city requires masks, you may decide that wearing a mask is the right decision for you.
On April 18, a court ruling voided the federal requirement that people wear masks on public transportation. This has led some airlines, airports, and transit systems to lift their requirement that passengers or employees wear masks, while other airlines and systems are keeping those requirements in place. Check with your airline or local carrier for their current mask policy.
The CDC is still recommending that everyone age 2 and older wear a well-fitting mask or a high filtration mask such as an N95, KN95, and KF94 when indoors on public transportation and transportation hubs.
Whether or not a carrier is requiring mask wearing, individual passengers are recommended to wear a mask—especially when in crowds or poorly ventilated areas, during international travel or long-distance domestic travel, when the COVID-19 Community Level is high, or if you or a family member is at high risk for getting severely ill if infected with COVID-19. For example, older adults and anyone with an underlying health condition that would make COVID-19 infection more serious, (e.g., diabetes, obesity, heart disease, cancer) or anyone who has older family members or family members with underlying health issues, should continue to wear a mask as a precaution against becoming infected and spreading the virus.
CDC recommendations on mask-wearing on public transportation are based on the latest scientific data on COVID-19 and current and projected trends in the CDC’s COVID-19 Community Level Framework. For more information about safer travel during the pandemic, including mask-wearing tips and recommendations for post-travel, visit the CDC Domestic and International Travel pages.
In many cases, yes. Regardless of state or local policies, private businesses have the authority to require masks (both for employees and customers) if they choose to. Some school systems may also continue to require students and school personnel to wear masks, and those policies vary by jurisdiction. Regardless of state, local, or school policy, teachers, students, and other individuals can choose to wear masks to safeguard their health.
The authority for making mask requirements most often resides at the state and local level. The CDC issues recommendations and guidance to help inform policy decisions made at the local levels. Public health officials, employers, and schools typically consider local transmission rates of COVID-19, flu, and RSV, along with hospitalizations and hospital capacity when issuing mask guidance.
Quarantine and isolation
Talking Points
- The CDC updated recommendations for quarantine (staying away from others when you have been in close contact with someone with COVID-19) and isolation (staying away from others when you test positive for COVID-19). The recommendations for quarantine and isolation no longer differ by vaccination status.
Quarantine: what happens if you’re exposed to COVID-19?
- If you are exposed to COVID-19, you should wear a high-quality mask for 10 days and get tested on day 5. The CDC no longer recommends quarantining if you are exposed.
Isolation: what happens if you test positive?
- If you test positive for COVID-19, or if you’re sick and suspect you have COVID-19 and are awaiting test results, you should isolate from others, regardless of vaccination status.
- If you test positive for COVID-19, you should isolate from others for at least 5 days. If you had mild or asymptomatic COVID-19 and are fever-free after 5 days, you can end isolation and wear a high-quality mask through day 10. But if you had moderate or severe COVID-19 or you are immunocompromised, you should isolate through day 10.
- If you ended isolation but your COVID-19 symptoms recur or worsen, you should restart your isolation period back to day 0.
COVID-19 exposure or testing positive
On August 11, 2022, the CDC updated its COVID-19 guidelines. Many of the recommendations remain the same and are rooted in the most effective strategies to protect ourselves against COVID: get vaccinated and stay up-to-date with boosters, test if you have symptoms or have been exposed to COVID-19, isolate if you test positive, and wear a mask if you are in an area with a high COVID-19 Community Level. The CDC also continues to recommend that people take additional precautions if they are at higher risk for severe COVID-19.
The CDC updated recommendations for quarantine (staying away from others when you have been in close contact with someone with COVID-19) and isolation (staying away from others when you test positive for COVID-19). The recommendations for quarantine and isolation no longer differ by vaccination status.
Quarantine: what happens if you’re exposed to COVID-19?
- If you are exposed to COVID-19, you should wear a high-quality mask for 10 days and get tested on day 5. The CDC no longer recommends quarantining if you are exposed.
Isolation: what happens if you test positive?
- If you test positive for COVID-19, or if you’re sick and suspect you have COVID-19 and are awaiting test results, you should isolate from others, regardless of vaccination status.
- If you test positive for COVID-19, you should isolate from others for at least 5 days. If you had mild or asymptomatic COVID-19 and are fever-free after 5 days, you can end isolation and wear a high-quality mask through day 10. But if you had moderate or severe COVID-19 or you are immunocompromised, you should isolate through day 10.
- If you ended isolation but your COVID-19 symptoms recur or worsen, you should restart your isolation period back to day 0.
In most settings, the CDC also no longer recommends testing for COVID-19 if you are asymptomatic and have no known exposure.
The latest guidance from the CDC recommends that people who test positive for COVID-19 should stay home and away from others (isolation) for at least five days after testing positive, as this time period is when you are most infectious.
CDC recommendations for ending isolation:
- If you had mild or asymptomatic COVID-19 and are fever-free after 5 days, you can end isolation but should wear a high-quality mask through day 10.
- If you had moderate illness (shortness of breath or trouble breathing) or severe illness (you were hospitalized), or you are immunocompromised, you should isolate through day 10.
- If you ended isolation but your COVID-19 symptoms recur or worsen, you should restart your isolation from day 0.
In addition to isolating, you should notify people you have been in close contact with, which the CDC defines as someone who was less than six feet from you for at least 15 minutes. If you have had symptoms, you should notify all the people you had close contact with, starting from two days prior to the onset of symptoms up until you tested positive and began isolating. If you are asymptomatic, you should notify all of your close contacts within the two days leading up to your positive test.
If you are symptomatic, you should monitor your symptoms. The risk of severe illness from COVID-19 is elevated for some groups — including older adults, people with underlying medical conditions, immunocompromised people, and pregnant or recently pregnant women. If you are at an increased risk for severe illness or have worsening symptoms over time, you should consult a health provider. If you experience emergency warning symptoms – such as difficulty breathing or chest pain – you should seek medical care immediately.
Regardless of when you end isolation, you should wear a mask through day 10. You can shorten this if you have access to rapid antigen testing and test negative twice, 48 hours apart.
The CDC recommends that anyone who comes into close contact with someone who has COVID-19 should wear a high-quality mask as soon as you find out you were exposed, and for 10 full days after exposure. The CDC recommends that you get tested for COVID-19 after five days. If you test positive, isolate immediately. Even if you test negative, you should continue wearing a high-quality mask when around others at home and indoors in public through day 10.
Travel
Travelers should continue to follow CDC guidance for traveling, along with state and local travel return requirements. After a trip, travelers are recommended to self-monitor for COVID-19 symptoms; and isolate and get tested if you develop symptoms.
If you plan to travel internationally, you will need to get a COVID-19 viral test (regardless of vaccination status) before you travel by air into the U.S., and show your negative result to the airline before boarding. The CDC recommends that all travelers returning from international travel get tested for COVID-19 3-5 days after travel.
If you are not fully vaccinated, the CDC also recommends that you get tested for COVID-19 3-5 days after returning from travel (domestic or international), and to stay home and self-quarantine for 7 days after travel. If you don’t get tested, stay home and self-quarantine for 10 days after travel.
Testing, Tracing, and Treatment
Talking Points
- Vaccination and booster shots are the best line of defense against COVID-19. People should be tested if they’re experiencing COVID-19 symptoms or five days after being in close contact with someone who’s tested positive for the virus.
- To find testing options near you, search on the U.S. Health and Human Services testing site web page or visit your local health department’s website. Additionally, most people with health plans are able to get up to eight free tests per month through their insurance.
- If you test positive and have symptoms, you should notify all the people you’ve had close contact with – from two days before your symptoms started to the day you tested positive. If you do not have symptoms, you should notify all of your close contacts within the two days leading up to your positive test.
Testing
Rapid at-home tests are COVID-19 antigen tests that are self-administered with a testing kit. When used correctly, at-home tests are highly reliable and a critical tool in controlling the spread of the virus because of their easy access and fast results.
At-home tests are most effective when there are high amounts of the virus present, such as when you are symptomatic. For this reason, they are less able to detect COVID-19 during the earliest phase of the illness when low amounts of the virus are present. This is why at-home tests sometimes require repeat or serial testing (re-testing in 24-48-hour intervals). Repeat testing reduces the chances of getting a false negative result. If you are infected with COVID-19 but tested negative early in the course of your illness, you may test positive later on when virus levels increase. Multiple negative at-home tests increase the confidence that you are not infected.
If you have COVID-19 symptoms, the CDC recommends taking an at-home test immediately. If you were exposed to someone with COVID-19, you should test at least five days after exposure, even if you don’t have symptoms. If your first rapid at-home test is negative, test again after 24-48 hours.
You can also take an at-home test as a precautionary measure before attending an indoor gathering. Consider testing immediately before attending an indoor event or gathering, especially if you are at risk of severe disease or if you will be around others who are at high risk, such as immunocompromised people or older adults.
Rapid at-home test instructions vary according to the manufacturer, but most testing kits include a collection swab, dropper bottle, and a test card. To ensure test accuracy, carefully read the instructions and closely follow the manufacturer’s directions when collecting the sample, performing the test, and timing the test result.
For instructional videos on how to complete a rapid at-home test by manufacturer, visit the CDC’s webpage on self-testing videos.
How many times you take an at-home test depends on your result. Positive results from an at-home test are considered highly reliable because these tests are very effective at detecting high amounts of the virus. If you receive a negative test result you should test again 24-48 hours after your initial test–especially if you are experiencing symptoms or have been exposed to COVID-19. Multiple negative at-home tests increase the confidence that you are not infected.
What to do if you have a positive result on an at-home test:
- If your at-home test result is positive, this means the virus was detected and you have an infection. Follow the latest CDC guidance on quarantine and isolation. If you are at an increased risk for severe illness or have worsening symptoms over time, you should consult a health care provider.
What to do if you have a negative result on an at-home test:
- If your at-home test result is negative, this means that the virus was not detected, but this doesn’t rule out an infection. You should test again 24-48 hours after your first at-home test especially if you are continuing to experience symptoms.
If you continue to receive negative at-home results, but have symptoms or are otherwise concerned that you could have COVID-19, consider getting a PCR test, which is the most accurate COVID-19 test available. Pharmacies, health centers, diagnostic labs, and health departments offer PCR testing. Check where such testing is available in your community.
COVID-19 tests are often administered at clinics, pharmacies, health centers, and other community testing sites. To find testing options near you, including free testing options, search on the U.S. Health and Human Services testing site web page or visit your local health department’s website.
Rapid at-home tests are also available at many pharmacies, retailers, community sites, and online. Tests typically cost about $10-12 for an individual test without insurance. As of January 15, 2022, these tests are covered by health insurance, meaning that most people with health plans will be able to get up to eight tests per month for free by using their insurance coverage or can get reimbursed for purchasing tests by submitting a claim to their insurer. If you don’t have health insurance, you may be able to access free at-home tests from local community sites.
As of December 15, 2022, the U.S. government relaunched its free delivery program for at-home COVID-19 tests in response to the recent winter surge of COVID-19 cases. Every U.S. household is eligible to order four at-home COVID-19 tests and orders can be placed here.
If you plan on using a rapid at-home test, it is advised to have several tests readily available so that you can test more than once. Since test quantities vary by manufacturer, check how many are included in a kit to ensure you have enough tests on hand. For more information on FDA-authorized COVID-19 at-home tests, expiration dates, and age limits, click here.
There are a few options for viral COVID-19 tests. The main two types of tests are PCR tests and rapid antigen tests:
PCR Test (NAAT is an alternative name)
- Most accurate test currently available
- Typically administered by health providers at a clinic or pharmacy and analyzed in a laboratory
- Results in typically in 24-72 hours
Rapid Antigen Test
- Less accurate than PCR tests
- Results in as little as 15 minutes when taken at home
- Can be self-administered with an at-home testing kit, or taken at a testing site
There’s another kind of test known as an antibody test, which can help indicate whether you have had COVID-19 in the past. Antibody tests are used by scientists to better understand the virus, but they are not used to determine whether you currently have an infection.
See: Quarantine and Isolation.
More FAQs and resources on COVID-19 testing
Antiviral drugs
Paxlovid is an oral antiviral drug used to reduce the risk of hospitalization or death from COVID-19. Paxlovid is authorized for use early in the course of a COVID infection—when illness is mild or moderate—in people aged 12 and older who are at high risk for severe COVID-19. Treatment must begin with 5 days of onset of illness. In clinical trials, Paxlovid reduced the risk of hospitalization or death by 89%. People who are considered high risk include older adults and those with underlying medical conditions such as cancer, diabetes, or heart disease.
Currently, Paxlovid is not available over the counter, but it is available at no cost when prescribed by a healthcare provider or pharmacist.
A small proportion of people who have taken Paxlovid have experienced a return of their symptoms several days after they initially recover and test negative for COVID-19. In clinical trials, one to two percent of participants experienced a recurrence of their symptoms after taking Paxlovid. While medical experts continue to monitor this issue, data from Pfizer and the CDC show that people who experience COVID-19 rebounds have had mild illness. The CDC continues to recommend the antiviral as a treatment for people who test positive and are at high risk for severe COVID-19.
If you experience COVID-19 rebound, you should restart the recommended 5-day isolation period. Currently, there is no evidence that you need to extend your treatment or be treated again with Paxlovid. You should contact a healthcare provider if your symptoms persist or worsen.
Vaccination is the best line of defense against COVID-19 and can prevent infection altogether. While antiviral drugs and other treatments are an important advancement, they are not 100% effective in reducing risk of hospitalization or death from COVID-19, and they are no substitute for getting vaccinated. Getting COVID-19 still causes serious health impacts for some people, especially those who are not vaccinated. Preventing serious infection by getting vaccinated (and boosted, if you’re eligible) and taking other precautions, like masking and distancing — particularly if your COVID-19 Community Level is high — are the best ways to protect your health.
Herd Immunity
Herd immunity is achieved when a virus stops circulating because a large segment of the population has already been infected or has been vaccinated against the virus. Getting vaccinated and getting boosted, when eligible, continues to be the best way to protect yourself against COVID-19.
Contact notification
Notifying contacts helps to control the spread of the virus by quickly informing people who may have been exposed to a person who has tested positive for COVID-19. If you contract COVID-19 or are exposed to someone who has tested positive, you can protect other people from getting sick by notifying your close contacts (anyone who has been within six feet of you for at least 15 minutes).
If you test positive for COVID-19 and have had symptoms, you should notify all the people you have had close contact with, starting from two days before your symptoms started up until you tested positive. If you don’t have symptoms, you should notify anyone who you were in close contact with in the two days before you got your positive test.
COVID-19 + the flu shot
Yes. The CDC recommends that everyone 6 months and older get a flu vaccine every season, which occurs in the U.S. in the fall and winter. The best time to get your flu shot is in September or October before the flu is spreading in your community.
Based on CDC guidance, the COVID-19 vaccines can be given the same day as other vaccines, including the flu vaccine. Some people choose to get each shot in a different limb to minimize possible discomfort. Ask your health provider if you have any questions about getting either or both vaccines.
Trust and Uncertainty
Trust
Public health officials are trained and experienced in responding to infectious disease outbreaks and life-threatening emergencies. They work closely with scientists and researchers to translate the latest findings into action with the express goal of keeping people as safe and healthy as possible.
It can be frustrating when guidance changes. It’s the job of public health officials to tell you what they know, when they know it, and guidance regarding COVID-19 has evolved as our understanding of the virus itself has improved and evolved.
Public health officials and scientists are continuing to learn about how the virus spreads, how it affects different people, and how best to control it. As scientists discover new information about COVID-19, public health officials work to provide accurate and timely guidance.
Pandemic fatigue
Understandably, people are asking when the pandemic will end or if the pandemic is over. The following tips and messaging can help you communicate about the state of the pandemic and the continuing need for precautions.
- Emphasize the progress we’ve made: We have come a long way in combating COVID-19, and we are on the right track. Case numbers, hospitalizations, and deaths are on the decline, and we have effective tools to stay healthy. Our progress continues with the release of new vaccines and boosters.
- Explain that the threat remains: Though we have come far, COVID-19 continues to be a serious threat in some communities, with the U.S. still averaging hundreds of deaths per day. We must continue to take the public health measures we know work to protect people, especially those who are at highest risk of severe disease.
- Emphasize public health recommendations: We know the most effective ways to protect ourselves from COVID-19—getting vaccinated and boosted, testing when exposed or sick, and monitoring COVID-19 Community Level. Taking appropriate precautions will keep us on the right track by reducing the spread of COVID-19 and protecting against serious illness.
- Recognize uncertainty: Scientists continue to monitor COVID-19, tracking new variants and community spread. It’s likely new variants will continue to emerge, and there may be a fall or winter surge. Staying vigilant and taking up-to-date public health precautions is the best way to protect the progress we’ve made.
- Underscore the role of public health: Public health departments and guidance are here not only to keep communities safe and informed in an emergency, but also to advance health and well-being year-round. Public health measures that keep communities safe from COVID-19 will continue to be present—just like public health measures dealing with the flu, mental health, air quality, and more.
Many Americans are tired and frustrated, but public health measures are not the enemy — they are the roadmap for a faster and more sustainable recovery. The pandemic has posed so many hardships, from the loss of loved ones, to job loss, to depression and loneliness, to parenting in the context of virtual schooling. However, COVID-19 still represents a real risk to the health of our communities and our economy.
Many communities have made tremendous progress in protecting community members, but vaccination and booster rates are still lagging in many communities – and infections continue to rise in some places.
We’re all looking forward to a time when we can do all the things we love safely, and the best way to get there is by getting vaccinated and following local guidelines.
Data and reporting
The CDC COVID-19 Community Level is a measure that takes into consideration COVID-19 cases, hospitalizations, and hospital capacity within a community. When the level is higher, more prevention measures, like masking, are recommended to keep people healthy and limit strain on the local healthcare system.
CDC’s masking recommendations based on COVID-19 community level are:
- Low: Mask use is based on personal preference and risk assessment.
- Medium: People who are at high risk for severe health impacts if infected with COVID-19, or who regularly interact with someone at high risk, should strongly consider wearing a mask in indoor public settings for additional protection from COVID-19.
- High: People should wear masks in indoor public settings, including in schools and workplaces.
There are also some situations where people should wear a mask, regardless of Community Level—such as if they have symptoms, have tested positive for COVID-19, or have been exposed to COVID-19. (See Quarantine and Isolation).
Depending on where you live, state or local elected officials typically have the authority to create or lift mask requirements and issue mask recommendations. As respiratory illnesses are spiking in many parts of the country, and based on CDC’s COVID-19 Community Level framework, some state and local officials are revisiting their indoor mask guidance. While the COVID-19 Community Level doesn’t currently take into account flu or RSV levels, data show that masks can also be effective in reducing the transmission of flu and RSV.
Questions that may help you make a decision about whether to wear a mask include:
- What is your COVID-19 Community Level?
- What health risks do you and your family members have? For example, are you or anyone in your family an older adult or have an underlying health condition, such as diabetes or heart disease?
- Do you have young children in your household who are not yet eligible to be vaccinated?
- Are you up to date on your vaccinations (fully vaccinated and boosted if eligible)?
- Are other respiratory illnesses circulating at high levels in your community?
Regardless of Community Level or whether your state, county, or city requires masks, you may decide that wearing a mask is the right decision for you.
Hospitals, healthcare providers, and laboratories track COVID-19 cases and report COVID-19 case information to public health departments, which report detailed data to the CDC. The CDC makes this data publicly available and reports national COVID-19 data to the World Health Organization, as required under international health regulations. Accurately tracking the spread of COVID-19 helps federal, state, and local decision-makers allocate critical emergency response funding and develop public health guidance.
COVID-19 remains a serious threat to public health, and there is evidence to support the current case count. In fact, experts agree that the number of COVID cases and deaths are probably undercounted because not everyone with COVID will have been tested and diagnosed.
The CDC’s data report also helps scientists and medical experts evaluate trends to identity groups most at risk. For example, data show that underlying conditions like diabetes and heart disease greatly increases a person’s risk for life-threatening consequences from the infection. The high rate of chronic illness in the U.S. (6 in 10 adults have a chronic disease) has contributed to the high number of COVID-19 deaths, but it is important to remember that people with pre-existing conditions would likely have lived years longer if they had not been infected with COVID-19. For that reason, even with an underlying condition, the cause of these deaths is COVID-19.
Emergency Declarations
In January 2023, the Biden administration announced it planned to end both the COVID-19 public health emergency (PHE) and the national emergency declarations on May 11, 2023. The national emergency declaration on COVID-19 ended earlier than announced, on April 10, 2023, and the public health emergency (PHE) declaration is still set to expire on May 11, 2023. The administration has been communicating with agencies and departments about winding down any COVID-19-related measures that will end when the declarations expire. Governors in all 50 states have also issued state emergency declarations related to COVID-19, which are separate from the national emergency and PHE.
End of the PHE
Under U.S. law, the president can declare a state of emergency during a crisis. While the state of emergency is in effect, the executive branch has “emergency powers” to address the crisis. When the state of emergency ends, those powers are lifted, and policies that the president has enacted using emergency powers expire. This is separate from an emergency declaration issued by a governor at the state level.
No. COVID-19 cases are down sharply, but the end of the emergency declarations does not mean the virus is no longer a threat. The virus remains a leading cause of death in the United States, with about 250 daily deaths on average. Visit CDC’s website and your state and local health departments for information about local infection rates and recommended precautions.
CDC continues to advise that everyone stay up to date on COVID-19 vaccinations, use at-home tests if they’ve been exposed or have symptoms, stay home if they’re sick, and wear a high-quality mask when COVID-19 levels are high. These precautions are the best ways to protect yourself and your loved ones.
The availability, access, and costs of COVID-19 vaccines, including boosters, will not be impacted by the end of the public health emergency since vaccine access, cost, and distribution are determined by the supply of federally purchased vaccines, not the public health emergency. As long as the federal government’s supply of vaccines lasts, COVID-19 vaccines will remain free to all people, regardless of insurance coverage.
Once the federal supply of vaccines is depleted, vaccines will continue to be available and free for most people with private and public insurance.
The end of the public health emergency declaration will impact coverage for COVID-19 testing, including at-home, PCR, and rapid tests.
At-home testing coverage:
- Medicare: People with traditional Medicare coverage will no longer receive free at-home tests.
- Medicaid: People with Medicaid coverage will have at-home tests covered at no cost through September 2024. After that date, COVID-19 at-home testing coverage will vary by state.
- Private insurance: People with private insurance and private Medicare plans (such as Medicare Advantage) will no longer be guaranteed free at-home tests. However, some insurers may continue to choose to cover them at their discretion.
- No insurance: People who are uninsured will continue to pay full price for at-home tests. Those who are uninsured or who cannot afford at-home tests may still be able to find them at a free clinic, community health center, public health department, library, or other local organization.
Looking for more communications resources about COVID-19 at-home tests? Find messaging and sample graphics in PHCC’s toolkit: When to Take an At-Home COVID-19 Test.
PCR and rapid antigen testing coverage:
- Medicare: People with traditional Medicare coverage will continue to receive free PCR and rapid antigen tests administered by a provider, but there may be a copay for the associated doctor’s visit.
- Medicaid: People with Medicaid will continue to receive free PCR and rapid antigen tests through September 2024. After that date, COVID-19 PCR and rapid antigen test coverage will vary by state.
- Private insurance: Coverage for PCR and rapid antigen tests will vary by insurer. People with private insurance and private Medicare plans may be subject to copays, depending on the plan. Some insurers may also begin to limit the number of covered tests or require tests to be done by in-network providers.
- No insurance: People who are uninsured can continue to purchase tests. Those who are uninsured or who cannot afford PCR and rapid antigen tests may still be able to access them at a free clinic or community health center.
With the end of the public health emergency declaration, COVID-19 pharmaceutical treatments purchased by the federal government–such as Paxlovid–will continue to be free to the public, regardless of insurance coverage.
COVID-19 treatments not purchased by the federal government may require a copay:
- Medicare: For people with Medicare, some COVID-19 pharmaceutical treatments may require a copay.
- Medicaid and Children’s Health Insurance Program (CHIP) coverage: People covered by Medicaid and CHIP programs will continue to receive all pharmaceutical treatments at no cost through September 2024. After that date, these treatments will continue to be covered, but states may set limits on usage and may impose a copay on some COVID-19 treatments.
- Private insurance: Coverage for COVID-19 treatment will continue to vary by private insurer. Most people with private insurance coverage will continue to incur cost-sharing for COVID-19 treatments, with the exception of treatments that are currently free to everyone, such as Paxlovid.
- No insurance: People who are uninsured will continue to pay out of pocket for COVID-19 treatments, except for federally-funded treatments like Paxlovid, which are free for everyone. People may continue to find low- and no-cost options at community health centers.
Under U.S. law, the president can declare a national emergency during a crisis. This allows the president to access previously restricted measures, specialized laws, and funding. Although there are nuanced policy differences between the two emergency declarations, the end of the national emergency declaration will limit executive powers granted under the order. The end of the public health emergency will more directly affect the measures, laws, and funding that were made available to combat COVID-19.
Vaccines
Talking Points
Some people and organizations who oppose vaccines continue to share false information intended to create doubt about the safety of COVID-19 vaccines, and this is likely to continue in the months ahead. The best way to counter false and misleading information is by continuing to share science-based facts: research shows that the vaccines have saved tens of millions of lives, are safe, and continue to be effective at preventing severe illness from COVID-19. Instead of trying to respond to specific allegations or falsehoods, pivot to sharing what has been researched and proven.
- COVID-19 vaccines save lives. COVID-19 vaccines saved about 20 million lives worldwide in the first year they were available, based on a scientific model that used country-level data across the globe.
- Vaccines are safe. COVID-19 vaccines are the most tested and monitored vaccines in U.S. history. Hundreds of millions of people have safely received a COVID-19 vaccine to date.
- COVID-19 vaccines prevent serious illness. Vaccines safeguard against severe illness, hospitalization, and death. In fact, for adults who received the updated bivalent booster, the risk of visiting an emergency room or being hospitalized was reduced by 50 percent.
- Adverse reactions to COVID-19 vaccines are rare and less severe than infection. Based on more than two years of experience with the vaccines, including ongoing monitoring of side effects, the risk of having an adverse reaction to the vaccine is extremely low – much lower than the risk of serious illness if infected by the virus.
Additional Resources
The following messages can help you answer common questions about the COVID-19 vaccines. For more messaging guidance and vaccine communications resources, see below:
- PHCC Messaging Resources
- Changing the COVID Conversation: polling results and tested messaging produced by the de Beaumont Foundation
- Vaccine Resource Hub: free resources to support individuals and organizations working to increase adult immunization across all communities, especially those experiencing racial and ethnic disparities (Partnership for Vaccine Equity, CDC, and CDC Foundation)
For more information about the vaccines and CDC recommendations, visit the CDC’s Clinical Resources for Each COVID-19 Vaccine.
Vaccine recommendations
On April 19, 2023 the CDC updated its COVID-19 vaccine recommendations to simplify guidance and allow people at higher risk for severe COVID-19 to get an additional vaccine dose. The CDC’s updated guidance followed FDA’s regulatory action the day prior, which authorized the additional vaccine doses for older adults and immunocompromised people.
If you are 65 or older or immunocompromised, you can now get an additional updated (bivalent Pfizer/Moderna) vaccine dose at least four months after your initial bivalent dose. If you’re in this group and have questions about getting an additional COVID-19 vaccine dose, you should consult your healthcare provider.
- Why did the CDC make this recommendation? Older adults and people with compromised immune systems are at higher risk for severe COVID-19, and data show that the effectiveness of COVID-19 vaccines wanes over time. An additional dose of the updated vaccine offers this group extra protection from getting seriously ill with COVID-19.
The CDC continues to recommend that everyone ages 6 years and older get an updated (bivalent) booster dose. You’re up to date on COVID-19 vaccines if you already received an updated bivalent dose since they became available in fall 2022; you’re not currently eligible for another dose unless you’re 65 and older or immunocompromised.
The CDC continues to recommend multi-dose series for young children (as young as 6 months), and these recommendations vary by age, vaccine, and which COVID-19 vaccines they previously received. Visit the CDC’s website for details about vaccine recommendations for young children. Consult with your child’s healthcare provider if you have questions about what vaccines they are eligible for and if it’s time for a booster.
On April 19, the CDC also updated its guidance to no longer recommend the use of monovalent (original) COVID-19 mRNA vaccines, which only protect against the original strain of the virus. Pfizer and Moderna’s updated bivalent vaccine–which protect against the original strain as well as the BA.4 and BA.5 subvariants of the Omicron variant–will be used as the primary series for people who aren’t yet vaccinated.
Summary of the latest COVID-19 vaccine recommendations:
- What has changed:
- Adults age 65 and older and immunocompromised people can get an additional COVID-19 vaccine dose, at least four months after their initial updated (bivalent) vaccine dose.
- Monovalent (original) COVID-19 mRNA vaccines will no longer be recommended for use in the U.S.
- What has not changed:
- CDC continues to recommend that everyone ages 6 years and older receive an updated (bivalent) mRNA COVID-19 vaccine. Individuals ages 6 years and older who have already received an updated mRNA vaccine do not need to take any action unless they are 65 years or older or immunocompromised.
- For young children, multiple doses continue to be recommended and will vary by age, vaccine, and which vaccines were previously received.
Booster doses
The CDC recommends that everyone who is eligible stay up-to-date on vaccinations by getting an updated booster dose at least 2 months after their last COVID-19 shot—either since their last booster dose, or since completing their primary series. Pfizer’s and Moderna’s updated vaccines are available for individuals as young as 6 months. The CDC expanded the use to the youngest group of children (age 6 months to 5 years) on December 9, 2022.
These new boosters contain an updated bivalent formula that both boosts immunity against the original coronavirus strain and also protects against the newer Omicron variants that account for most of the current cases. Updated boosters are intended to provide optimal protection against the virus and address waning vaccine effectiveness over time.
Eligible individuals can get either the Pfizer or Moderna updated booster, regardless of whether their primary series or most recent dose was with Pfizer, Moderna, Novavax, or the Johnson & Johnson vaccine. As per the CDC’s recommendations, the new bivalent booster replaces the existing monovalent vaccine booster, therefore that vaccine will no longer be authorized for use as booster doses.
For children age 6 months to 5 years who get the Pfizer primary series, the updated bivalent vaccine will be used as the third dose in the series, rather than as a separate booster.
Novavax Booster: The Novavax vaccine is authorized as a first booster dose for adults, at least 6 months after completing primary vaccination with any authorized COVID-19 vaccine. Adults age 18 and older may choose to receive a Novavax booster instead of an updated Pfizer or Moderna booster if they are allergic to mRNA vaccines or they are otherwise inaccessible.
Yes, the CDC recommends that everyone age 5 and up should get an updated COVID-19 booster this fall to stay up-to-date on vaccinations. The same is true for people who completed their primary series or received one or two boosters: they should get an updated booster dose at least two months after their last shot.
For maximum effectiveness of the updated booster dose, individuals who recently had COVID-19 may consider delaying any COVID-19 vaccination, including the updated booster dose, by 3 months from the start of their symptoms or positive test.
No. The updated bivalent formula is in use only for COVID-19 booster doses, and not for initial vaccination. The best way to protect yourself from getting severely ill from COVID-19 is to get vaccinated. The CDC recommends that currently unvaccinated people get their primary series (the initial two doses of either the Pfizer, Moderna, or Novavax vaccines, or one dose of the Johnson & Johnson vaccine), and then wait at least two months to get the updated Pfizer or Moderna booster dose. Adults age 18 and older also have the option to receive a Novavax booster instead of an updated Pfizer or Moderna booster if they are unable to receive mRNA vaccines and haven’t previously received any booster dose.
On December 9, 2022 the CDC expanded the use of Pfizer and Moderna’s updated (bivalent) COVID-19 vaccine for children as young as 6 months.
- Pfizer: For children age 6 months to 5 years who get the Pfizer primary series, the updated bivalent vaccine will be used as the third dose in the series, rather than as a separate booster. Children and teens age 5 and up should get the updated booster at least 2 months after they finish their 2-dose primary series.
- Moderna: Children and teens age 6 months and up should get the updated Moderna booster at least 2 months after they finish their 2-dose primary series.
For more information about the vaccine and booster dose schedule, see: Pediatric Vaccines.
Booster doses are common for many vaccines, and over time, booster doses may need to be updated to provide optimal protection against new variants of the virus. The scientists and medical experts who developed the COVID-19 vaccines continue to watch for waning immunity, how well the vaccines protect against new mutations of the virus, and how that data differ across age groups and risk factors.
To date, booster doses have worked well in extending the protection of the vaccine against serious illness, but have been somewhat less effective in boosting immunity against new variants of COVID-19 compared to the original strain. The updated booster dose formula is designed to protect against original strains of the virus, as well as Omicron variants that account for the majority of current new infections.
The latest CDC recommendations on booster doses help to ensure more people across the U.S. are better protected against COVID-19. The best way to protect yourself from COVID-19 is to get vaccinated and boosted if eligible. Vaccination and boosting is particularly important for individuals more at risk for severe COVID-19, such as older people and those with underlying medical conditions.
Yes. Eligible individuals can get either the Pfizer or Moderna updated booster, regardless of whether their primary series or most recent dose was with Pfizer, Moderna, Novavax, or the Johnson & Johnson vaccine. The Novavax vaccine is also authorized as a first booster dose for adults who are unable to get mRNA vaccines, at least 6 months after completing primary vaccination with any authorized COVID-19 vaccine.
A booster dose is given after a complete vaccine series to provide additional protection against a vaccine’s effectiveness has decreased over time, while an additional dose is given to people with compromised immune systems to improve their response to the initial vaccine series.
People with compromised immune systems may have a reduced ability to respond to vaccines, and having a weakened immune system can increase the risk of becoming severely ill from COVID-19. The CDC recommends that immunocompromised people who received the Pfizer or Moderna vaccine get an additional dose at least 28 days after their second shot. Data show that an additional dose of the Pfizer or Moderna vaccines helps to increase protection for this group.
Patients who are immunocompromised should consult with their health care provider to discuss additional precautions and any questions they have about protecting themselves from COVID-19.
Development, safety, and effectiveness
On January 13, the Centers for Disease Control and Prevention (CDC) announced that a vaccine safety monitoring system called the Vaccine Safety Datalink picked up a signal possibly linking Pfizer’s COVID-19 bivalent vaccine with an increased risk of stroke in people 65 and older. Here’s what you need to know:
- What’s a safety signal and what does it mean? A “safety signal” occurs when vaccine monitoring systems pick up on an adverse medical event after vaccination at a rate higher than statistically expected. When a system “signals” a possible adverse event, researchers review other monitoring systems to check if other data are signaling the same risk. The Vaccine Safety Datalink, a collaborative database involving the CDC and healthcare organizations, includes electronic health records on 12 million people, and it is one of several independent vaccine safety monitoring systems. To date, no such possible risk of stroke among people age 65 and older has been detected by these other monitoring systems.
- After extensive review of the latest vaccine safety data, federal health officials have said it’s very unlikely that there’s a true clinical risk of stroke associated with Pfizer’s COVID-19 booster. After the possible risk was detected in the Vaccine Safety Datalink, no other systems independently monitoring COVID-19 vaccine safety have observed any correlation between Pfizer’s updated bivalent vaccine and an increased risk of stroke. This safety signal has not been seen with Moderna’s bivalent COVID-19 vaccine.
- The safety system that monitors COVID-19 vaccine safety is the most extensive in U.S. history. According to safety experts, safety signals occur frequently, which is a sign that the safety system monitoring COVID-19 vaccines is effective and sensitive enough to detect potential concerns and safety risks. The CDC will continue to monitor vaccine safety systems for any updates.
- The COVID-19 vaccines and updated boosters are safe. Getting vaccinated and boosted remains our best defense against serious illness and hospitalization due to COVID-19. The CDC continues to recommend everyone age 6 months and older stay up to date with COVID-19 vaccination, including those who are eligible for an updated bivalent booster. As the virus continues to evolve and new variants emerge, the data consistently show that COVID-19 vaccines have saved tens of millions of lives, are safe, and continue to be effective at preventing severe illness.
For more messaging guidance on COVID-19 vaccine safety, see our Talking Points on Vaccine Safety and Effectiveness.
There are a few reasons why people who are vaccinated continue to get COVID-19. For one, no vaccine is 100% effective at preventing infection, and highly contagious variants have led to breakthrough infections among vaccinated people. Also, the level of protection from the vaccine decreases over time, leading to less protection against the virus. Ultimately, as the total number of vaccinated people increases, the pool of unvaccinated people gets smaller—that means proportionally, more cases will be among the vaccinated.
While vaccines are developed in part to prevent infection from disease, the main goal of vaccines is to prevent severe illness or death. The COVID-19 vaccines continue to be highly effective in reducing risk of severe disease, hospitalization, and death, and can provide sustained protection when you receive a booster dose. When COVID-19 cases rise, breakthrough infections among vaccinated individuals are significantly more likely to be mild cases, while unvaccinated people are more likely to become severely ill or require hospitalization. CDC data show that through December 25, 2021, the risk of being hospitalized with COVID-19 in the U.S. was 16 times greater for unvaccinated adults than fully vaccinated adults.
The COVID-19 vaccines have received the most intense safety monitoring in U.S. history, which has allowed public health officials to make science-based recommendations that keep people safe.
All COVID-19 vaccines have been rigorously tested and reviewed. The vaccine’s clinical trials three-phase process was detailed and thorough, and no shortcuts were taken. More than 150,000 people participated in U.S. clinical trials of the vaccines, and now, hundreds of millions of vaccine doses in the U.S. have been safely administered. Data from trial will continue to be collected for two years after each vaccine is first administered to ensure that they are safe for the long term. As with all vaccines, there will be ongoing monitoring for adverse events among people who are vaccinated into the future.
It may seem like the vaccines were developed quickly, but the process included rigorous safety reviews required for all new vaccines. The urgency of the pandemic created greater access to research funding, reduced bureaucratic obstacles, and encouraged unparalleled levels of government and industry cooperation. With these supports in place, scientists built upon previous work on coronavirus vaccines and on mRNA vaccine technology to develop these new vaccines quickly and effectively.
In general, you are considered fully vaccinated for COVID-19 two weeks after you have received the second dose in a two-dose series (Pfizer-BioNTech or Moderna) or two weeks after you have received a single-dose vaccine (Johnson & Johnson).
As the science and the virus evolve, so does our understanding of what it means to be fully vaccinated. Scientists and medical experts continue to closely watch for signs of waning vaccine immunity over time, how well the vaccines protect against new variants of the virus, and how that data differs across the population.
While additional or booster doses are recommended for some people, the CDC definition of what it means to be “fully vaccinated” has not changed at this time. More messaging guidance about booster doses can be found here.
The CDC recommends all people age 5 and older get vaccinated against COVID-19, including people who were previously infected with the virus. Data show that immunity in people who have been infected with COVID-19 wanes over time, and scientists continue to study this. New data show that COVID-19 vaccination can provide a higher, more robust, and more consistent level of immunity to protect people from COVID-19 than antibodies from infection alone.
COVID-19 vaccination is effective in preventing reinfection in people who previously had COVID-19. One study, for example, showed that among people hospitalized with COVID-19, those who were previously infected with COVID-19 were 5 times more likely to get COVID-19 again if they were unvaccinated than people who were fully vaccinated. For that reason, even if you have already had COVID-19, vaccination is an important step to protect yourself and those around you.
While COVID-19 vaccines are highly effective, no vaccine provides 100% immunity. Because this is a new virus, scientists and medical experts continue to monitor how long immunity lasts, whether some groups may need additional doses, and how well the vaccines protect against new variants of the virus.
Data continue to show that the COVID-19 vaccines are extremely effective in protecting fully vaccinated people from catching and spreading the virus, including the Delta variant, and scientists continue to monitor vaccine efficacy for new variants. A small percentage of vaccinated people experience breakthrough cases, but they are much more likely to have milder symptoms than unvaccinated people who get COVID-19.
Unvaccinated people continue to account for the vast majority of severe cases, hospitalizations, and deaths from COVID-19. CDC data show that in August 2021, the risk of dying from COVID-19 in the U.S. was more than 11 times greater for unvaccinated people than for fully vaccinated people.
The risk of severe illness from COVID-19 is elevated for some groups — including older adults, people with underlying medical conditions, immunocompromised people, and pregnant or recently pregnant women. If you have questions about your risk of COVID-19, how to protect yourself, or the vaccines, speak to your health care provider.
The threat of COVID-19 is real and urgent, and getting vaccinated is the best way to protect yourself. Side effects to the COVID-19 vaccines are typically mild and subside in one to two days — like soreness in the arm, fatigue, headaches, or a slight fever.
The risk of having a serious adverse reaction to the COVID-19 vaccine is very low — far lower than the risk of contracting COVID-19. The CDC and FDA are closely monitoring vaccine outcomes to ensure safety.
If you have a question about the vaccines, talk with your healthcare provider.
Pregnancy and fertility
Yes. Based on data on the safety of COVID-19 vaccines during pregnancy, CDC recommends COVID-19 vaccination for all people who are pregnant, breastfeeding, or trying to get pregnant now or in the future. Data show that pregnant and recently pregnant people are more likely than non-pregnant people to get severely ill if they are infected with COVID-19, and the highly contagious Delta and Omicron variants makes it even more important for eligible people to get vaccinated.
In addition, the American College of Obstetricians and Gynecologists and other leading maternal health and public health organizations are “strongly urging” all pregnant individuals, and anyone planning to become pregnant, to get vaccinated against COVID-19.
No. There is no evidence to show that getting a vaccine increases the risk of miscarriage.
There has been extensive safety monitoring of the COVID-19 vaccines, including analysis of vaccination during pregnancy. Specifically, studies show that the rate of miscarriage in the first 20 weeks of pregnancy in the general population is about 11-16%, and an analysis of safety monitoring data of people who received an mRNA COVID-19 vaccine showed a similar rate of 13%.In other words, being vaccinated with one of the currently available COVID-19 vaccines does not increase miscarriage risk; rather, it protects against the higher risk of serious illness if you are pregnant and become infected with the virus.
Antibodies made after a pregnant person received an mRNA COVID-19 vaccine have been found in umbilical cord blood, which means that COVID-19 vaccination during pregnancy might help protect babies against COVID-19. Additionally, recent reports have shown that breastfeeding people who have received mRNA COVID-19 vaccines have antibodies in their breast milk, which could help protect their babies. In both of these cases, more data are needed to determine the level of protection these antibodies may provide to the baby and how long that protection would last.
FDA approval
Emergency use authorization (EUA) allows the FDA to authorize the use of yet to be approved drugs, or unapproved uses of approved drugs, for life-threatening conditions when there are no other adequate, approved, and available options and other conditions are met. In the case of COVID-19, the FDA issued EUAs for the Pfizer, Moderna, and Johnson & Johnson vaccines, and has now issued full approval for the Pfizer and Moderna COVID-19 vaccines.
In an emergency when lives are at risk, like a pandemic, it may not be possible to have all the evidence that the FDA would usually have before approving a vaccine or drug. If there’s evidence that strongly suggests that patients have benefited from a treatment, the agency can issue an EUA to make it available. For the COVID-19 vaccines, FDA required two months of safety and efficacy data before the EUA was granted. That included clinical trials with tens of thousands of people and rigorous testing and review, and all the vaccines continue to be closely monitored. Compared to emergency use authorization, FDA approval of vaccines requires even more data on safety, manufacturing, and effectiveness over longer periods of time and includes real-world data.
The CDC recommends that most people get a Pfizer or Moderna COVID-19 vaccine over the Johnson & Johnson vaccine, but there is no preference between the Pfizer or Moderna vaccine. These two vaccines are widely available, and for most people, getting the first available COVID vaccine is the best thing you can do to safeguard your health. If you have additional questions about which vaccine is best for you, check with your doctor.
The Pfizer and Moderna COVID-19 vaccines have both received full FDA approval. Before receiving EUA, all three vaccines underwent rigorous testing and review—including clinical trials with tens of thousands of people, and the FDA evaluated comprehensive data on their safety and effectiveness. All three showed excellent safety and effectiveness profiles, and now, hundreds of millions of vaccine doses in the U.S. and billions worldwide have been safely administered. The Johnson & Johnson vaccines will continue to be safely administered through emergency use authorization as the FDA reviews data about their real-world use.
Johnson & Johnson vaccine
On May 5, the FDA updated its authorization of the Johnson & Johnson COVID-19 vaccine, limiting its use to adults 18 and older in certain cases where other vaccines are not appropriate. This means that most people should receive either the Moderna or Pfizer vaccine, and should only get the Johnson & Johnson vaccine if other vaccines are not accessible or clinically appropriate (such as people who have had an anaphylactic reaction to a different COVID-19 vaccine) or in cases where individuals who elect to get a Johnson & Johnson vaccine would otherwise not receive a COVID-19 vaccine.
This update was based on the latest data about the risk of developing a rare blood clotting disorder after receiving the Johnson & Johnson vaccine. While the risk of a serious adverse reaction to the Johnson & Johnson vaccine is very low and far lower than the risks for COVID-19 infection, it is higher than for the Moderna and Pfizer vaccines, which is why the CDC recommends that most people should get a Moderna or Pfizer vaccine. The identification of any possible risks, like the risks associated with the Johnson & Johnson vaccine, is a sign that the nation’s safety monitoring system for COVID-19 vaccines is working.
People who are not yet vaccinated, along with those who received the Johnson & Johnson vaccine and are now eligible for a booster shot, should get a Pfizer or Moderna vaccine. These two vaccines are widely available, but Johnson & Johnson vaccines are still on the market for cases where other vaccines are not accessible or clinically appropriate.
Data show an overall rate of 3.23 cases of the blood clotting disorder per 1 million Johnson & Johnson doses administered, and the onset of symptoms for the individuals typically occurred one to two weeks after getting the vaccine. Risk varies by age and gender, but data show that the risk of developing a rare blood clotting disorder after receiving the Johnson & Johnson vaccine is highest for women age 30-49. Most people should get a Pfizer or Moderna COVID-19 vaccine, with the use of Johnson & Johnson limited to adults age 18 and older in instances where other vaccines are not accessible or clinically inappropriate.
Rare adverse events associated with the Johnson & Johnson vaccine typically present within days or weeks following the shot. The risk of having an adverse reaction to the vaccine is very low, and even lower as time passes.
Data show that symptoms of a blood clotting disorder (severe headache or abdominal pain, shortness of breath, neurological symptoms, leg swelling) typically developed about nine days after vaccination, and in no cases did the onset of symptoms occur after 18 days. If you have questions or concerns, consult your doctor.
Novavax vaccine
On July 19, 2022, the CDC updated its COVID-19 vaccine recommendations, approving the Novavax vaccine for emergency use authorization for adults 18 years and older. Novavax is a two-dose, protein-based COVID-19 vaccine that is currently being used in more than 40 countries and has been authorized by the European Union and the World Health Organization.
Novavax is a two-dose, protein-based COVID-19 vaccine authorized for use in adults 18 and older. It is the fourth COVID-19 vaccine available in the U.S., in addition to Pfizer, Moderna, and Johnson & Johnson. As a protein-based vaccine, Novavax is another option for people who are allergic to one of the components in a mRNA or viral-vector vaccine.
The Novavax vaccine is also authorized as a first booster dose for adults, at least 6 months after completing primary vaccination with any authorized COVID-19 vaccine.
The Novavax vaccine is created using more traditional protein-based technology for vaccine development, unlike the other vaccines currently available in the United States (the Pfizer and Moderna mRNA vaccines and viral-vector Johnson & Johnson vaccine).
The Novavax vaccine uses a combination of purified coronavirus spike proteins and an immune-boosting stimulant called an adjuvant (common in many vaccines) to strengthen the body’s immune response against COVID-19. Novavax has already been authorized in more than 40 countries and has been granted emergency authorization from the European Union and the World Health Organization.
Data from the Novavax clinical trial also show that Novavax is more than 90% effective at protecting against symptomatic COVID-19, and 100% effective against severe illness and death. Common side effects include soreness at the injection site, fatigue, muscle pain, and headaches.
In terms of serious adverse reactions to Novavax, data show there were six cases of myocarditis from a clinical trial of about 30,000 people, primarily among young men. The cases of myocarditis in the clinical trial were treatable, and all six individuals recovered well. The risk of developing myocarditis from COVID-19 remains higher than the risk of developing it from a COVID-19 vaccine, including Novavax.
Vaccine mandates
Vaccines are a safe and effective way to stop the spread of preventable diseases and decrease rates of infection, hospitalization, and death. The CDC recommends all people age 5 and older get vaccinated against COVID-19, and get a booster shot when eligible. Schools or employers may require vaccinations for attendance or employment, and requirements vary by state and employer.
While vaccine requirements vary by state, location, business, and school, the science remains the same: the best way to protect yourself from getting COVID-19 is to get vaccinated, and boosted when eligible.
Schools: All states have vaccination requirements for children attending school and childcare facilities. Vaccination requirements help safeguard children by making sure they are protected when they begin school, where there is a higher potential for transmission of some diseases. To learn more about vaccine requirements by state, visit the CDC’s SchoolVaxView Requirements Database.
Employers: On January 13, 2022, the Supreme Court ruled that the federal government cannot enforce a vaccine mandate for large businesses. This does not mean that private employers are blocked from creating vaccine mandates. Vaccines remain the safest and most effective way to protect against COVID-19, and employers are still legally able to mandate COVID-19 vaccinations for employees.
Other Vaccine Requirements:
- Health care workers at facilities that receive Medicare and Medicaid funding are required to get a COVID-19 vaccine.
- Businesses may also require patrons to show proof of vaccination for entry, and these requirements vary on the state and local level.
Variants
Talking Points
- Variants emerge as a result of naturally occurring mutations in viruses. For example, the flu virus changes often, which is why doctors recommend a flu shot each year.
- Scientists monitor all COVID-19 variants but may classify certain ones, like Omicron and Delta, as “variants of concern.” Scientists monitor these variants carefully to learn if they spread more easily, cause more severe cases than other variants, or evade vaccine protection.
- As long as COVID-19 spreads, mutations and new variants are expected to occur, and the best way to prevent the spread of COVID-19, including its variants, is to get vaccinated and boosted. Being vaccinated decreases the likelihood you will get sick and makes it less likely you will need hospitalization or die if you get infected. Increased vaccination rates around the world will decrease the likelihood that the coronavirus will mutate into other dangerous variants.
New COVID-19 variants
Variants emerge as a result of naturally occurring mutations in viruses. For example, the flu virus changes often, which is why doctors recommend a new flu vaccine each year.
Scientists monitor all COVID-19 variants but may classify certain ones, like Omicron and Delta, as “variants of concern.” Scientists monitor these variants carefully to learn if they spread more easily, cause more severe cases than other variants, or evade vaccine protection.
As long as COVID-19 spreads, mutations and new variants are expected to occur, the best way to prevent the spread of COVID-19, including its variants, is to get vaccinated and boosted. Being vaccinated decreases the likelihood you will get sick, and makes it less likely you will need hospitalization or die if you get infected. Increased vaccination rates around the world will decrease the likelihood that the coronavirus will mutate into other dangerous variants.
Omicron
What we know about the Omicron variant continues to evolve, but preliminary data do not suggest that the Omicron variant is causing more severe illness in children. However, the Omicron variant is spreading rapidly, leading to record-breaking case counts, including pediatric cases. As the total number of children with COVID-19 increases, hospitalizations are also rising, even if the proportion of hospitalizations remains small. Lower vaccination and booster rates among children compared to adults may also be a factor contributing to increased cases and hospitalizations in children.
The best way to protect children from the virus is to follow the leading COVID-19 prevention strategies. Children age 5 and older should get vaccinated, and adolescents age 12 and older are now eligible to get boosted at least 5 months after their second shot for optimal protection against the virus. Parents and adults can help protect their children by getting all eligible family members vaccinated and boosted if eligible—which will also help protect children under 5 who are currently ineligible to be vaccinated. Children over 2 should also wear a well-fitting mask in indoor public settings or crowded environments, wash their hands, stay home if they are feeling sick, and get tested if they were exposed to the virus or are symptomatic.
Scientists have been studying this question since the variant was first identified. While experts continue to learn more about the Omicron variant, data show that the vaccines continue to be highly effective in reducing risk of severe disease, hospitalization, and death. The latest data show that booster doses significantly increase protection from the Omicron variant. Based on this data, the CDC recommends that everyone age 5 and older get vaccinated, and everyone age 12 and older get boosted when eligible.
Data suggest that the Omicron variant is more contagious than other variants, including the fast-spreading Delta variant. Studies suggest the variant may be less likely to cause severe disease, but Omicron infection continues to lead to hospitalization and deaths, particularly in unvaccinated people and people at risk of severe COVID-19. Any coronavirus infection can be life-threatening, and the best way to prevent the spread of this or any other variant is to get vaccinated, get a booster if you are eligible, and to wear a mask in indoor public settings or in crowded environments.
Emergent Public Health Concerns
Tripledemic
The “tripledemic” is a term that some public health leaders and the news media are using to describe the current spread of three respiratory illnesses: COVID-19, flu (influenza), and RSV (respiratory syncytial virus).
COVID-19, flu, and RSV cases and hospitalizations are spiking in many parts of the country. Each virus can pose a serious health threat, especially for older people and people with underlying health conditions. RSV and flu are also serious concerns for young children.
Most cases of COVID-19, flu, and RSV are mild, but as millions of people are getting sick, the number of people with serious illness is also rising. The “tripledemic” is placing pressure on hospitals and health care facilities, and it is already straining the capacity and resources of many pediatric hospitals.
“Tripledemic” does not have a scientific definition, like “epidemic” or “pandemic.” It is an informal term used to convey the significance of the current spread of COVID-19, flu, and RSV.
There are many precautions that can help you stay healthy and reduce your chances of getting sick with or spreading COVID-19, flu, or RSV. Here are a few of the most important and effective measures:
- Get vaccinated and boosted. You should get a flu shot if you haven’t already this year, and stay up-to-date with COVID-19 vaccinations with an updated booster dose. Everyone ages 6 months and older is eligible to get vaccinated against flu and COVID-19. There is not currently a vaccine to prevent RSV.
- Wear a mask. Wearing a high-quality, well-fitting mask is an effective way to reduce the spread of COVID-19, and data show it also likely reduces the transmission of other respiratory illnesses like RSV and flu. These viruses spread from person to person via respiratory droplets, so properly wearing a high-quality mask helps prevent the spread of the virus to others, and it also helps protect the mask-wearer. The CDC continues to recommend wearing a mask indoors where COVID-19 Community Level is high, though anyone may choose to wear a mask to protect themselves and others, regardless of community level.
- Stay home if you’re sick. If you’re feeling sick, you should stay home and away from others. You should also test for COVID-19. While there isn’t an at-home test for flu or RSV, at-home antigen COVID-19 tests are effective and reliable when used properly.
- Wash your hands. Washing your hands is a simple and important way to prevent the spread of viruses like RSV, flu, and COVID-19. Read more from the CDC about how and when to wash your hands.
- Contact your health care provider. Consult your health care provider if you have questions about testing and treatment, especially if you or your child are at high risk for complications from flu, RSV, or COVID-19. There are effective treatments for both COVID-19 and flu, but both need to be started early in the course of illness to be effective. And your health care provider can help you manage symptoms of RSV if you or your child are sick.
With COVID-19, flu, and RSV cases and hospitalizations spiking in many parts of the country, some public health officials are revisiting mask guidance and are again recommending mask wearing, particularly in indoor public spaces.
Data show that high-quality, well-fitting masks are effective at reducing the transmission of COVID-19. Studies also show that high-quality, well-fitting masks are likely effective at reducing the transmission of flu and RSV. Scientists continue to study the use of masks, including what kinds of masks work best and which viruses can be prevented from spreading by wearing masks.
When making mask recommendations, local public health authorities typically consider transmission rates of COVID-19, flu, and RSV, along with hospitalizations and hospital capacity. The CDC continues to recommend that you should wear a mask indoors if your COVID-19 Community Level is high. If your COVID-19 Community Level is medium, you should consider wearing a mask if you’re at high risk for severe COVID-19.
Regardless of COVID-19 Community Level or current local mask guidance, anyone can wear a mask as an additional precaution to protect themselves and their families from respiratory infections during the holiday season.
Flu
Everyone ages 6 months and older should get a flu vaccine every year.
If you’re at higher risk of developing serious flu complications, flu vaccination is especially important. These groups include:
- Adults 65 and older
- Adults with certain chronic health conditions, such as asthma, heart disease, diabetes, and chronic kidney
- Pregnant people
- Children younger than 5 years, but especially those younger than 2 years old.
No. You should get a flu shot as soon as you can if you’re not yet vaccinated.
Flu season starts in the fall, and most of the time, flu activity peaks between December and February. The CDC recommends that people get vaccinated early in the season, ideally by October 30, but it’s not too late to get critical protection from the flu if you’re not yet vaccinated.
Getting the vaccine reduces your chance of getting sick. It’s possible to catch the flu even if you’re vaccinated, but the vaccine reduces the severity of illness if you do get sick. If you’re vaccinated and still get the flu, you have a lower chance of getting seriously ill or needing hospitalization.
Yes. It is safe to get your flu shot and COVID-19 booster the same day if you are eligible for both. (See: COVID-19 Booster Doses for more information about eligibility.)
The best way to know if you or your child is sick with flu, RSV, or COVID-19 is to get tested for these viruses.
Flu, RSV, and COVID-19 are respiratory illnesses that can have varying degrees of symptoms, from no symptoms to severe symptoms. You cannot tell the difference between these illnesses by symptoms alone because they have some of the same signs and symptoms. Common symptoms between the two viruses include fever, cough, fatigue, runny or stuffy nose, and several others.
You need specific testing to confirm if you are sick with either virus. You can test for COVID-19 at home, while most flu tests and RSV tests are administered by a medical professional. Contact your health care provider if you have questions about testing and treatment, especially if you or your child are at high risk for complications from flu, RSV, or COVID-19.
Monkeypox
On November 28, 2022, WHO announced its recommendation of “mpox” as the new, preferred name for monkeypox disease. WHO issued this recommendation after consultation with global experts, and in response to racist and stigmatizing language online that was observed this year with the expanding outbreak of monkeypox.
CDC and WHO will adopt the term mpox in their communications. According to WHO, both names will be used simultaneously for one year while the name monkeypox is phased out. WHO encourages others to follow these recommendations, to minimize any ongoing negative impact of the current name and from adoption of the new name.
Read more about WHO’s recommendation, rationale, and naming protocol: WHO recommends new name for monkeypox disease
Monkeypox is an illness caused by the monkeypox virus. Common symptoms of monkeypox can include fever, headache, muscle aches, swollen lymph nodes, and a rash that can look like pimples or blisters and may be painful or itchy. The rash may be on the face, the inside of the mouth, hands, feet, chest, genitals, or anus. Symptoms are usually mild or moderate and typically resolve within 2-4 weeks. Monkeypox is rarely fatal.
There is a growing outbreak of monkeypox in the U.S. and globally, and currently cases have primarily been in men who have sex with men. The White House declared monkeypox a national public health emergency on August 4, 2022 and the World Health Organization declared a global health emergency in late July 2022.
Monkeypox spreads through direct skin-to-skin contact with the infection rash, scabs, or body fluids. It can also be spread through respiratory droplets during prolonged, face-to-face contact or during intimate physical contact. Any person, regardless of gender identity or sexual orientation, can acquire and spread monkeypox. Currently, the vast majority of the known monkeypox cases are among men who have sex with men.
Anyone can contract monkeypox but to date the vast majority of the cases have been in men who have sex with men, and the general population is currently at low risk of contracting the infection.
The CDC recommends vaccination for people who have been in close contact with people who have monkeypox. The current supply of the vaccine is limited, and so currently vaccination is prioritized for individuals at high risk. Eligibility for vaccination varies locally, but typically includes groups considered to be at high risk for monkeypox, including:
- People who have been in close physical contact with someone with monkeypox in the past two weeks
- People who have had multiple sexual partners in the past two weeks in an area with known monkeypox cases
- People whose jobs may expose them to monkeypox, including some healthcare or public health workers
The preferred vaccine to protect against monkeypox is Jynneos. There is a limited supply of Jynneos, but more is expected in the coming weeks and months. Guidelines may be expanded to others (at some, but lower risk) as vaccine supply increases). The alternative to Jynneos is the ACAM2000 vaccine, but it is not recommended for people with weakened immune systems and has the potential for more side effects. Contact your local health department for information about vaccine eligibility and testing.
Monkeypox is much less contagious and less likely to cause severe illness or death than COVID-19. The spread of monkeypox is also different than the early stages of the COVID-19 pandemic in a few key ways:
- There is already a vaccine for monkeypox.
- Monkeypox can be treated with available antiviral medicines.
- While COVID-19 passed easily from person to person, monkeypox does not spread as easily between people. Monkeypox transmission typically requires skin-to-skin contact, direct contact with body fluids, or prolonged, close face-to-face contact.