Answers to Tough Questions about Public Health
Children and COVID-19
- COVID-19 is among the top 10 causes of pediatric death in the U.S. While the risk of children and adolescents becoming severely ill or hospitalized is lower than the risk for adults, tens of thousands of children have been hospitalized with COVID-19, and the effects of the virus are unpredictable.
- Vaccination is the best way to protect children from COVID-19. To protect against severe illness, the CDC recommends that all children and adolescents age 6 months and older complete their age-appropriate COVID-19 vaccine series. Children and adolescents are eligible for three vaccines — Moderna, Pfizer-BioNTech, or Novavax.
- COVID-19 vaccines are safe and effective. Before they were authorized for young children, preteens, and teenagers, health experts reviewed safety and effectiveness data from clinical trials involving thousands of children.
The CDC recommends that all children and adolescents, age 6 months and older, complete their age-appropriate COVID-19 vaccine series. This vaccine series will provide the best possible protection against severe illness.
The recommended dose(s) depends on a child’s age, COVID-19 vaccine history, and vaccine type (e.g., Moderna, Pfizer-BioNTech, or Novavax). These recommendations are informed by clinical trials on safety and effectiveness of the vaccines for children age 6 months and older.
Moderna COVID-19 Vaccine Authorization
- Unvaccinated children age 6 months through 4 years: Children in this group should complete a two-dose series as soon as possible.
- Vaccinated children age 6 months through 4 years: Children who have received any number of previous Moderna doses should receive the remaining dose to complete the vaccine series.
- Children age 5 years and older: Children in this group should get one dose of the most recently available Moderna vaccine as soon as possible.
Moderna vaccination timing: In most cases, the first and second doses should be spaced at least four to eight weeks apart. At least two months after completing the primary series, children who have not received the updated Moderna vaccine should receive their third dose.
Pfizer-BioNTech COVID-19 Vaccine Authorization
- Unvaccinated children age 6 months through 4 years: Children in this group should complete a three-dose series as soon as possible.
- Vaccinated children age 6 months through 4 years: Children who have received any number of previous Pfizer-BioNTech doses should receive the remaining dose(s) to complete the vaccine series.
- Children age 5 years and older: Children in this group should get one dose of the most recently available Pfizer-BioNTech vaccine as soon as possible.
Pfizer-BioNTech vaccination timing: In most cases, the first and second doses should be spaced at least three to eight weeks apart. At least two months after the second dose, children should get their third dose to complete their primary COVID-19 vaccine series. Children who have completed their primary series, but have not received the most recently available Pfizer-BioNTech vaccine, should receive their fourth dose at least two months after their third dose.
Novavax COVID-19 Vaccine Authorization
- Unvaccinated adolescents and teens age 12 years and older: Children in this group should complete a two-dose series as soon as possible.
- Vaccinated adolescents and teens age 12 years and older: Children who have received any number of previous vaccine doses should receive one dose of the most recently available Novavax vaccine to complete the vaccine series.
Novavax vaccination timing: If a child has not previously been vaccinated with any COVID-19 vaccine, the first and second Novavax doses should be received three weeks apart. If a child has previously received one or more of the COVID-19 vaccine doses, a single updated Novavax dose should be received at least two months after the last dose.
Recommendations for Children with Compromised Immune Systems
The CDC recommends that children and adolescents age 6 months to 17 years who have moderately or severely compromised immune systems get vaccinated as outlined in the COVID-19 vaccination schedule, according to their age and immune status at the time of dose eligibility. This means that one to three doses may be necessary depending on vaccination history and personal health status. For more information on COVID-19 vaccine recommendations for immunocompromised children and adolescents, follow the CDC’s guidelines here.
COVID-19 is among the top 10 causes of pediatric death in the U.S. 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 serious illness.
The vaccine is the best way to protect children from becoming severely ill or having long-lasting health impacts from COVID-19. While the risk of children and adolescents becoming severely ill or hospitalized is lower than the risk for adults, tens of thousands of children have been hospitalized with COVID-19, and the effects of the virus are unpredictable.
Yes, researchers and medical experts have worked to ensure the vaccine is safe for children and adolescents age 6 months to 17 years old. COVID-19 vaccines have continued to be proven safe and effective for children because of medical expert reviews of the clinical trial data and multi-year monitoring of thousands of vaccinated children.
Health agencies, such as the Food and Drug Administration and Centers for Disease Control and Prevention, will continue to monitor the health data of clinical trial participants for two years after each vaccine is first administered to ensure their safety for the long term. As with all vaccines, these agencies will also continue monitoring the public’s health to ensure vaccine safety and effectiveness.
Yes, it is safe for children and adolescents to get a COVID-19 vaccine and other routine vaccines, including the flu vaccine, during the same visit. The CDC recommends that all children and adolescents remain up-to-date with routine vaccinations, and those age 6 months and older receive the COVID-19 vaccine.
For additional and more personalized information about pediatric vaccine administration options, caregivers should contact their child’s healthcare provider.
Side effects of the COVID-19 vaccines, similar to other routine vaccinations, are typically mild and subside in a few days. Common experiences include soreness and swelling in the injected arm or leg, chills, joint pain, swollen lymph nodes, irritability, loss of appetite, fatigue, headaches, and a mild 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). Data demonstrates a higher risk for such inflammation amongst male children and adolescents. 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 COVID-19 vaccines, myocarditis, or how to protect your children from COVID-19, speak to your healthcare 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.
- Wearing a high-quality, well-fitting mask helps prevent the spread of COVID-19. Alongside vaccination, 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.
- Studies show that high-quality, well-fitting masks can be effective at reducing the transmission of respiratory viruses, such as flu and RSV, when worn consistently and appropriately. 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 a mask.
- You should wear a mask indoors if you’re in an area with a high level of hospital admissions related to COVID-19. 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 or hospitalization, you may 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 KF94s provide the best protection against respiratory viruses.
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 the absence of a high filtration mask, you can improve the protection of your mask by wearing two masks. An example of this could be that you wear a cloth mask over a disposable mask.
- Fit. A mask may be less effective if it is not the right size for you, worn improperly, or taken off frequently. Ensure that your mask is the right size to provide a tight seal on your face. If you have facial hair, you may need a larger mask to ensure that you have a secure fit. 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 at the nose, knotting and tucking ear loops of your mask, or wearing a mask that is secured behind the head instead of secured with ear loops.
- Comfort. Some masks are more protective than others, and some are more comfortable than others. High filtration masks, such as N95s, KN95s, and KF94s are recommended. You can get the best protection against COVID-19 by consistently wearing the most protective mask that fits you well.
When to Wear a Mask
Data show that high-quality, well-fitting masks are effective at reducing the transmission of COVID-19, and that they are likely effective at reducing the transmission of flu and RSV. Health experts 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.
Regardless of the rate of flu, RSV, and COVID-19 hospital admissions or current local mask guidance, anyone can choose to wear a mask as an additional precaution to protect themselves and their families from respiratory infections during high transmission seasons.
Quarantine and isolation
- The most helpful actions you can take to prevent the spread of COVID-19 include wearing a mask if exposed, testing for COVID-19, and isolating if you test positive. Isolation is a key health precaution used to prevent people with confirmed or suspected COVID-19 from spreading the virus to those without COVID-19.
If you are exposed to COVID-19:
- Wear a high-quality mask for 10 days after exposure, especially when indoors or around others at high risk of COVID-19 complications. You should also get tested five full days after exposure.
- If you become sick and believe you have COVID-19, test immediately.
- If you become sick 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 immediately, for at least 5 days after testing positive and wear a mask through day 10 after testing positive.
- 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 no symptoms or mild symptoms and have no fever after 5 days, you can end isolation. You should still wear a high-quality mask through day 10 after testing positive.
- If you are still having symptoms on day five, you should continue isolation until you are fever free for 24 hours and your symptoms improve or resolve.
- People who have severe COVID-19 may be infectious beyond 10 days, and may need to extend isolation for up to 20 days based on healthcare provider guidance.
- If you have a weakened immune system, you should isolate through day 20. The CDC recommends repeat COVID-19 testing and speaking with your healthcare provider before ending isolation.
- If you end isolation but your COVID-19 symptoms recur or worsen, you should restart your isolation period.
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 CDC recommends that people who test positive for COVID-19 should stay home and away from others for at least five days after testing positive, as this is when people are most infectious. You should wear a mask through day 10 to reduce the spread of COVID-19 to other people.
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 before symptoms started 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 higher for some groups — including older adults, people with underlying medical conditions, immunocompromised people, and pregnant or recently pregnant people. 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.
CDC recommendations for ending isolation after testing positive for COVID-19:
- 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), severe illness (you were hospitalized), or you are immunocompromised, you should isolate through day 10 and consult with a healthcare provider about extending or ending isolation.
- If you ended isolation but your COVID-19 symptoms recur or worsen, you should restart your isolation.
Regardless of when you end isolation, you should wear a mask through day 10. You can shorten this if you have access to at-home rapid antigen testing and test negative twice, 48 hours apart.
If you came into close contact with someone who has COVID-19, you 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 five full days after exposure.
If you test positive, you should isolate immediately.
Even if you test negative, you should continue wearing a high-quality mask when indoors and around other people through day 10.
Masking is essential to limit the spread of COVID-19.. If you have a weakened immune system, you should isolate through day 20. The CDC recommends repeat COVID-19 testing and speaking with your healthcare provider before ending isolation.
Before you travel, the CDC recommends that you get up to date with your COVID-19 vaccination schedule for best protection against severe illness or hospitalization.
You can also take other precautions to protect your health and the health of others.
- Test for COVID-19 before leaving, during the trip, and once you return. Testing is especially important before visiting people who are at high risk of severe illness from a COVID-19 infection.
- If you test positive, stay home and isolate based on test results and symptoms.
- Consider wearing a mask in crowded or poorly ventilated indoor spaces, like on public transportation, on airplanes, and in transport hubs.
- Frequently wash your hands and avoid touching your face (e.g., eyes, mouth, nose) when out in public.
- Avoid contact with people who are showing symptoms related to COVID-19.
Travelers should continue to follow CDC guidance for traveling, along with state and local travel return requirements. After a trip, you should self-monitor for COVID-19 symptoms, and isolate and test if you develop symptoms.
Testing, Tracing, and Treatment
- You should test immediately if you are experiencing COVID-19 symptoms.
- You should test five days after being in close contact with someone who has tested positive for the virus.
- As of May 2023, private insurance companies are no longer required to fully cover COVID-19 at-home rapid antigen tests and lab tests. If you are using government-sponsored health insurance or if you are uninsured, you may also pay out-of-pocket costs related to COVID-19 testing.
- To find free and local testing options near you, search on the U.S. Health and Human Services testing web page or visit your local health department’s website.
- If you test positive for COVID-19 you should notify people you have had close contact with. If you have symptoms, you should notify all the people you have 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.
COVID-19 rapid antigen tests provide rapid results, can be taken in any location, and can be administered by a healthcare provider or yourself. Rapid antigen tests that are self-administered are also known as self-tests, “at-home tests”, or “over-the-counter” testing kits. When used correctly, these rapid antigen tests are highly reliable, easily accessible, and provide fast results. They are a critical tool in controlling the spread of COVID-19.
If you have COVID-19 symptoms: take a rapid antigen test immediately.
If you were exposed to someone with COVID-19: the CDC recommends testing at least five full days after exposure, even if you don’t have symptoms. If your first rapid antigen test is negative, you should schedule a PCR test or take a rapid antigen test again after 24-48 hours.
In either case, the CDC recommends repeat testing (e.g., re-testing in 24-48-hour intervals) to help ensure accurate reporting and monitoring of infection results over time.
You can also take a rapid antigen test as a precautionary measure before visiting or gathering with others. Consider testing in advance, at least 1 to 2 days before attending an indoor event or gathering. This is especially important if you are at risk of severe illness or if you will be around others who are at high risk, such as immunocompromised people or older adults.
Rapid antigen tests are most effective when there are high levels 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 levels of the virus are present. This is why rapid antigen testing may require repeat or serial testing (e.g., 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 days later when your virus levels increase. Multiple negative rapid antigen tests increase the confidence that you are not currently infected.
The specific number of times you should take a rapid antigen test depends on your result(s). Positive results from a rapid antigen 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, the CDC recommends that you test again 48 hours after your initial test, especially if you continue to experience symptoms or have been exposed to COVID-19.
What to do if you have a positive result on a rapid antigen test:
If your rapid antigen test result is positive, this means the virus was detected, and you have an infection. Follow the latest CDC guidance on isolation. If you are at an increased risk for severe illness or have worsening symptoms over time, you should consult a healthcare provider.
What to do if you have a negative result on a rapid antigen test:
If your rapid antigen 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 test, especially if you are experiencing symptoms or have recently been exposed to the virus.
If you continue to receive negative rapid antigen test results, but have symptoms or are otherwise concerned that you could have COVID-19, consider visiting your healthcare provider and getting a PCR test. PCR testing is the most accurate COVID-19 test available, and your healthcare provider can test for other potential viral infections.
Pharmacies, health centers, diagnostic labs, and health departments offer COVID-19 PCR testing and other viral tests. Check where such testing is available in your community using the U.S. Health and Human Services “Test to Treat” testing web page.
COVID-19 PCR and rapid antigen tests are often administered at clinics, pharmacies, health centers, and other community testing sites. To find PCR and rapid antigen testing options near you, including free testing options, search the U.S. Health and Human Services “Test to Treat” testing web page or visit your local health department’s website.
Rapid antigen tests are available at many pharmacies, retailers, community sites, and online stores. If you plan on using an at-home rapid antigen test, you should 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 rapid antigen tests, expiration dates, and age limits, click here.
As of May 2023, private insurance companies are no longer required to fully cover at-home rapid antigen tests and lab tests. People using government-sponsored health insurance or those without insurance may also pay out-of-pocket costs related to COVID-19 testing.
See more information about how the End of the Public Health Emergency has most recently impacted testing coverage.
There are two primary options for COVID-19 testing: PCR tests and rapid antigen tests.
Polymerase Chain Reaction (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 typically in 24-72 hours
Rapid Antigen Test
- Less accurate than PCR tests
- Results in as little as 15 minutes
- Can be administered by a healthcare provider at a testing site, or self-administered with an at-home testing kit (at-home test, self-test, and over-the-counter test are alternative names)
A third test, known as an antibody test, can help indicate whether you have had COVID-19 in the past. Antibody tests are used by researchers to better understand the virus, but they are not used to determine whether you currently have an infection.
Data and reporting
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 case counts and deaths are key public health indicators. The accuracy of case counts may vary because of reporting barriers like the convenience of at-home rapid antigen testing and varied access to COVID-19 testing and diagnosis by a healthcare provider. COVID-19 death reporting is less burdened by the previous barriers but can be impacted by the timing lags in data entry across many systems of monitoring. There is evidence to support reported data, but experts agree that the number of COVID cases is likely undercounted and underreported.
The CDC COVID Data Tracker is a collaborative hub of COVID-19 monitoring information informed by state and county reports from hospitals, healthcare providers, and laboratories. The CDC makes this data publicly available and reports national COVID-19 data to the World Health Organization, as required under international health regulations. The current key indicators – COVID-19 test positivity, emergency department visits, hospitalizations, and deaths – help reveal COVID-19 trends across the nation as we navigate COVID-19 as an endemic disease.
The National Center for Health Statistics also updates national statistics guidelines to ensure increased specificity and accuracy of COVID-19 death reporting. The cause-of-death determination guidelines distinguish COVID-19 and post-acute COVID-19 syndrome (PACS) as either an immediate or underlying cause of death on death certificates and medical reports. These updates help to clarify if people are dying from COVID-19 illness as an immediate cause of death, or dying with a COVID-19-related illness or condition as an underlying cause of death.
Paxlovid is an oral antiviral drug, manufactured by Pfizer, that is used to reduce the risk of hospitalization or death from COVID-19. In clinical trials, Paxlovid reduced the risk of hospitalization or death by 89%.
Paxlovid is fully authorized for use early in the course of a COVID-19 infection, when illness is mild or moderate, in people ages 12 and older who are at risk for disease progression and severe illness. Treatment must begin within five days of the onset of illness. People who are considered high risk include older adults and those with underlying medical conditions such as cancer, diabetes, or heart disease.
Paxlovid is available over the counter by provider or pharmacist prescription. This medication will only be prescribed to those who meet the eligibility criteria and will not experience negative interactions with the medication.
Paxlovid can also be provided by healthcare providers working within the U.S. Department of Health and Human Services “Test to Treat” program. Depending on medication availability at these community health sites, providers may be able to provide Paxlovid at no cost to qualifying community members.
“Paxlovid rebound” refers to people who have taken Paxlovid and experience a return of their symptoms several days after they initially recover and test negative for COVID-19.
Results from a Pfizer study from May 2023, showed that 10% to 16% of users 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 the COVID-19 “rebound” illness is mild. The CDC continues to recommend this antiviral as a treatment for people who test positive and are at higher risk for disease progression and severe illness.
If you experience Paxlovid rebound, you should restart the recommended five-day isolation period and remain masked for 10 days to avoid exposing others to the virus. Medical professionals do not recommend extending your treatment or being treated again with Paxlovid. You should contact a healthcare provider if your symptoms persist or worsen.
Vaccination is the best defense against serious COVID-19-related illness and can prevent infection altogether. While antiviral drugs and other treatments are an important advancement, they are not 100% effective in reducing the risk of hospitalization or death from COVID-19, and they are not a substitute for getting vaccinated.
COVID-19 can cause serious health impacts, especially for those who are not vaccinated and/or live with risk factors for severe disease progression. Alongside vaccination, 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. These measures may be particularly important if your community’s COVID-19 Hospital Admission Level is high.
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.
Notifying recent contacts helps to control the spread of the virus by quickly informing people that they should take health precautions.
If you contract COVID-19, you can protect other people from getting sick by immediately wearing a mask, isolating, and notifying the people who you have been around most recently.
If you test positive for COVID-19 and have symptoms, you should notify all the people you have had close contact with, starting from two days before your symptoms began until you tested positive.
If you test positive for COVID-19 and you don’t have symptoms, you should notify anyone who you were in close contact with during the two days before you tested positive.
COVID-19 + the flu shot
Should people get a seasonal flu vaccine? Can I get the flu vaccine at the same time as I get my COVID-19 vaccine?
Yes, the CDC recommends that everyone age 6 months and older get an updated flu vaccine every flu season, which occurs in the U.S. in the fall and winter. The best time to get your flu vaccine is in September or October, before the flu is spreading in your community.
It is safe to receive a COVID-19 vaccine dose at the same time you receive a flu vaccine. Some people may choose to get each vaccine in a different limb to minimize possible discomfort. Ask your healthcare provider if you have any questions about getting either or both vaccines.
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.
CDC continues to advise that everyone stay up to date on COVID-19 vaccinations, use at-home rapid antigen tests if exposed or symptomatic, stay home if sick, and wear a high-quality mask when appropriate. These precautions are the best ways to protect yourself and your loved ones from severe illness. Visit CDC’s website, along with your state and local health departments’ websites, for local statistics and information about recommended precautions.
What is the difference between the COVID-19 national emergency declaration and the public health emergency?
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.
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.
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.
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.
COVID-19 vaccines have prevented many deaths and hospitalizations, but the illness is still a public health risk. COVID-19 was the fourth leading cause of death in the U.S. in 2022 and is still a leading cause of illness and death, particularly for the elderly and immunocompromised.
In the same way that health experts track the flu and other common illnesses, these experts will continue to monitor COVID-19 and recommend measures to stay safe and healthy.
CDC continues to advise the public to practice precautions such as receiving updated COVID-19 vaccines, using at-home rapid antigen tests if you’ve been exposed or have symptoms, staying home and isolating if you’re sick, and wearing a high-quality mask, as needed, when in public indoor areas.
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.
Should I get an updated COVID-19 booster if I’ve previously gotten a booster? What if I recently had COVID-19?
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.
If we need an updated booster dose, does that mean that the vaccines aren’t working? Will we need additional boosters?
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
Yes, COVID-19 vaccines are safe. The COVID-19 vaccines have been tested and monitored for safety more than any previous vaccine in U.S. history. All COVID-19 vaccines have been rigorously tested and reviewed for human safety through a three-phase clinical trial process. Based on this thorough process, public health officials can make evidence-based recommendations to keep the public safe.
More than 150,000 people participated in U.S. vaccine clinical trials, and almost 700 million vaccine doses have been safely administered in the U.S., with rare instances of adverse reactions. To ensure the continued safety of COVID-19 vaccines, data from clinical trials will continue to be collected for two years after each vaccine is first administered to ensure that they are safe over the long term. As with all vaccines, there will be ongoing monitoring for adverse events among people who are vaccinated in the future.
Yes, the COVID-19 vaccines are highly effective at reducing the risk of severe infection, symptomatic illness, hospitalization, and death by providing immune protection that lasts several months.
The original Moderna and Pfizer-BioNTech COVID-19 vaccines approved in December 2020 were both shown to have 95% efficacy in preventing symptomatic COVID-19 illness. These vaccines were also shown to have high efficacy, 93% and 88% efficacy respectively, in targeting the predominant strain and preventing hospitalization.
However, a vaccine can only protect against a strain that it recognizes. As the virus continues to circulate and mutate, new variants are less recognizable to our immune systems and may lead to new infections — even for people who are vaccinated. COVID-19 vaccine effectiveness wears off over time and the coronavirus is constantly evolving and mutating. As a result, updated vaccines have been developed to more closely target the currently circulating variants of concern and “boost” the public’s immune protection to avoid another wave of infections, hospitalizations, and deaths.
The updated Moderna and Pfizer-BioNTech vaccines that were approved in fall 2023 are critical in boosting the public’s COVID-19 immunity. According to the latest research data, the newly updated COVID-19 vaccines are effective at producing strong immune responses to new variants. The updated vaccines provide increased protection against currently circulating COVID-19 strains, especially those originating from the Omicron variant. Individuals who received the updated COVID-19 vaccines have shown antibody responses that were almost 10 to 17 times higher against subvariants than before their re-vaccination.
There are two key measures that determine vaccine effectiveness: clinical trial efficacy and real-world effectiveness. Trial efficacy is measured in a structured clinical trial. These trials involve groups of diverse people and measure how much a vaccine reduces their risk of getting sick. If a vaccine has high efficacy, that means there were significantly fewer people in the vaccinated group who got sick compared with the unvaccinated group. Vaccine effectiveness measures successful immune protection under real-world conditions. If a vaccine has high effectiveness, there is real-world proof that the vaccine protects people against severe infection, symptomatic illness, hospitalization, and death.
While vaccine effectiveness can be quantified using percentages, without context these statistics can oversimplify the number of factors used to determine outcomes. Vaccine effectiveness varies based on location, population, research approach, and specific health outcomes. CDC and other public health researchers routinely monitor and evaluate data for vaccine effectiveness.
It’s true that these specific vaccines were developed more quickly than most, but their development built upon many decades of work on coronavirus vaccines and mRNA technology.
The process included the same rigorous safety reviews that are required for all new vaccines. Scientists were able to develop the vaccines quickly, safely, and effectively because the urgency of the pandemic created greater access to research funding, reduced bureaucratic obstacles, and encouraged unparalleled levels of government and industry cooperation.
As new variants appear, vaccine researchers will continue to develop updated COVID-19 vaccines, also called “boosters,” to provide the highest level of protection against the virus.
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.
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 risk of having a serious adverse reaction to the COVID-19 vaccine is very low—far lower than the risk of contracting COVID-19.
Common reactions to COVID-19 vaccination include mild side effects, such as limb soreness, fatigue, low-grade fever, headaches, and chills, which typically resolve within a few days.
Severe adverse reactions after vaccination are extremely rare, but can cause long-term health issues. Adverse events, such as anaphylaxis and other allergic reactions, blood-clotting syndromes, heart inflammation, autoimmune diseases impacting the nervous system, and death, have been reported within the Vaccine Adverse Event Reporting System (VAERS).
If you have a question about the risks associated with vaccines, talk with your healthcare provider.
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.
Given that COVID-19 is an evolving virus, researchers and medical experts continue to monitor how long vaccines provide immunity, which groups may benefit from additional doses, and how well the vaccines protect against new variants of the virus.
COVID-19 vaccines, like all other vaccines, do not provide 100% immunity. But they have been shown to be extremely effective in preventing serious illness, and they provide continued protection during periods of peak respiratory virus spread, such as the fall and winter months.
“Breakthrough” COVID-19 infections refer to infections in people who have fully completed the recommended vaccination schedule. This type of infection is not uncommon and can occur for multiple reasons. With the benefit of protection from the COVID-19 vaccine, breakthrough infections typically produce mild symptoms and do not require hospitalization. People who are not vaccinated continue to account for the vast majority of severe cases, hospitalizations, and deaths from COVID-19.
COVID-19 vaccines are a very important tool to protect against serious health outcomes, however vaccination alone is not enough to protect the public. It is also encouraged to practice other precautionary measures such as wearing a mask, covering a sneeze with a bent elbow or tissue, handwashing, avoiding crowded and closed spaces, social distancing from others, and isolating when sick.
Those who have compromised immune systems particularly benefit from practicing all recommended health precautions, including being vaccinated. If you have questions about your risk of COVID-19, how to protect yourself, or the vaccines, consult with your healthcare provider.
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.
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, getting a COVID-19 vaccine does not increase the risk of miscarriage. To date, no monitoring system or studies have identified any association between miscarriage and COVID-19 vaccination.
Studies show that miscarriages are a common outcome of a typical pregnancy, impacting 11% to 22% of all reported pregnancies. However, there is no evidence to show that pregnancy risks or complications, such as miscarriage, preterm delivery, stillbirth, or birth defects, are increased because of the COVID-19 vaccines.
Data do show that experiencing a COVID-19 infection during pregnancy increases the risk of delivering a preterm or stillborn infant. For this reason, vaccination is critical to protect the pregnant person and the infant from negative health outcomes. COVID-19 vaccination provides antibodies to the pregnant person and the baby, protecting them both from the increased risk of serious illness.
Will getting a COVID-19 vaccine during pregnancy or while breastfeeding protect my baby from COVID-19?
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.
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.
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.
Yes, your school or work can mandate the COVID-19 vaccine, with some exceptions. Schools or employers may require vaccinations for attendance or employment, and those requirements vary by state and employer.
While these requirements vary, the research remains the same: the best way to protect yourself from getting COVID-19 is to get vaccinated, and practice precautionary measures like handwashing, social distancing, wearing a mask, and isolating when sick.
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. Employers are still legally able to mandate COVID-19 vaccinations for employees.
Other Vaccine Requirements:
- As of June 5, 2023, the Omnibus COVID-19 Health Care Staff Vaccination interim final rule (IFR) was lifted. This means that workers and contractors at Medicare- and Medicaid-certified facilities are not required to be fully vaccinated against COVID-19.
- Private businesses may still require patrons to show proof of vaccination for entry, and these requirements vary by state and locality.
- 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 mutates often, which is why doctors recommend a new flu vaccine each year.
Researchers monitor all COVID-19 variants but may classify certain ones, like Omicron and Delta, as “variants of concern.” This is determined by which variants 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 protect yourself against COVID-19 variants is to stay up to date with vaccines. Being vaccinated decreases the likelihood you will get sick and makes it less likely you will need hospitalization or die if you get infected.
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
Respiratory syncytial virus, also called RSV, is a common respiratory virus that usually causes cold-like symptoms. Most people infected with RSV will experience mild illness and typically recover within one to two weeks. However, infants and young children, older adults, adults with chronic heart or lung disease, adults living in nursing homes and long-term care facilities, and immunocompromised people are at higher risk for severe illness from RSV infection. RSV can also lead to more severe infections, such as pneumonia (an infection of the lungs) and bronchiolitis (inflammation of the small airways in the lung). It is estimated that RSV causes approximately 60,000–160,000 hospitalizations and 6,000–10,000 deaths among older adults.
RSV season generally starts during the fall and peaks in the winter. RSV is very contagious and can spread in several ways: through exposure to respiratory droplets when an infected person coughs or sneezes, through direct contact with an infected person, or by touching a contaminated surface with RSV. People infected with RSV tend to show symptoms within four to six days after exposure. Symptoms of RSV may include runny nose, decrease in appetite, coughing, sneezing, fever, and wheezing.
People infected with RSV are typically contagious for three to eight days and may become contagious a day or two before showing signs of illness. Infants and immunocompromised people infected with RSV can continue to spread the virus even after they stop showing symptoms for as long as four weeks.
There are various tests available that confirm RSV infection, all of which are administered by a healthcare professional. Contact your local health care provider if you have questions about RSV or RSV testing.
On June 29 2023, the CDC recommended two new RSV vaccines for adults age 60 and up. The single-dose vaccines—one developed by Pfizer (called Abrysvo) and the other developed by GSK (called Arexvy)—were determined to be equally effective by the CDC Advisory Committee on Immunization Practices (ACIP) after reviewing results from clinical trials. The vaccines are expected to be available to the public this fall when RSV typically begins to circulate at higher levels.
Once the vaccines are available, adults age 60 and up will be eligible to receive an RSV vaccine after consulting with their health care provider.
On August 3, 2023, the CDC approved and recommended the use of nirsevimab (Beyfortus)—a new monoclonal antibody treatment for infants and toddlers to protect against severe illness caused by RSV. Monoclonal antibodies are proteins that mimic the antibodies that our bodies naturally produce. While there is not currently an approved pediatric vaccine, monoclonal antibody treatments–like Beyfortus–provide an extra layer of defense that helps fight RSV infections and protect infants’ lungs.
Beyfortus is expected to be available for fall 2023–when the RSV season begins. One dose of Beyfortus can protect infants for five months, the length of an average RSV season. The treatment has been shown to reduce the risk of both hospitalizations and healthcare visits for RSV in infants by about 80%. A dose of Beyfortus is recommended for:
- All infants younger than eight months in their first RSV season
- Children between the ages of eight months and 19 months who are at increased risk of severe RSV disease, such as severely immunocompromised children, in their second RSV season.
In addition to Beyfortus, there is another monoclonal antibody treatment to help protect infants and young children from severe RSV infection. This treatment is called palivizumab (Synagis). Synagis is currently available, but only recommended for infants and young children with certain health conditions who are at high risk for severe RSV infection. Synagis injections must be given monthly during RSV season (typically fall through spring) to provide increased protection.
These products are not treatments for a child who already has an infection. Caregivers to young children are encouraged to contact their health care provider to see if Synagis or Beyfortus should be used as a preventive measure for their child.
Pfizer has developed and conducted safety and efficacy trials of a single-dose RSV vaccine for pregnant women. The results from clinical trials are promising and are currently under review for approval. If the vaccine is approved by the FDA and CDC, it may be available as soon as fall 2023.
The vaccine would be administered between 32 and 36 weeks of pregnancy, which would then trigger the development of antibodies that would be passed on to the newborn. These antibodies would provide protection for about the first six months of the baby’s life when they’re extremely vulnerable to infections like RSV.
Expectant families are encouraged to contact their respective obstetricians for further information on the availability and accessibility of this vaccine.
Updated September 8, 2023
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.
Data show that high-quality, well-fitting masks are effective at reducing the transmission of COVID-19, and that they are likely effective at reducing the transmission of flu and RSV. Health experts 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.
Regardless of the rate of flu, RSV, and COVID-19 hospital admissions or current local mask guidance, anyone can choose to wear a mask as an additional precaution to protect themselves and their families from respiratory infections during high transmission seasons.
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.
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.