Top 5 Takeaways

1. High Booster Uptake: 18.7 million adults aged ≥65 years received a booster or additional primary dose, representing 44.1% of eligible individuals in this age group.
2. Coverage Variation: Booster coverage varied by vaccine type and race/ethnicity, with the highest coverage among non-Hispanic White and multiracial/other race recipients.
3. ACIP Recommendations: ACIP recommended booster doses for specific populations at different times, affecting overall coverage rates.
4. Homologous vs. Heterologous Doses: The majority (95.8%) of booster doses were homologous, with a notable exception among Janssen recipients, where 61.5% received a heterologous dose.
5. Public Health Implications: Strategic efforts are needed to encourage booster doses among eligible adults, particularly those aged ≥65 years and immunocompromised individuals, to ensure maximal protection.

Original Article Author and Citation

Corresponding Author

Hannah E. Fast, hfast@cdc.gov

Suggested Citation

Fast HE, Zell E, Murthy BP, et al. Booster and Additional Primary Dose COVID-19 Vaccinations Among Adults Aged ≥65 Years — United States, August 13, 2021–November 19, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1735-1739. DOI: http://dx.doi.org/10.15585/mmwr.mm7050e2

Summary

During August 13–November 19, 2021, 18.7 million adults aged ≥65 years received a booster or additional primary dose of COVID-19 vaccine, constituting 44.1% of eligible individuals. Coverage varied by primary series vaccine product and race/ethnicity, with the highest coverage among non-Hispanic White and multiracial/other race recipients. Strategic efforts are needed to encourage booster doses among eligible adults, particularly those aged ≥65 years and immunocompromised individuals, to ensure maximal protection against COVID-19.

Methods

Data on COVID-19 vaccinations were reported to the CDC from 50 states, DC, and eight territories. The analysis evaluated coverage by primary series vaccine product, demographic characteristics, trends over time, and whether the booster or additional primary dose was homologous or heterologous. Coverage was calculated among persons aged ≥65 years who were eligible by the end of the analysis period, based on the interval since primary series completion.

Discussion

As of November 19, 2021, 44.1% of eligible adults aged ≥65 years had received a booster or additional primary dose. Coverage varied by vaccine product and race/ethnicity, with the lowest coverage among non-Hispanic American Indian or Alaska Native, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander persons. Differences in coverage can be partially explained by the staggered timing of ACIP recommendations and the inclusion of additional primary doses for mRNA vaccine recipients.

Conclusion

Booster or additional primary doses of COVID-19 vaccine provide robust immune responses and protect against severe COVID-19 outcomes. Strategic efforts are needed to encourage eligible adults, especially those aged ≥65 years and immunocompromised individuals, to receive booster doses to ensure maximal protection against COVID-19.

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