A group of World Health Organization experts is recommending COVID-19 booster shots for people at the highest risk of severe illness and death. The Strategic Advisory Group of Experts on Immunization or SAGE, which met in extraordinary session August 11, issued its updated guidance Thursday.

SAGE recommends continued use of the two-dose mRNA COVID-19 vaccines. Since the vaccines’ efficacy wanes after several months, however, the group of experts advises a booster shot for everyone, beginning with those at highest risk.

This is the first time SAGE has updated its guidance on the administration of a second booster shot. Its recommendations are based on increasing evidence on the benefits of a second booster dose of COVID-19 vaccines for select groups of people.

SAGE chairman Alejandro Cravioto said the group recommends a second booster shot for people older than 55 who are considered at highest risk of developing severe disease and in need of hospitalization. He said SAGE does not advocate a second booster for the general public, for adults who are generally healthy and do not suffer from severe immunodeficiency.

“We also include persons with moderate and severe immuno-compromising conditions from, say, 6 months and above,” Cravioto said. “And that includes the children and adults with co-morbidities at higher risk of severe disease. We also include pregnant women and health workers.”

SAGE recommends a second booster be given four to six months after the administration of the first. It says healthy children and adolescents remain at low risk of severe disease from COVID-19, so there currently is no recommendation for youth groups to be vaccinated.

Cravioto, however, said SAGE has made interim recommendations for the use of Pfizer and Moderna vaccines in relation to their use in children.

“In the case of both vaccines, children from 6 months to 17 years with co-morbidities should be vaccinated to avoid a higher risk in these groups of severe disease. … This includes, of course, children with Down syndrome, who we know are at the highest risk of dying of COVID if they get infected.”

The group of experts notes the recommendations are based on the current available data. They say it is not a projection into the future but relates specifically to the omicron variant of the coronavirus. It says the guidance is likely to change depending on how the pandemic evolves and new variants circulate.

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