† A COVID-19 case in a fully vaccinated person occurred when SARS-CoV-2 RNA or antigen was detected in a respiratory specimen collected ≥14 days after completing the primary series of a COVID-19 vaccine with Food and Drug Administration (FDA) approval or emergency use authorization. The COVID-19 case definition, including criteria to distinguish a new case from an existing case, is per the July 2021 update to the national standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19) (21-ID-01) (https://ndc.services.cdc.gov/case-definitions/ coronavirus-disease-2019-2021/). Fully vaccinated persons were those with a completed primary series of 2 doses of the Pfizer-BioNTech or Moderna mRNA vaccine or a single dose of the Janssen vaccine (https://www.cdc.gov/ coronavirus/2019-ncov/vaccines/stay-up-to-date.html). A COVID-19 case in an unvaccinated person occurred when the person did not receive any FDAauthorized COVID-19 vaccine doses before the specimen collection date. Cases were excluded in partially vaccinated persons who received at least one FDAauthorized or approved vaccine dose but did not complete a primary series ≥14 days before collection of a respiratory specimen with SARS-CoV-2 RNA or antigen detected. Ascertaining vaccination status for COVID-19 patients through active linkage of case surveillance and immunization information systems typically assumes that cases among persons who are unmatched to the registry are unvaccinated. This analysis represents the combined impact of the Pfizer-BioNTech, Moderna, and Janssen COVID-19 vaccines, which had different clinical efficacies against confirmed infection. Information on different FDA-authorized and approved COVID-19 vaccine products, including clinical efficacy, is available online. https://www.cdc.gov/coronavirus/2019-ncov/ vaccines/different-vaccines.html

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A lthough more common among adults, severe coronavirus disease (COVID-19) and hospitalization can occur in children. Among >8,300 hospitalized children 5-11 years of age, 1/3 required intensive care (1,2). Children can transmit severe acute respiratory syndrome coronavirus 2 to others, highlighting the need for pediatric COVID-19 vaccinations. On November 2, 2021, the US Centers for Disease Control and Prevention (CDC) recommended the use of the Pfizer-BioNTech COVID-19 vaccine (Pfizer Inc., https://www.pfizer.com) in children 5-11 years of age. We analyzed first-dose vaccination coverage among children 5-11 years of age and stratified coverage by age group, sex, race/ ethnicity, and jurisdiction. The StudyWe analyzed COVID-19 vaccine administration data among children 5-11 years of age in the United States during November 2-December 31, 2021. We collected data that were reported to CDC from jurisdictions, pharmacies, and federal entities through immunization information systems, the Vaccine Administration Management System, and direct data submission by January 21, 2022 (Appendix, https://wwwnc.cdc. gov/EID/article/28/5/22-0166.pdf). We calculated daily and cumulative total numbers of children receiving the first dose of Pfizer-BioNTech COVID-19 vaccine. We calculated vaccination coverage by dividing the number of children who received the first vaccine dose by the total population of children in the corresponding age group living in the defined jurisdiction. We stratified vaccine coverage by jurisdiction, age group (5-6, 7-8, and 9-11 years), and sex. We obtained the population size for children 5-11 years of age from the US Census Bureau 2020 Population Estimates (3). Among 82.1% of children 5-11 years of age for whom race and ethnicity data were available, we calculated the percentage of children receiving their first COVID-19 vaccine dose by race/ ethnicity and compared this with the racial and ethnic makeup of the US population 5-11 years of age.We did not conduct tests for statistical significance because these data reflect US population and not population samples. We used SAS version 9.4 (SAS Institute, Inc., https://www.sas.com) to perform analyses. This study was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.

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A COVID-19 vaccine booster dose is intended to boost the immune system for better, long-lasting protection when the primary vaccine response decreases over time. Studies have shown that a booster increased the immune response in trial participants who completed a Pfizer-BioNTech (https://www.pfizer.com) or Moderna (https://www.modernatx.com) primary series 6 months earlier or who received a Johnson & Johnson/Janssen (https://www.jnj.com) singledose vaccine 2 months earlier (1,2).With an increased immune response, booster doses provide additional protection against both Delta and Omicron variants for clinical COVID-19 emergency department visits and hospitalization even for those persons who have received an initial vaccine series (1,3). For example, the mRNA vaccine effectiveness (VE) against emergency room visits during the period of Delta predominance was 76%-86% after the second initial dose and 94% after a booster dose; estimates of VE during Omicron variant predominance were 38%-52% after the second initial dose and 82% after a booster dose. VE against hospitalizations during the period of Delta predominance was 81%-90% after the second initial dose and 94% after a booster dose, and estimates of VE for during Omicron variant predominance were 57%-81% after the second initial dose and 90% after a booster dose (3).The Centers for Diseases Control and Prevention (CDC) first recommended booster doses for select populations in September 2021 and on November 29, 2021, recommended that all persons >18 years of age should get a booster dose when eligible (1,2). By March 2022, approximately 84% of American adults were fully vaccinated with the COVID-19 primary vaccine series; primary vaccine series completion rates varied by some social-demographic characteristics (4). Receiving a COVID-19 booster dose is useful both to prevent COVID-19-related illness and death and slow the spread of COVID-19 in the United States. The objective of this study was to assess COVID-19 booster dose vaccination coverage by demographics and behaviors and experiences

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