Disproportionate Hospitalization Rates Among Older Adults Highlight Ongoing COVID-19 Threat


Despite overall reductions, the elderly remain vulnerable to severe COVID-19 outcomes.

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COVID-19 vaccine to an elder man.

Image credits: Unsplash

COVID-19 continues to pose a threat to public health despite reductions in severe disease cases overall since the pandemic's onset. Hospitalization rates associated with COVID-19 remain disproportionately high among adults aged 65 and older compared to younger age groups, including adolescents and children.

The CDC's Advisory Committee on Immunization Practices (ACIP) recommended an updated vaccination strategy for COVID-19, utilizing a monovalent vaccine derived from the XBB.1.5 variant for individuals 6 months and older. Recognizing the ongoing circulation of SARS-CoV-2 and the heightened risk of severe illness in those aged 65 and older, ACIP further recommended, on February 28, 2024, an additional dose of the updated vaccine specifically for this age group.

3 Key Takeaways

  1. There is a vulnerability of older adults to severe outcomes of COVID-19, with individuals aged 65 and older accounting for a significant portion of COVID-19 hospitalizations despite overall reductions in severe disease cases.
  2. Importance of updated vaccination strategies, including the recommendation for an additional vaccine dose specifically for individuals aged 65 and older.
  3. This recommendation aims to enhance protection against COVID-19-associated illness and death, particularly in light of the ongoing circulation of SARS-CoV-2 and the emergence of high cases from variants like KP2.

“Early vaccine effectiveness (VE) estimates demonstrate that updated COVID-19 vaccination provided increased protection against symptomatic SARS-CoV-2 infection and COVID-19–associated emergency department and urgent care visits and hospitalization, compared with receipt of no updated vaccine dose,” according to the CDC. “Effectiveness of an additional dose in older adults has been demonstrated for previously recommended additional original COVID-19 vaccine doses.” 1

From October 2023 to January 2024, individuals aged 65 and older accounted for 67% of all COVID-19-associated hospitalizations. This underscores the vulnerability of this age group to severe outcomes related to COVID-19.

“ACIP recommended that all persons aged ≥6 months receive updated (2023–2024 Formula) monovalent, XBB.1.5 component (updated) COVID-19 vaccination to protect against severe COVID-19–associated illness and death,” according to the CDC. “As of February 3, 2024, approximately 6.7 million COVID–19–associated hospitalizations and 1.1 million COVID–19–associated deaths had occurred in the US. Although the overall risk for COVID-19–associated hospitalization and death has decreased, severe illness related to COVID-19 continues to be a public health problem, especially among older adults.” 1

COVID-19 vaccines show overall safety over 3 years of use, with rare reports of anaphylactic reactions and myocarditis. No new safety concerns emerged. Reactogenicity is lower in adults aged 65 and older. While a statistical signal for ischemic stroke after the Pfizer-BioNTech bivalent mRNA COVID-19 vaccine was noted in older adults, ongoing evaluations found no clear safety concern. Recent studies show the bivalent vaccine is 47% effective in preventing COVID-19-related thromboembolic events in this age group.1

It is important to keep up to date with the recommended vaccinations, especially with the CDC reporting the KP2 variant is the dominant strain of COVID-19 in terms of cases being reported in the United States, with 25% of all current infections from it.1 This comes from the federal agency’s latest reporting week, April 21-27, 2024. 2

KP2 is included in a newer family of variants, called “FLiRTs,” named after their mutations.2 According to the CDC, another FLiRT variant, KP11, accounts for about 7.5% of cases. Together, they account for 32.5% of all reported cases in the country. 2

The recommendation for an additional dose of the updated COVID-19 vaccine for individuals 65 and older is a proactive measure to bolster immunity and reduce the likelihood of severe COVID-19-associated illness. This recommendation is crucial for enhancing protection against COVID-19, especially in the face of evolving variants such as KP2, and potential waning immunity conferred by previous vaccinations.


  1. CDC. Use of an Additional Updated 2023–2024 COVID-19 Vaccine Dose for Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024. Published April 25, 2024. Accessed May 7, 2024. https://www.cdc.gov/mmwr/volumes/73/wr/mm7316a4.htm
  2. Parkinson J. A Member of Newer Family of ‘FLiRT’ COVID-19 Variants is Dominant Strain In United States. Published May 6, 2024. Accessed May 7, 2024. https://www.contagionlive.com/view/a-member-of-newer-family-of-flirt-covid-19-variants-is-dominant-strain-in-united-states
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