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Nonsevere pneumonia
Overview
Infection control measures: these include isolation, source control, and transmission precautions r52
Supportive care: for all patients; in hospitalized patients, such care includes oxygenation and ventilation, conservative fluid support, and measures to prevent common complications (eg, pressure injury, stress ulceration, secondary infection) r23
Antiviral agents
Monoclonal antibodies with antiviral action (against SARS-CoV-2 spike protein)
Systemic corticosteroid therapy is suggested or recommended for most hospitalized patients with an oxygen requirement r23
Immunomodulators of other classes are used to diminish an excessive inflammatory response (eg, monoclonal antibodies against interleukin-6 receptors, such as tocilizumabr120 and sarilumabr121; Janus kinase inhibitors, such as baricitinibr122 and tofacitinibr123; monoclonal antibody vilobelimabr124 against complement activity)
Antithrombotic therapy
Convalescent plasma continues to be investigated; only high-titer formulations have shown any benefitr141
Several medications with a mechanism of action that could potentially alter response to COVID-19 have been evaluated either for use in treatment and prevention, or for discontinuation to prevent harms r144
Other options not currently recommended under NIH, Infectious Diseases Society of America, and WHO guidelines (although some are still under study in clinical trials) r2r84r86
Product name | Manufacturer | Active ingredient | Age range for use | Comments |
---|---|---|---|---|
Moderna COVID-19 vaccine, bivalent (original and Omicron BA.4/BA.5) | ModernaTX | Synthetic mRNA of SARS-CoV-2 | 6 months or older | • Used under EUA in the United States |
Pfizer-BioNTech COVID-19 vaccine, bivalent (original and Omicron BA.4/BA.5) | Pfizer-BioNTech | Nucleoside-modified mRNA of SARS-CoV-2 | 6 months or older | • Used under EUA in the United States |
Novavax COVID-19 vaccine, adjuvanted | Novavax | Recombinant spike protein (rS) of SARS-CoV-2 | 12 years or older | • Used under EUA in the United States |
Janssen COVID-19 vaccine | Janssen Biotech, Inc (a Janssen Pharmaceutical Company of Johnson and Johnson) | Recombinant, replication-deficient adenovirus 26 vector expressing SARS-CoV-2 spike glycoprotein (S protein) | 18 years or older | • Used under EUA in the United States • Use in the United States was paused then resumed in April 2021 • On May 5, 2022, FDA limited the use to people aged 18 years or older for whom other approved COVID-19 vaccines are unavailable or not clinically appropriate, or when elected by the recipient who would otherwise not be vaccinated |
Manufacturer | Age | Dose 1 | Dose 2 | Dose 3 | Dose 4 | Notes |
---|---|---|---|---|---|---|
Schedule for unvaccinated individuals who are NOT moderately to severely immunocompromised | ||||||
Moderna | 6 months to 5 years | Primary bivalent (dark blue/gray), 0.25 mL | In 4 to 8 weeks, primary bivalent (dark blue/gray), 0.25 mL | NA | NA | |
Moderna | 6 years to 11 years | Primary bivalent (dark blue/gray), 0.25 mL | NA | NA | NA | |
Moderna | 12 years or older | Primary bivalent (dark blue/gray), 0.5 mL | Optional for adults aged 65 years or older: bivalent booster (dark blue/gray), 0.5 mL, at least 4 months after last dose | NA | NA | For adults aged 65 years or older, either Moderna or Pfizer bivalent booster may be used |
Pfizer | 6 months to 4 years | Primary bivalent (maroon/maroon), 0.2 mL | In 3 to 8 weeks, primary bivalent (maroon/maroon), 0.2 mL | In at least 8 weeks, primary bivalent (maroon/maroon), 0.2 mL | NA | Maroon formulation requires dilution; children who transition from 4 years to 5 years during primary series should receive all doses of maroon/maroon, 0.2 mL |
Pfizer | 5 years to 11 years | Primary bivalent (orange/orange), 0.2 mL | NA | NA | NA | Orange formulation requires dilution |
Pfizer | 12 years or older | Primary bivalent (gray/gray), 0.3 mL | Optional for adults aged 65 years or older: bivalent booster (gray/gray), 0.3 mL, at least 4 months after last dose | NA | NA | For adults aged 65 years or older, either Pfizer or Moderna bivalent booster may be used |
Novavax | 12 years or older | Primary monovalent (royal blue/no color), 0.5 mL | In 3 to 8 weeks, primary monovalent (royal blue/no color), 0.5 mL | In at least 8 weeks after last primary dose, should receive either Moderna or Pfizer bivalent booster | Optional for adults aged 65 years or older: Moderna or Pfizer bivalent booster at least 4 months after last dose | |
Schedule for unvaccinated individuals who ARE moderately to severely immunocompromised | ||||||
Moderna | 6 months to 5 years | Primary bivalent (dark blue/gray), 0.25 mL | In 4 weeks, primary bivalent (dark blue/gray), 0.25 mL | In at least 4 weeks, primary bivalent (dark blue/gray), 0.25 mL | In at least 2 months, optional bivalent booster (dark pink/yellow), 0.2 mL (recommended formulation) OR (dark blue/gray), 0.25 mL (alternative) | At clinician's discretion, additional booster doses at an interval of at least 2 months; patients aged 6 months to 4 years should receive Moderna booster(s) only; those aged 5 years may receive either Moderna or Pfizer booster(s) |
Moderna | 6 years to 11 years | Primary bivalent (dark blue/gray), 0.25 mL | In 4 weeks, primary bivalent (dark blue/gray), 0.25 mL | In at least 4 weeks, primary bivalent (dark blue/gray), 0.25 mL | In at least 2 months, optional bivalent booster (dark blue/gray), 0.25 mL | At clinician's discretion, additional booster doses at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
Moderna | 12 years or older | Primary bivalent (dark blue/gray), 0.5 mL | In 4 weeks, primary bivalent (dark blue/gray), 0.5 mL | In at least 4 weeks, primary bivalent (dark blue/gray), 0.5 mL | In at least 2 months, optional bivalent booster (dark blue/gray), 0.5 mL | At clinician's discretion, additional booster doses at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
Pfizer | 6 months to 4 years | Primary bivalent (maroon/maroon), 0.2 mL | In 3 weeks, primary bivalent (maroon/maroon), 0.2 mL | In at least 8 weeks, primary bivalent (maroon/maroon), 0.2 mL | In at least 2 months, optional bivalent booster (maroon/maroon), 0.2 mL | Maroon formulation requires dilution; at clinician's discretion, additional booster doses at an interval of at least 2 months; Pfizer booster(s) only |
Pfizer | 5 years to 11 years | Primary bivalent (orange/orange), 0.2 mL | In 3 weeks, primary bivalent (orange/orange), 0.2 mL | In at least 4 weeks, primary bivalent (orange/orange), 0.2 mL | In at least 2 months, optional bivalent booster (orange/orange), 0.2 mL | Orange formulation requires dilution; at clinician's discretion, additional booster doses at an interval of at least 2 months; patients aged 5 years should receive Pfizer booster(s) only; those aged 6 years to 11 years may receive either Pfizer or Moderna booster(s) |
Pfizer | 12 years or older | Primary bivalent (gray/gray), 0.3 mL | In 3 weeks, primary bivalent (gray/gray), 0.3 mL | In at least 4 weeks, primary bivalent (gray/gray), 0.3 mL | In at least 2 months, optional bivalent booster (gray/gray), 0.3 mL | At clinician's discretion, additional booster doses at an interval of at least 2 months; booster dose(s) may be either Pfizer or Moderna |
Novavax | 12 years or older | Primary monovalent (royal blue/no color), 0.5 mL | In 3 to 8 weeks, primary monovalent (royal blue/no color), 0.5 mL | In at least 8 weeks after last primary dose, should receive either Moderna or Pfizer bivalent booster | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
Age | Prior doses | Recommended doses | Notes |
---|---|---|---|
Schedule for individuals who are NOT moderately to severely immunocompromised | |||
6 months to 4 years | 1 dose monovalent Moderna | 1 dose bivalent Moderna (dark blue/gray), 0.25 mL, 4 to 8 weeks after monovalent dose | |
6 months to 4 years | 2 doses monovalent Moderna | 1 dose bivalent Moderna (dark pink/yellow), 0.2 mL, at least 8 weeks after last monovalent dose | |
6 months to 4 years | 1 dose monovalent Pfizer | 2 doses bivalent Pfizer (maroon/maroon), 0.2 mL: first dose 3 to 8 weeks after monovalent dose, second dose at least 8 weeks after first bivalent dose | Maroon formulation requires dilution |
6 months to 4 years | 2 or 3 doses monovalent Pfizer | 1 dose bivalent Pfizer (maroon/maroon), 0.2 mL, at least 8 weeks after last monovalent dose | Maroon formulation requires dilution |
6 months to 4 years | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | No further doses recommended | |
5 years | 1 dose monovalent Moderna | 1 dose bivalent Moderna (dark blue/gray), 0.25 mL, 4 to 8 weeks after monovalent dose, OR 1 dose bivalent Pfizer (orange/orange), 0.2 mL, at least 8 weeks after monovalent dose | Orange formulation requires dilution |
5 years | 2 doses monovalent Moderna | 1 dose bivalent Moderna (dark pink/yellow), 0.2 mL, OR 1 dose bivalent Pfizer (orange/orange), 0.2 mL, at least 8 weeks after last monovalent dose | Orange formulation requires dilution |
5 years | 1, 2, or 3 doses monovalent Pfizer | 1 dose bivalent Pfizer (orange/orange), 0.2 mL, at least 8 weeks after last monovalent dose | Orange formulation requires dilution |
5 years | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | No further doses recommended | |
6 years to 11 years | Any doses monovalent, any manufacturer, but no prior bivalent | 1 dose bivalent Moderna (dark blue/gray), 0.25 mL, OR 1 dose bivalent Pfizer (orange/orange), 0.2 mL, at least 8 weeks after last monovalent dose | Orange formulation requires dilution |
6 years to 11 years | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | No further doses recommended | |
12 years to 64 years | Any doses monovalent, any manufacturer, but no prior bivalent | 1 dose bivalent Moderna (dark blue/gray), 0.5 mL, or 1 dose bivalent Pfizer (gray/gray), 0.3 mL, at least 8 weeks after last monovalent dose | |
12 years to 64 years | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | No further doses recommended | |
65 years or older | Any doses monovalent, any manufacturer, but no prior bivalent | 1 dose bivalent booster Moderna (dark blue/gray), 0.5 mL, or Pfizer (gray/gray), 0.3 mL, at least 8 weeks after last monovalent dose; followed by optional second dose bivalent booster, either manufacturer, at least 4 months after first bivalent booster | |
65 years or older | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | Optional dose bivalent booster Moderna (dark blue/gray), 0.5 mL, or Pfizer (gray/gray), 0.3 mL, at least 4 months after bivalent dose | |
Schedule for individuals who ARE moderately to severely immunocompromised | |||
6 months to 4 years | 1 dose monovalent Moderna | 2 doses bivalent Moderna (dark blue/gray), 0.25 mL: first dose 4 weeks after monovalent dose, second dose at least 4 weeks after first bivalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; Moderna booster(s) only, (dark pink/yellow), 0.2 mL (recommended formulation) OR (dark blue/gray), 0.25 mL (alternative) |
6 months to 4 years | 2 doses monovalent Moderna | 1 dose bivalent Moderna (dark blue/gray), 0.25 mL, at least 4 weeks after last monovalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; Moderna booster(s) only, (dark pink/yellow), 0.2 mL (recommended formulation) OR (dark blue/gray), 0.25 mL (alternative) |
6 months to 4 years | 3 doses monovalent Moderna | 1 dose bivalent Moderna (dark pink/yellow), 0.2 mL, at least 8 weeks after last monovalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; Moderna booster(s) only, (dark pink/yellow), 0.2 mL (recommended formulation) OR (dark blue/gray), 0.25 mL (alternative) |
6 months to 4 years | 1 dose monovalent Pfizer | 2 doses bivalent Pfizer (maroon/maroon), 0.2 mL: first dose 3 weeks after monovalent dose, second dose at least 8 weeks after first bivalent dose | Maroon formulation requires dilution; at clinician's discretion, additional booster doses at an interval of at least 2 months; Pfizer booster(s) only |
6 months to 4 years | 2 or 3 doses monovalent Pfizer | 1 dose bivalent Pfizer (maroon/maroon), 0.2 mL at least 8 weeks after last monovalent dose | Maroon formulation requires dilution; at clinician's discretion, additional booster doses at an interval of at least 2 months; Pfizer booster(s) only |
6 months to 4 years | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) should be from same manufacturer as prior doses | |
5 years to 11 years | 1 dose monovalent Moderna | 2 doses bivalent Moderna (dark blue/gray), 0.25 mL: first dose 4 weeks after monovalent dose, second dose at least 4 weeks after first bivalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
5 years to 11 years | 2 doses monovalent Moderna | 1 dose bivalent Moderna (dark blue/gray), 0.25 mL, at least 4 weeks after last monovalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
5 years to 11 years | 3 doses monovalent Moderna | 1 dose bivalent Moderna (dark blue/gray), 0.25 mL, OR bivalent Pfizer (orange/orange), 0.2 mL, at least 8 weeks after last monovalent dose | Orange formulation requires dilution; at clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
5 years to 11 years | 1 dose monovalent Pfizer | 2 doses bivalent Pfizer (orange/orange), 0.2 mL: first dose 3 weeks after monovalent dose, second at least 4 weeks after first bivalent dose | Orange formulation requires dilution; at clinician's discretion, additional booster doses at an interval of at least 2 months; patients aged 5 years should receive Pfizer booster(s) only; those aged 6 years to 11 years may receive either Pfizer or Moderna booster(s) |
5 years to 11 years | 2 doses monovalent Pfizer | 1 dose bivalent Pfizer (orange/orange), 0.2 mL at least 4 weeks after last monovalent dose | Orange formulation requires dilution; at clinician's discretion, additional booster doses at an interval of at least 2 months; patients aged 5 years should receive Pfizer booster(s) only; those aged 6 years to 11 years may receive either Pfizer or Moderna booster(s) |
5 years | 3 doses monovalent Pfizer | 1 dose bivalent Pfizer (orange/orange), 0.2 mL at least 8 weeks after last monovalent dose | Orange formulation requires dilution; at clinician's discretion, additional booster doses at an interval of at least 2 months; Pfizer booster(s) only |
5 years | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) for children who previously received Pfizer vaccine should be Pfizer bivalent dose(s); booster dose(s) for children who previously received Moderna vaccine may be Moderna or Pfizer bivalent dose(s) | |
6 years to 11 years | 3 doses monovalent Pfizer | 1 dose bivalent Pfizer (orange/orange), 0.2 mL, OR bivalent Moderna (dark blue/gray), 0.25 mL, at least 8 weeks after last monovalent dose | Orange formulation requires dilution; at clinician's discretion, additional booster doses at an interval of at least 2 months; booster dose(s) may be either Pfizer or Moderna |
6 years to 11 years | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | At clinician's discretion, additional bivalent booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer | |
12 years or older | 1 dose monovalent Moderna | 2 doses bivalent Moderna (dark blue/gray), 0.5 mL: first dose 4 weeks after monovalent dose, second dose at least 4 weeks after first bivalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
12 years or older | 2 doses monovalent Moderna | 1 dose bivalent Moderna (dark blue/gray), 0.5 mL at least 4 weeks after last monovalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
12 years or older | 3 doses monovalent Moderna | 1 dose bivalent Moderna (dark blue/gray), 0.5 mL, or 1 dose bivalent Pfizer (gray/gray), 0.3 mL, at least 8 weeks after last monovalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |
12 years or older | 1 dose monovalent Pfizer | 2 doses bivalent Pfizer (gray/gray), 0.3 mL: first dose 3 weeks after monovalent dose, second dose at least 4 weeks after first bivalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Pfizer or Moderna |
12 years or older | 2 doses monovalent Pfizer | 1 dose bivalent Pfizer (gray/gray), 0.3 mL, at least 4 weeks after last monovalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Pfizer or Moderna |
12 years or older | 3 doses monovalent Pfizer | 1 dose bivalent Moderna (dark blue/gray), 0.5 mL, or 1 dose bivalent Pfizer (gray/gray), 0.3 mL, at least 8 weeks after last monovalent dose | At clinician's discretion, additional booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Pfizer or Moderna |
12 years or older | Any doses of bivalent, any manufacturer (regardless of monovalent doses) | At clinician's discretion, additional bivalent booster dose(s) at an interval of at least 2 months; booster dose(s) may be either Moderna or Pfizer |