What are the recommended COVID-19 (Coronavirus Disease 2019) vaccine guidelines?

COVID-19 Vaccination Recommendations 2024-2025

All persons aged ≥6 months should receive the 2024-2025 COVID-19 vaccine, with specific dosing schedules based on age, vaccination history, and immune status. 1

General Recommendations for Non-Immunocompromised Individuals

Adults and Children ≥5 Years

• For previously unvaccinated persons aged ≥5 years:

  • One dose of Moderna or Pfizer-BioNTech 2024-2025 COVID-19 vaccine
  • For those ≥12 years choosing Novavax: Two doses, administered 3-8 weeks apart

• For previously vaccinated persons aged ≥5 years:

  • One dose of 2024-2025 COVID-19 vaccine (Moderna, Pfizer-BioNTech, or Novavax [≥12 years only])
  • Administer ≥8 weeks after the last COVID-19 vaccine dose

Children 6 Months to 4 Years

Children in this age group require a multi-dose primary series:

• Previously unvaccinated:

  • Moderna: 2 doses (4-8 weeks between doses)
  • Pfizer-BioNTech: 3 doses (3-8 weeks between doses 1 and 2; ≥8 weeks between doses 2 and 3)

• Previously received Moderna:

  • After 1 dose: 1 additional dose (4-8 weeks after dose 1)
  • After ≥2 doses: 1 dose of 2024-2025 vaccine (≥8 weeks after last dose)

• Previously received Pfizer-BioNTech:

  • After 1 dose: 2 additional doses
  • After 2 doses: 1 additional dose
  • After ≥3 doses: 1 dose of 2024-2025 vaccine (≥8 weeks after last dose)

Recommendations for Moderately or Severely Immunocompromised Individuals

Immunocompromised individuals require additional protection:

• Unvaccinated persons aged 6 months-11 years: 3-dose series of 2024-2025 mRNA COVID-19 vaccine (same manufacturer)

• Unvaccinated persons aged ≥12 years: Either 3 doses of 2024-2025 mRNA vaccine (same manufacturer) or 2 doses of 2024-2025 Novavax

• Previously vaccinated immunocompromised individuals: At least 1 dose of 2024-2025 COVID-19 vaccine, with potential for additional doses

• Additional doses: Those who completed an initial series and received ≥1 dose of 2024-2025 vaccine may receive 1 additional dose ≥2 months after the last dose 1

• Further doses: May be administered based on clinical judgment and personal circumstances, with at least 2 months between doses 1

Safety Considerations

Safety data from previous COVID-19 vaccination campaigns have shown:

• Local and systemic reactions are expected after booster doses but are generally mild to moderate 2
• Among v-safe registrants who received a third dose, 79.4% reported local reactions and 74.1% reported systemic reactions, similar to rates after the second dose (77.6% and 76.5%, respectively) 2
• For second boosters in adults ≥50 years, reactions were less frequent compared to first booster doses 3

Effectiveness Considerations

• During Omicron variant predominance, vaccine effectiveness (VE) against emergency department/urgent care visits was 87% during the first 2 months after a third dose but decreased to 66% at 4-5 months 4
• VE against hospitalizations was 91% during the first 2 months after a third dose and decreased to 78% at ≥4 months 4
• VE is generally higher for protection against hospitalizations than against emergency department/urgent care visits 4

Special Considerations

• Previous infection: Persons who recently had SARS-CoV-2 infection may consider delaying vaccination by 3 months from symptom onset or positive test 1

• Janssen (Johnson & Johnson) recipients: Should preferentially receive an mRNA vaccine booster due to risk for thrombosis with thrombocytopenia syndrome 1, 5

• Adverse event reporting: Healthcare providers should report adverse events to the Vaccine Adverse Event Reporting System (VAERS) 1

Common Pitfalls to Avoid

1. Incorrect dosing intervals: Ensure proper timing between doses based on vaccine type and patient history

2. Mixing vaccine types inappropriately: Follow recommendations for homologous vs. heterologous boosting

3. Overlooking immunocompromised status: These patients require different dosing schedules and may benefit from additional doses

4. Delaying vaccination unnecessarily: While those with recent infection may delay vaccination by 3 months, unnecessary delays leave individuals vulnerable to COVID-19

5. Continuing to use outdated vaccine formulations: Use the 2024-2025 COVID-19 vaccines that target current circulating variants

By following these updated recommendations, healthcare providers can help optimize protection against COVID-19, particularly for those at increased risk for severe illness and death.