What are the recommendations for receiving a new Covid-19 vaccine, such as Pfizer-BioNTech (mRNA vaccine) or Moderna (mRNA vaccine), including booster doses and additional shots for immunocompromised individuals?

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Last updated: August 16, 2025View editorial policy

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COVID-19 Vaccination Recommendations

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, 2

General Recommendations by Age Group

Adults and Adolescents (≥12 years)

  • Previously unvaccinated:
    • Option 1: One dose of Moderna or Pfizer-BioNTech 2024-2025 COVID-19 vaccine 1
    • Option 2: Two doses of Novavax 2024-2025 COVID-19 vaccine, administered 3-8 weeks apart 1, 2
  • Previously vaccinated: One dose of 2024-2025 COVID-19 vaccine (Moderna, Pfizer-BioNTech, or Novavax), administered ≥8 weeks after the last COVID-19 vaccine dose 1

Children (5-11 years)

  • Previously unvaccinated: One dose of Moderna or Pfizer-BioNTech 2024-2025 COVID-19 vaccine 1, 2
  • Previously vaccinated: One dose of 2024-2025 COVID-19 vaccine (Moderna or Pfizer-BioNTech), administered ≥8 weeks after the last COVID-19 vaccine dose 1

Young Children (6 months-4 years)

  • Require a multi-dose primary series:
    • Previously unvaccinated: 2 doses of Moderna (4-8 weeks between doses) or 3 doses of Pfizer-BioNTech (3-8 weeks between doses 1 and 2; ≥8 weeks between doses 2 and 3) 2
    • At least 1 dose should be with a 2024-2025 COVID-19 vaccine 3

Special Recommendations for Immunocompromised Individuals

Adults and Adolescents (≥12 years) with Immunocompromise

  • Previously unvaccinated: Complete an initial vaccination series with either:
    • 3 doses of 2024-2025 mRNA COVID-19 vaccine from the same manufacturer, or
    • 2 doses of 2024-2025 Novavax COVID-19 vaccine 1
  • Previously vaccinated: At least 1 dose of 2024-2025 COVID-19 vaccine, with potential for additional doses based on clinical judgment 1, 2

Children (6 months-11 years) with Immunocompromise

  • Previously unvaccinated: 3-dose series of 2024-2025 mRNA COVID-19 vaccine from the same manufacturer 1, 3
  • Previously vaccinated with 1-2 doses: Complete the three-dose series with 2024-2025 COVID-19 vaccine 3
  • Previously vaccinated with ≥3 doses: One dose of 2024-2025 COVID-19 vaccine, administered at least 2 months after the last dose 3

Timing Considerations

  • For those who recently had SARS-CoV-2 infection, consider delaying vaccination by 3 months from symptom onset or positive test 1, 2
  • Additional doses may be administered with at least 2 months between doses, based on clinical judgment and personal circumstances 2, 3

Safety Profile

Safety monitoring of COVID-19 vaccines has shown that adverse events are generally consistent with those reported after previous vaccine doses 4:

  • Common reactions include injection site pain, fatigue, headache, and muscle pain
  • Serious adverse events are rare (4.5% of reported events) 4
  • Health impacts after vaccination are less frequent and less severe than those associated with COVID-19 illness 4

Key Considerations for Implementation

  • Economic analyses show COVID-19 vaccines are most cost-effective in adults aged ≥65 years, who experience the highest rates of severe COVID-19 1
  • Bivalent COVID-19 vaccine booster doses improve protection against SARS-CoV-2 Omicron sublineages and are important to protect against COVID-19, particularly among those at increased risk for severe illness and death 1

Common Pitfalls to Avoid

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

  2. Mixing vaccine manufacturers in primary series: For immunocompromised individuals completing a primary series, use the same manufacturer for all doses when possible 1, 3.

  3. Ignoring vaccination history: The appropriate 2024-2025 vaccination schedule depends on previous COVID-19 vaccination history, so accurate documentation is essential 1, 2.

  4. Overlooking special populations: Immunocompromised individuals require additional protection with modified dosing schedules 1, 2, 3.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

COVID-19 Vaccination Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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