COVID-19 Vaccination and Transmission Risk in Individuals 18 Years and Under
Current Recommendations
The COVID-19 vaccine does not have sufficient evidence to demonstrate reduced transmission specifically in individuals 18 years and under, though it is still recommended for this age group primarily for its benefits in reducing disease severity and mortality. 1
The Advisory Committee on Immunization Practices (ACIP) and CDC recommend COVID-19 vaccination for all persons aged ≥6 months, including those 18 years and under, with the primary goal of reducing morbidity and mortality from COVID-19 infection rather than specifically targeting transmission reduction 1, 2.
Evidence on Transmission Reduction
The current guidelines and research do not provide strong evidence specifically addressing transmission reduction in the under-18 population:
- The 2024-2025 ACIP recommendations focus on the vaccine's ability to prevent severe COVID-19 illness, hospitalization, and death rather than transmission prevention 1
- The CDC's vaccination schedule for children and adolescents includes COVID-19 vaccines but does not make specific claims about transmission reduction 1
- Available studies on COVID-19 vaccines in children primarily report on safety, efficacy against symptomatic disease, and immunogenicity rather than transmission reduction 3, 4
Vaccination Benefits in Children and Adolescents
Despite limited evidence on transmission reduction, COVID-19 vaccination in individuals ≤18 years offers important benefits:
- High efficacy (>90%) against COVID-19 disease in children aged 5-11 years 3
- Protection against severe outcomes including multisystem inflammatory syndrome in children (MIS-C) and death 5
- Acceptable safety profile with mostly mild to moderate adverse reactions 6, 4
Vaccination Coverage and Implementation
Current vaccination coverage among children and adolescents in the US shows significant gaps:
- 61.8% of children ages 12-17 years have completed the primary series
- 32.9% of children ages 5-11 years have completed the primary series
- Only 5.5% of children ages 6 months-4 years have completed the primary series 5
Current Vaccination Schedule
For the 2024-2025 COVID-19 vaccination season:
- Previously unvaccinated individuals ≥12 years: Either Moderna or Pfizer-BioNTech (1 dose) or Novavax (2 doses, 3-8 weeks apart)
- Previously vaccinated individuals ≥12 years: 1 dose, ≥8 weeks after last dose, of Moderna, Pfizer-BioNTech, or Novavax
- Children 6 months-4 years: Initial multidose series including at least 1 dose of 2024-2025 COVID-19 vaccine 1, 2
Important Considerations
Focus on individual protection: Current recommendations emphasize protecting the individual from severe disease rather than reducing community transmission 1, 2
Broader population impact: While not specifically proven in the under-18 population, modeling studies suggest vaccination campaigns can reduce overall community transmission 7
Balancing risks and benefits: The ACIP has determined that benefits outweigh risks for COVID-19 vaccination in children and adolescents 3
Special populations: Immunocompromised individuals may require additional doses and special consideration 2
Timing after infection: Optimal timing for vaccination after COVID-19 infection is considered to be approximately 3 months, balancing natural immunity with the need for enhanced protection 2
Conclusion
While COVID-19 vaccines are recommended for individuals 18 years and under primarily to reduce disease severity, hospitalization, and death, current guidelines and research do not provide strong evidence specifically demonstrating reduced transmission in this age group. Vaccination decisions should prioritize the well-established benefits of preventing severe COVID-19 outcomes in children and adolescents.