What is the recommended Covid-19 (Coronavirus Disease 2019) vaccination schedule?

COVID-19 Vaccination Schedule Recommendations for 2024-2025

The Advisory Committee on Immunization Practices (ACIP) recommends that all individuals aged ≥6 months receive at least one dose of the 2024-2025 COVID-19 vaccine, with specific dosing schedules based on age, immunocompromise status, and previous vaccination history. 1

General Recommendations for Non-Immunocompromised Individuals

Adults and Children ≥5 Years:

• Individuals aged ≥5 years without moderate to severe immunocompromise need only 1 dose of 2024-2025 COVID-19 vaccine to be considered up to date 1
• For previously unvaccinated individuals aged ≥12 years:
  • If choosing Moderna or Pfizer-BioNTech: 1 dose is sufficient 1
  • If choosing Novavax: 2 doses are required, administered 3-8 weeks apart 1
• For individuals who previously received ≥1 COVID-19 vaccine dose: 1 dose of any 2024-2025 vaccine (Moderna, Pfizer-BioNTech, or Novavax if ≥12 years) is recommended, administered ≥8 weeks after the last dose 1, 2

Young Children (6 months–4 years):

• Unvaccinated children require a multi-dose primary series:
  • Moderna: 2 doses, administered 4-8 weeks apart 1
  • Pfizer-BioNTech: 3 doses, with 3-8 weeks between doses 1 and 2, and ≥8 weeks between doses 2 and 3 1
• Children with previous vaccination history:
  • Previous Moderna (1 dose): 1 additional dose, administered 4-8 weeks after dose 1 1
  • Previous Moderna (≥2 doses): 1 dose of 2024-2025 vaccine, administered ≥8 weeks after last dose 1
  • Previous Pfizer-BioNTech (1 dose): 2 additional doses, with 3-8 weeks between doses 1 and 2, and ≥8 weeks between doses 2 and 3 1
  • Previous Pfizer-BioNTech (2 doses): 1 additional dose, administered ≥8 weeks after dose 2 1
  • Previous Pfizer-BioNTech (≥3 doses): 1 dose of 2024-2025 vaccine, administered ≥8 weeks after last dose 1

Recommendations for Moderately or Severely Immunocompromised Individuals

• All immunocompromised persons aged ≥6 months should receive at least 1 dose of 2024-2025 COVID-19 vaccine 1
• Unvaccinated immunocompromised individuals aged 6 months–11 years: 3-dose series of a 2024-2025 mRNA COVID-19 vaccine from the same manufacturer 1
• Unvaccinated immunocompromised individuals aged ≥12 years: Either 3 doses of a 2024-2025 mRNA COVID-19 vaccine from the same manufacturer OR 2 doses of 2024-2025 Novavax COVID-19 vaccine 1
• Additional doses may be recommended based on vaccination history 1, 3

Vaccine Efficacy and Clinical Benefits

• COVID-19 vaccination provides significant protection against hospitalization and severe disease 3, 4
• A third dose in immunocompromised individuals significantly improves protection against COVID-19 hospitalization (88% effectiveness) compared to two doses (69% effectiveness) 3
• For immunocompetent individuals, a booster dose provides 97% effectiveness against COVID-19 hospitalization compared to 82% with two doses 3
• Vaccine effectiveness wanes over time, particularly during Omicron variant predominance, highlighting the importance of staying up to date with recommended doses 4

Important Considerations and Pitfalls to Avoid

• The 2024-2025 COVID-19 vaccines are updated monovalent formulations specifically targeting current virus variants (Omicron JN.1-line, including JN.1 and KP.2) 1, 2
• The manufacturer of the 2024-2025 vaccine does not need to match previous COVID-19 vaccines received 2
• Individuals who received a pediatric dose in error should receive an appropriate adult formulation at least 8 weeks after the incorrect dose 2
• For individuals who recently had a SARS-CoV-2 infection, consider delaying vaccination by 3 months after symptom onset or positive test 2
• Myocarditis and pericarditis are rare but serious adverse events associated with mRNA COVID-19 vaccines, with highest risk in males 12-24 years of age 5
• Most adverse reactions after additional doses are mild to moderate and similar to those experienced after the second dose 6