COVID-19 Vaccination Guidelines for 2025
All persons aged ≥6 months should receive the 2024-2025 COVID-19 vaccine, regardless of prior vaccination history. 1
Universal Recommendation
The Advisory Committee on Immunization Practices (ACIP) voted 11-0 (with one abstention) to recommend vaccination with 2024-2025 COVID-19 vaccines for everyone aged ≥6 months. 1 The updated vaccines are monovalent formulations targeting Omicron JN.1 lineage variants (JN.1 and KP.2 strains), specifically designed against currently circulating variants. 1, 2
Immunocompetent Individuals (Without Moderate or Severe Immunocompromise)
Adults and Adolescents (≥12 years)
- One dose of 2024-2025 COVID-19 vaccine is needed to be up to date, regardless of how many prior COVID-19 vaccines received. 1
- Available vaccine options include Moderna (KP.2 strain), Pfizer-BioNTech (KP.2 strain), or Novavax (JN.1 strain). 1, 2
- Minimum interval: ≥8 weeks after the last COVID-19 vaccine dose. 1
- Exception for Novavax-naïve individuals: Those who have never received any COVID-19 vaccine and choose Novavax should receive 2 doses, separated by 3-8 weeks. 1
Children (5-11 years)
- One dose of 2024-2025 COVID-19 vaccine (Moderna or Pfizer-BioNTech only) is needed to be up to date. 1
- Novavax is not authorized for this age group. 1
Young Children (6 months-4 years)
- Require a multidose initial vaccination series when first receiving COVID-19 vaccination, including at least 1 dose of the 2024-2025 vaccine. 1
- The specific number of doses depends on the vaccine manufacturer and prior vaccination history. 1
Moderately or Severely Immunocompromised Individuals
Key Principle
All immunocompromised persons aged ≥6 months should receive at least 1 dose of 2024-2025 COVID-19 vaccine, with additional doses often recommended. 1, 3
Unvaccinated Immunocompromised Persons
- Ages 6 months-11 years: Receive a 3-dose initial series of 2024-2025 mRNA COVID-19 vaccine (all doses from the same manufacturer). 1
- Ages ≥12 years: Complete an initial series with either:
- 3 doses of 2024-2025 mRNA vaccine (same manufacturer), OR
- 2 doses of 2024-2025 Novavax vaccine. 1
Previously Vaccinated Immunocompromised Persons
- Should receive at least 1 dose of 2024-2025 vaccine, with the possibility of 1 additional age-appropriate dose at least 2 months later. 3
- The decision for additional doses should be guided by assessment of immune status and clinical judgment. 3
Special Considerations for Cancer Patients
- All cancer patients should be considered moderately or severely immunocompromised and follow enhanced vaccination schedules. 2, 3
- Ideally vaccinate at least 2 weeks before initiation or resumption of immunosuppressive therapies. 2, 3
- Coordination with oncology teams is essential to optimize timing during active treatment. 3
Timing Considerations
Recent COVID-19 Infection
- May consider delaying vaccination by 3 months after symptom onset or positive test to allow natural immune response to mature. 4, 2, 3
- This is optional, not mandatory. 4
Interval Between Doses
- For most previously vaccinated individuals: ≥8 weeks after last dose. 1
- For additional doses in immunocompromised individuals: ≥2 months after the initial 2024-2025 dose. 3
Vaccine Interchangeability
The vaccine manufacturer does not need to match prior vaccinations. 4, 2 Individuals can choose from available vaccine options based on age-appropriate formulations. 1, 2
Economic and Clinical Rationale
COVID-19 vaccines are most cost-effective in adults aged ≥65 years, with an incremental cost-effectiveness ratio of $23,308 per quality-adjusted life year. 1 This age group experiences the highest rates of severe COVID-19 and accounts for 67% of COVID-19-associated hospitalizations. 5 The updated 2024-2025 formulations provide better protection against current variants than previous vaccine series. 2, 3
Common Pitfalls to Avoid
- Do not delay vaccination beyond recommended timeframes, as this prolongs suboptimal protection, especially for high-risk individuals. 2, 3
- Do not overlook immunocompromised status, which warrants additional doses beyond the standard single dose. 2, 3
- Do not assume prior vaccination is sufficient—the 2024-2025 formulation is recommended for everyone regardless of vaccination history. 1, 2
- Do not count pediatric doses as valid adult doses if administered in error; an additional age-appropriate dose should be given ≥8 weeks later. 4
- Report vaccination errors to VAERS as required. 4
Household Protection for High-Risk Individuals
All household members of immunocompromised individuals should be up-to-date with COVID-19 vaccines to provide indirect protection. 3