What are the current recommendations for Covid-19 (Coronavirus Disease 2019) vaccination?

COVID-19 Vaccination Recommendations

All persons aged ≥6 months should receive the updated 2024-2025 COVID-19 vaccine, regardless of prior vaccination history. 1

Universal Vaccination 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 This represents a universal recommendation that applies to all eligible individuals, whether previously vaccinated or not. 1, 2

The 2024-2025 vaccines are updated monovalent formulations specifically targeting currently circulating Omicron JN.1 lineage variants (JN.1 and KP.2 strains), providing superior protection compared to previous vaccine formulations. 1

Vaccine Options for 2024-2025

Available vaccines include:

• Moderna (KP.2 strain): Ages ≥6 months 1
• Pfizer-BioNTech (KP.2 strain): Ages ≥6 months 1
• Novavax (JN.1 strain): Ages ≥12 years only 1

The vaccine manufacturer does not need to match prior vaccinations—patients can choose any age-appropriate vaccine. 3, 2

Dosing Schedule for Immunocompetent Persons

Adults and Adolescents (≥12 years)

• One dose of 2024-2025 vaccine needed to be up to date 1, 2
• Minimum interval: ≥8 weeks after last COVID-19 vaccine dose 1
• Exception: Unvaccinated persons choosing Novavax require 2 doses, spaced 3-8 weeks apart 1

Children (5-11 years)

• One dose of 2024-2025 mRNA vaccine (Moderna or Pfizer-BioNTech only) 1, 2
• Minimum interval: ≥8 weeks after last dose 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 1
• Must include at least 1 dose of the 2024-2025 vaccine to be up to date 1
• Specific schedules vary by vaccination history and manufacturer 1

Dosing Schedule for Immunocompromised Persons

Persons with moderate or severe immunocompromise require enhanced vaccination schedules. 1, 2

Previously Unvaccinated Immunocompromised Persons

• Ages 6 months-11 years: 3-dose initial series of 2024-2025 mRNA vaccine (all doses from same manufacturer) 1, 2
• Ages ≥12 years: Either 3 doses of 2024-2025 mRNA vaccine (same manufacturer) OR 2 doses of 2024-2025 Novavax 1

Previously Vaccinated Immunocompromised Persons

• At least 1 dose of 2024-2025 vaccine required 1, 2
• Additional doses may be recommended depending on vaccination history 1
• Cancer patients should be considered moderately or severely immunocompromised and follow these enhanced schedules 2

Special Timing Considerations

Recent COVID-19 infection: Consider delaying vaccination by 3 months after symptom onset or positive test to allow natural immune response to mature. 3, 2 This is optional, not mandatory.

Cancer patients: Ideally vaccinate at least 2 weeks before initiation or resumption of immunosuppressive therapies. 2

Economic and Clinical Rationale

COVID-19 vaccines demonstrate the highest cost-effectiveness 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, making vaccination particularly critical. 1

Vaccine effectiveness data from the bivalent era showed protection of 62% against hospitalization in immunocompetent adults during the first 7-59 days after vaccination, declining to 24% by 120-179 days. 4 Protection was sustained longer against critical outcomes including ICU admission and in-hospital death. 4 Immunocompromised persons showed lower initial effectiveness (28%) and more rapid waning, supporting the need for additional doses in this population. 4

Safety Profile

Local and systemic reactions are expected and frequently reported (60.8% injection site reactions, 54.8% systemic reactions in the week after vaccination), but fewer than 1% of vaccinated persons require medical care. 5 Serious adverse events are uncommon (4.5% of reported events). 5 These reactions are less severe than complications from COVID-19 illness itself. 5

Critical Pitfalls to Avoid

• Do not delay vaccination beyond recommended timeframes, as this prolongs suboptimal protection, especially for high-risk individuals. 2
• Do not overlook immunocompromised status, which warrants additional doses beyond the standard single dose. 2
• Do not assume prior vaccination is sufficient—the 2024-2025 formulation is recommended for everyone regardless of vaccination history. 2
• Do not count pediatric doses as valid adult doses if administered in error—an additional age-appropriate dose should be given at least 8 weeks later. 3
• Do not use Janssen (Johnson & Johnson) vaccine except in very limited situations due to thrombosis with thrombocytopenia syndrome risk. 3