Before 2025, CDC recommended that all doses of COVID-19 vaccine given to children age 6 months through 4 years be from the same manufacturer. However, beginning with the 2025–26 season, only Moderna’s Spikevax mRNA vaccine has been licensed and recommended for use in children younger than age 5 years. AAP and CDC recommend that all children in this age group who are vaccinated against COVID-19 receive Spikevax, regardless of the brand they received in previous seasons. AAP and CDC recommend that if the child is age 6 months through 23 months and received an incomplete (1- or 2-dose) initial COVID-19 vaccination series with Pfizer-BioNTech, a 3-dose initial series should be completed with Spikevax. It is not necessary to start the initial series over.
In previously unvaccinated people age 5 years or older with moderate or severe immunocompromise, CDC recommends the same manufacturer for all initial COVID-19 vaccine series doses (either 2 doses of Nuvaxovid [if age 12 years or older] or 3 doses of an mRNA product). After completion of the initial series, any age-appropriate COVID-19 vaccine may be used in this age group.
CDC sets out conditions when it is acceptable to use an age-appropriate COVID-19 vaccine from a different manufacturer in any situation where CDC recommends the same manufacturer:
- Same vaccine not available at the time of the clinic visit
- Previous dose unknown
- Person would otherwise not receive a recommended vaccine dose
- Person starts but unable to complete a vaccination series with the same COVID-19 vaccine due to a contraindication
Last reviewed:
October 18, 2026
CDC recommends vaccination for children age 6 months through 17 years with moderate or severe immunocompromise. For all other children in this age group, CDC recommends shared clinical decision-making, emphasizing the greater benefit for children at increased risk of severe disease. CDC recommends vaccination for all adults beginning at age 18 years: www.cdc.gov/covid/hcp/vaccine-considerations/routine-guidance.html.
AAP’s 2026–27 recommendations cover children and adolescents through age 18 years. Refer to the full statement and the 2026 AAP immunization schedule: https://doi.org/10.1542/peds.2026-079045; www.aap.org/ImmunizationSchedule. In summary, AAP recommends age-appropriate COVID-19 vaccination of the following groups:
- All children age 6 months through 23 months
- Residents of long-term care facilities or other congregate settings
- Children who have never been vaccinated against COVID-19
- Infants and children with household contacts who are at high risk for severe COVID-19
- All children who are at risk of severe COVID-19 due to underlying conditions or treatments, including: chronic pulmonary disease, cardiovascular disease, gastrointestinal disorders, hepatic disease, hematologic disease, metabolic disorders, obesity, neurologic and neurodevelopmental conditions, immunosuppressive conditions, and rheumatologic or autoimmune disease
- Children age 2 through 18 years not in the above categories whose parent or guardian desires their protection from COVID-19
Last reviewed:
October 18, 2026
AAP specifically recommends a single, age-appropriate, current-season dose for children age 2 through 18 years who have never been vaccinated, even without another risk condition. AAP also recommends vaccination for children in this age range with high-risk household contacts. Finally, AAP supports vaccination of any child whose parent or guardian wants them to be protected through vaccination. CDC recommends vaccination based on shared clinical decision-making between parent or guardian and healthcare provider for all children without moderate or severe immunocompromise. For additional details, see https://doi.org/10.1542/peds.2026-079045 and www.cdc.gov/covid/hcp/vaccine-considerations/routine-guidance.html.
Last reviewed:
October 18, 2026
AAP recommends giving the updated vaccine as soon as it is available and the child is eligible, rather than waiting for a particular point in the season. AAP also supports vaccination later in the year for eligible children who missed fall vaccination because SARS-CoV-2 circulates year-round. COVID-19 and influenza vaccines may be coadministered. It is acceptable to delay vaccination for up to 3 months following a confirmed COVID-19 infection, due to the reduced risk of infection in the weeks following an infection and evidence of a better response to vaccination if spaced longer after an infection. Individual risk and local epidemiology may also affect timing decisions. See https://doi.org/10.1542/peds.2026-079045.
Last reviewed:
October 18, 2026
AAP recommends that this child receive one dose recommended for his age at the time of the vaccination visit. At age 11 years, an age-appropriate single dose of either Comirnaty (Pfizer-BioNTech) or Spikevax (Moderna) mRNA vaccine is recommended. If the patient arrives in your clinic after turning 12 years old, the 2026–2027 Nuvaxovid (Sanofi-Novavax) protein subunit vaccine and the mNexspike (Moderna) mRNA vaccine are also options. These single-dose recommendations apply if he is not moderately or severely immunocompromised.
Last reviewed:
October 18, 2026
CDC recommends that moderately or severely immunocompromised children who transition from age 11 years to age 12 years during the initial vaccination series complete the 3-dose series using the dosage for people ages 12 years and older for all doses received once they are age 12 years.
See www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html for additional details.
Last reviewed:
October 18, 2026
Both vaccines have been demonstrated to be safe, with side effects typical of those in older age groups. The most common local reaction in this age group is pain at the injection site; the most common systemic symptom in older children was fatigue and in younger children (6 through 23 months) irritability/crying and sleepiness were most common. Fever may occur after either vaccination. Febrile seizures can occur in infants and young children ages 6 months through 5 years as a result of any condition that causes a fever (most common with high fevers). Febrile seizures are uncommon after vaccination. Febrile seizures were rare after mRNA COVID-19 vaccine clinical trials in this age group, and CDC continues to monitor for this adverse event following vaccination in infants and young children.
No cases of myocarditis were reported during the clinical trials for either vaccine. To date, post-authorization surveillance has not detected an increased risk for myocarditis and pericarditis following mRNA COVID-19 vaccination in children ages 6 months–4 years (Pfizer-BioNTech) and ages 6 months–5 years (Moderna).
Last reviewed:
October 18, 2026
Last reviewed:
June 22, 2023
If exactly half the required volume was given, CDC allows the other half to be administered on the same clinic day and the two injections to count as one dose. If the error cannot be corrected on the same clinic day, a full repeat dose should be given as soon as feasible. CDC’s error guidance also allows consideration of an 8-week interval before a repeat dose for people age 6 months through 64 years who are not moderately or severely immunocompromised, to potentially reduce the rare myocarditis risk. For guidance on a range of dosing errors, refer to CDC at www.cdc.gov/covid/hcp/vaccine-considerations/appendices.html.
Last reviewed:
October 18, 2026
