Ask the Experts: COVID-19: For Special Populations

Results (12)

Yes. Evidence continues to demonstrate that COVID-19 vaccination is safe and effective during any stage of pregnancy; the benefits of vaccination clearly outweigh any known or potential risks of COVID-19 vaccination during pregnancy. The currently licensed COVID-19 vaccines are non-replicating vaccines and cannot cause infection in either the mother or the fetus. No evidence exists of risk to the fetus from vaccinating during pregnancy with non-replicating vaccines in general.

Data from the Vaccine Adverse Events Reporting System (VAERS), the V-safe surveillance system, and the V-safe pregnancy registry have not signaled any safety concerns related to vaccination during pregnancy for mother or infant.

Pregnant women have historically been at an increased risk of severe disease, adverse pregnancy outcomes, and maternal death from COVID-19 infections. ACIP recommends the use of 2025–2026 COVID-19 vaccine during pregnancy based upon individual decision-making (i.e., shared clinical decision-making).

The American College of Obstetricians and Gynecologists (ACOG) recommends all pregnant women receive any age-appropriate 2025–2026 Formula COVID-19 vaccine if they have not already received one. Current ACOG recommendations are available here: www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care.

Last reviewed: November 16, 2025

Pregnant women have historically been at an increased risk of severe disease, adverse pregnancy outcomes, and maternal death from COVID-19 infections. Studies have shown that antibodies produced after COVID-19 vaccination during pregnancy are transferred to the newborn, and COVID-19 vaccination during pregnancy reduces the risk of COVID-19 hospitalization in infants younger than 6 months.

ACIP recommends the use of 2025–2026 COVID-19 vaccine during pregnancy based upon individual decision-making (i.e., shared clinical decision-making) after a discussion with a nurse, doctor, or pharmacist.

The American College of Obstetricians and Gynecologists (ACOG) recommends all pregnant women receive any age-appropriate 2025–2026 Formula COVID-19 vaccine if they have not already received one. A person who is up to date on COVID-19 vaccination and becomes pregnant is not recommended to get an additional dose. Current ACOG recommendations are available here: www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care.

Last reviewed: November 16, 2025


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Last reviewed: November 16, 2025

Yes. COVID-19 vaccination may be given during lactation.

Last reviewed: November 16, 2025

Please see CDC’s Interim Clinical Considerations for the Use of COVID-19 Vaccines for dosage guidance for detailed tables, including dosing intervals and options (www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html). You will also find the vaccination schedules for people who are moderately or severely immunocompromised in the Immunize.org standing orders templates for administration of COVID-19 vaccines:

In general, people who are moderately or severely immunocompromised and previously unvaccinated are recommended to receive a 2-dose (protein subunit) or 3-dose (mRNA) initial series of COVID-19 vaccine, with an additional dose 6 months later of any age-appropriate COVID-19 brand (minimum interval of 2 months for Nuvaxovid, Spikevax, or Comirnaty; 3-month minimum interval for mNexspike). CDC recommends use of the same manufacturer for all doses of the initial series when feasible. Spikevax and mNexspike are both made by Moderna and are interchangeable in ages 12 years and older.

Those who completed an initial series before the 2025–2026 formula vaccines were available should receive 2 doses of 2025–2026 Formula COVID-19 vaccine (any age-appropriate brand) about 6 months apart (minimum interval of 2 months for Nuvaxovid, Spikevax, or Comirnaty; 3-month minimum interval for mNexspike).

Immunocompromised people should be counseled that they may have a reduced immune response to COVID-19 vaccination. Continuing other infection prevention measures, such as wearing a face mask and avoiding crowds, can help limit their risk of exposure to the SARS-CoV-2 virus.

Pemivibart (Pemgarda, Invyvid) is a monoclonal antibody for COVID-19 pre-exposure prophylaxis in people who are moderately or severely immunocompromised and unlikely to mount an adequate immune response to COVID-19 vaccination and who meet the FDA-authorized conditions for use. See additional information from CDC at the immunocompromised link in the first paragraph.

Last reviewed: November 16, 2025

The conditions and treatments that CDC specifies may result in moderate or severe immunocompromise include but are not limited to:

  • Active treatment for solid tumor and hematologic malignancies
  • Hematologic malignancies associated with poor responses to COVID-19 vaccines regardless of current treatment status (e.g., chronic lymphocytic leukemia, non-Hodgkin lymphoma, multiple myeloma, acute leukemia)
  • Receipt of solid-organ transplant or an islet transplant and taking immunosuppressive therapy
  • Receipt of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic cell transplant (HCT) (within 2 years of transplantation or taking immunosuppressive therapy)
  • Moderate or severe primary immunodeficiency (e.g., common variable immunodeficiency disease, severe combined immunodeficiency, DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced HIV infection (people with HIV and CD4 cell counts less than 200/mm³, history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV) or untreated HIV infection
  • Active treatment with high-dose corticosteroids (i.e., 20 mg or more of prednisone or equivalent per day when administered for 2 or more weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory (e.g., B-cell-depleting agents)

Additional factors to consider in assessing the general level of immune competence in a patient include disease severity, duration, clinical stability, complications, comorbidities, and any potentially immune-suppressing treatment. A patient’s clinical care team is in the best position to evaluate the degree of immunocompromise and timing of vaccination.

See CDC’s interim clinical considerations for this population: www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html.

Last reviewed: November 16, 2025

Yes. See revaccination considerations at www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html. This is the most current statement from CDC on COVID-19 revaccination:

Recipients of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic cell transplant (HCT) who received 1 or more doses of COVID-19 vaccine prior to or during treatment should be revaccinated. Revaccination should start at least 3 months (12 weeks) after transplant or CAR-T-cell therapy and should follow the currently recommended schedule for people who are unvaccinated.

Revaccination may also be considered for patients who received 1 or more doses of COVID-19 vaccine during treatment with B-cell-depleting therapies (e.g., rituximab, ocrelizumab) that were administered over a limited period (e.g., as part of a treatment regimen for certain malignancies) according to the currently recommended schedule for people who are unvaccinated. The suggested interval to start revaccination is about 6 months after completion of the B-cell-depleting therapy. Timing of vaccination for patients who receive B-cell-depleting therapies on a continuing basis (e.g., for treatment of certain autoimmune conditions such as rheumatoid arthritis or multiple sclerosis) is addressed in CDC’s considerations for timing of COVID-19 vaccination in relation to immunosuppressive therapies.

CDC continues to recommend that a patient’s clinical team is best positioned to determine the degree of immune compromise, need for revaccination, and appropriate timing of revaccination.

Last reviewed: November 16, 2025

According to CDC’s interim clinical considerations for the use of COVID-19 vaccines, whenever possible, COVID-19 vaccines should be administered at least 2 weeks before initiation or resumption of immunosuppressive therapies. For patients who receive B-cell-depleting therapies on a continuing basis, COVID-19 vaccines should be administered approximately 4 weeks before the next scheduled therapy.

CDC also notes that timing of COVID-19 vaccination should take into consideration current or planned immunosuppressive therapies, optimization of both the patient’s medical condition and response to vaccination, and individual benefits and risks. Review the CDC’s considerations for COVID-19 vaccination of those on immunosuppressive therapies here: www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html#cdc_cg_special_populations_about-considerations-for-timing-of-covid-19-vaccination-in-relation-to-immunosuppressive-therapies.

On a case-by-case basis, providers caring for these patients may administer COVID-19 vaccines outside of the FDA and CDC dosing schedules based on their clinical judgment of what is most beneficial to the patient.

Last reviewed: November 16, 2025

CDC states that no additional medical documentation is required before administering COVID-19 vaccine. The patient’s self-attestation of a high-risk condition, including moderate or severe immunocompromise, is sufficient. Those who report moderate or severe immunocompromise should be offered the modified schedule for people with moderate or severe immunocompromise. Vaccinators should not deny COVID-19 vaccination to a person due to lack of documentation of a self-reported high-risk condition.

Last reviewed: November 16, 2025

Immunocompromised people who require an initial series of 3 doses of mRNA COVID-19 vaccine or two doses of Nuvaxovid (Sanofi-Novavax) adjuvanted protein COVID-19 vaccine should receive the initial series using COVID-19 vaccines from the same manufacturer, unless it is not feasible. If the same manufacturer cannot be used for all primary series doses (e.g., the brand is unavailable at the time of the vaccination visit, the previous brand is unknown, or the patient would not be vaccinated with the previous brand due to a contraindication or other reason), then administer another age-appropriate brand. Spikevax (Moderna) is the only licensed 2025–2026 Formula COVID-19 vaccine option for children younger than age 5 years. If the immunocompromised recipient is age 5 years or older, once the initial series is complete, any appropriate brand may be used for all subsequent doses. Spikevax and mNexspike are interchangeable: both vaccines are made by Moderna.

Last reviewed: November 16, 2025

The patient’s initial series is considered complete following a single dose of the Janssen COVID-19 Vaccine. People who are moderately or severely immunocompromised and have completed an initial series (no matter how long ago) should now receive 1 dose of an age-appropriate 2025–2026 Formula COVID-19 vaccine (at least 8 weeks after their most recent dose of a previous formulation). They should receive a second 2025–2026 Formula COVID-19 vaccine dose 6 months later (minimum interval 2 months for Comirnaty, Spikevax, and Nuvaxovid; minimum interval of 3 months if using mNexspike).

Last reviewed: November 16, 2025

The patient should receive a 2025–2026 COVID-19 mRNA dose now, of the same manufacturer as the initial two doses (if feasible), in order to complete the 3-dose initial mRNA vaccine series recommended for people with moderate or severe immunocompromise. Advise the patient that he should receive an additional 2025–2026 Formula COVID-19 dose of any brand in 6 months (minimum interval 2 months if using Comirnaty, Spikevax, or Nuvaxovid; minimum interval 3 months if using mNexspike).

Last reviewed: November 16, 2025

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