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Ask the Experts: COVID-19: For Special Populations

Results (15)

ACOG recommends COVID-19 vaccination during pregnancy and permits vaccination in any trimester, emphasizing receipt as soon as a dose is due to protect maternal and infant health. ACOG also recommends vaccination for eligible postpartum and lactating patients.

CDC’s September 2026 clinical considerations recommend vaccination for all adults, but its pregnancy and breastfeeding section emphasizes product-specific data in FDA package inserts. Previous versions of CDC recommendations have emphasized the evidence for the safety and benefits of COVID-19 vaccination during pregnancy; however, changes made to the website since 2025 have resulted in this information being removed from CDC’s website. As a result, CDC’s guidance no longer echoes ACOG’s strong pregnancy-specific recommendation, although no evidence supports a change in previous conclusions on the safety and effectiveness of the vaccine during pregnancy. See www.acog.org/clinical-information/maternal-immunization-schedule and www.cdc.gov/covid/hcp/vaccine-considerations/special-situations-and-populations.html.

Last reviewed: October 18, 2026

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 nonreplicating 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 nonreplicating 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.

The American College of Obstetricians and Gynecologists (ACOG) recommends all pregnant women receive any age-appropriate 2026–2027 COVID-19 vaccine if they are due for vaccination; ACOG recommends vaccination in any trimester as soon as possible to protect maternal and infant health. 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. ACOG’s 2026 maternal schedule is available at www.acog.org/clinical-information/maternal-immunization-schedule.

Last reviewed: October 18, 2026

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.

CDC’s September 2026 clinical considerations have removed text documenting the safety and benefits of COVID-19 vaccination during pregnancy; however, CDC continues to routinely recommend COVID-19 vaccination for all adults, including during pregnancy, and pregnancy is a high-risk condition for severe COVID-19.

The American College of Obstetricians and Gynecologists (ACOG) routinely recommends all pregnant women receive any age-appropriate 2026–2027 COVID-19 vaccine if they have not already received one. ACOG recommends vaccination in any trimester as soon as possible when a dose is due. ACOG’s guidance does not call for an extra dose solely because a person becomes pregnant after receiving the current-season 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. ACOG’s 2026 maternal schedule is available at www.acog.org/clinical-information/maternal-immunization-schedule.

Last reviewed: October 18, 2026


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Last reviewed: January 9, 2026

Yes. The American College of Obstetricians and Gynecologists (ACOG) recommends COVID-19 vaccination for eligible lactating and postpartum patients. Breastfeeding does not need to be interrupted for vaccination. See www.acog.org/clinical-information/maternal-immunization-schedule.

Last reviewed: October 18, 2026

IDSA strongly recommends age-appropriate 2026–2027 COVID-19 vaccination for immunocompromised adults and children, with timing tailored to the condition and treatment. Details of timing considerations are provided in Table 1 of the IDSA recommendations at: www.idsociety.org/practice-guideline/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/. For children and adolescents through age 18 years, use AAP’s 2026 immunization schedule: www.aap.org/ImmunizationSchedule. CDC provides detailed schedule tables here: www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html.

Immunize.org also provides current COVID-19 vaccination resources and standing orders templates on its main page: www.immunize.org/vaccines/a-z/covid-19/. The following links provide standing orders templates:

Due to the timing and clinical considerations outlined by IDSA, the standing orders templates refer moderately or severely immunocompromised patients for individual clinical evaluation rather than providing their complete dosing schedule. Use the AAP or CDC schedules linked above for dosing schedules.

CDC recommends that people who are moderately or severely immunocompromised and previously unvaccinated 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. These recommendations were originally made in the 2023–24 season and are endorsed by IDSA.

CDC recommends that those who completed an initial series before the 2026–2027 vaccines were available receive 2 doses of 2026–2027 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).

IDSA recommends a single dose of current season vaccine and remarks that a second dose 6 months later may extend protection, but it does not routinely recommend a second dose.

AAP’s 2026 schedule permits additional doses for moderately or severely immunocompromised children and adolescents based on shared clinical decision-making, at least 2 months after the most recent dose. For ages 12 through 18 years, AAP lists a 2-month minimum interval for the post-initial-series dose, including either Moderna product; CDC specifically recommends a 3-month interval when using mNexspike.

Last reviewed: October 18, 2026

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. CDC recommends deferring to the patient’s clinical care team 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.

IDSA did not change the definition of conditions considered moderately or severely immunocompromising when it issued its 2026 guidance. See Infectious Diseases Society of America (IDSA) recommendations for the immunocompromised at:  www.idsociety.org/practice-guideline/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/.

Last reviewed: October 18, 2026

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.

The Infectious Diseases Society of America (IDSA) also addresses people with immunocompromise, including revaccination, in its guidance: www.idsociety.org/practice-guideline/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/.

Last reviewed: October 18, 2026

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. CDC’s considerations for COVID-19 vaccination of those on immunosuppressive therapies here: www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html

CDC states that 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.

The Infectious Diseases Society of America (IDSA) 2026 guidance provides condition-specific timing, including consideration of vaccination at least 3–6 months after the last B-cell-depleting infusion. IDSA allows for vaccination during treatment when optimal timing is not feasible, and notes that the immune response may be reduced. IDSA recommends coordinating timing decisions with the treating specialist: www.idsociety.org/practice-guideline/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/.

Last reviewed: October 18, 2026

CDC and medical societies all agree that people may self-attest to a high-risk condition, including moderate or severe immunocompromise and should not be denied vaccination because they lack documentation.

Last reviewed: October 18, 2026


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Last reviewed: January 9, 2026

CDC recommends that immunocompromised people who need an initial series of 3 doses of mRNA COVID-19 vaccine or two doses of Nuvaxovid (Sanofi-Novavax) adjuvanted protein COVID-19 vaccine 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 2026–2027 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 when age-appropriate: both vaccines are made by Moderna.

Last reviewed: October 18, 2026

Under CDC’s guidance, 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 2026–2027 COVID-19 vaccine (at least 8 weeks after their most recent dose of a previous formulation for Comirnaty, Spikevax, or Nuvaxovid; at least 3 months for mNexspike). CDC routinely recommends they receive a second 2026–2027 COVID-19 vaccine dose 6 months later (minimum interval 2 months for Comirnaty, Spikevax, and Nuvaxovid; minimum interval of 3 months if using mNexspike). Infectious Diseases Society of America (IDSA) simply remarks that a second current-season dose may extend protection.

Last reviewed: October 18, 2026

CDC recommends (and IDSA concurs with this schedule) that the patient receive a 2026–2027 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 2026–2027 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: October 18, 2026

The Infectious Diseases Society of America (IDSA) published 2026 recommendations for the use of influenza, RSV, and COVID-19 vaccines in people with immunocompromise (see www.idsociety.org/practice-guideline/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/). Its timing considerations align with AAP recommendations for timing of influenza vaccination of children with immunocompromise. A table with timing considerations is available at www.idsociety.org/globalassets/idsa/practice-guidelines/vaccine-gl/table-3-2026..pdf

Last reviewed: October 11, 2026

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