ACIP recommended on September 18, 2025 that all people age 6 months and older in the United States may receive one or more doses of an age-appropriate 2025–2026 Formula COVID-19 vaccination based on individual decision-making, following shared clinical decision-making discussion with a healthcare professional (e.g., a nurse, doctor, or pharmacist). The decision to vaccinate may be influenced by the presence of conditions that increase the risk of severe COVID-19 illness.
Product options include three FDA-licensed mRNA vaccines: Comirnaty (Pfizer-BioNTech, ages 5 years and older); Spikevax (Moderna, ages 6 months and older); mNexspike (Moderna, ages 12 years and older). There is one FDA-licensed adjuvanted protein subunit vaccine: Nuvaxovid (Sanofi-Novavax, ages 12 years and older). Schedules vary by age and immunocompromised status.
Although the FDA licenses limit use of COVID-19 vaccines among recipients younger than age 64 to those with one or more conditions that increases the risk of severe COVID-19, the fact that ACIP did not include any restrictions in its shared clinical decision-making recommendation means that it is an acceptable standard of care for people younger than age 65 without a high risk condition to be vaccinated when desired.
Last reviewed:
November 16, 2025
CDC recommends individual decision-making (also known as shared clinical decision-making) for COVID-19 vaccination of all people age 6 months and older. Among people age 6 months through 64 years, ACIP emphasizes that the risk-benefit of vaccination is most favorable for individuals who are at an increased risk for severe COVID-19 disease and lowest for individuals who are not at an increased risk. Details of the vaccination schedule are available here: www.cdc.gov/covid/hcp/vaccine-considerations/routine-guidance.html.
Of note, among previously unvaccinated people who are not moderately or severely immunocompromised, an initial vaccination series is recommended only for young children age 6 through 23 months. All others younger than age 65 years are recommended to receive a single dose of an age-appropriate 2025–2026 formula COVID-19 vaccine. People age 65 years and older are recommended to receive a second 2025–2026 formula COVID-19 vaccine dose 6 months later (minimum interval 2 months if using Comirnaty, Spikevax, or Nuvaxovid; minimum interval 3 months if using mNexspike).
Major U.S. professional medical societies have issued their own recommendations for the 2025–26 COVID-19 season that differ from CDC, primarily in their stronger, routine recommendations for vaccination of people at risk of severe COVID-19 illness:
Last reviewed:
November 16, 2025
People who are moderately or severely immunocompromised are at increased risk for severe COVID-19 illness. ACIP and CDC recommend individual decision-making (also known as shared clinical decision-making) after a discussion with a healthcare professional (nurse, doctor, or pharmacist) for people age 6 months and older who are moderately or severely immunocompromised. They are recommended to receive at least 2 doses during the season. The CDC vaccination schedule for people with moderate or severe immunocompromise is available here: www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html.
The Infectious Diseases Society of America (IDSA) strongly recommends administration of age-appropriate 2025–2026 COVID-19 vaccinations to all adults and children with compromised immunity. They also recommend that household members and close contacts of immunocompromised people should be up to date with COVID-19 vaccination. See IDSA recommendations for full details: www.idsociety.org/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/.
Last reviewed:
November 16, 2025
In past seasons, CDC recommended that all doses of COVID-19 vaccine given to children age 6 months through 4 years be from the same manufacturer. However, in the 2025–26 season, only Moderna’s Spikevax mRNA vaccine is licensed and recommended for use in children younger than age 5 years. All children in this age group who are vaccinated against COVID-19 should receive Spikevax, regardless of the brand they received in previous seasons. 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 repeat the initial series.
In previously unvaccinated people age 5 years or older with moderate or severe immunocompromise, the same manufacturer is recommended 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 the same manufacturer is recommended:
- 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:
November 16, 2025
Individuals with moderate to severe immunocompromise who have completed an initial COVID-19 series should receive two dose of 2025–2026 Formula COVID-19 vaccine this season with the second dose given 6 months later (minimum interval 2 months for Comirnaty, Spikevax, and Nuvaxovid; minimum interval 3 months for mNexspike).
In previous seasons, CDC recommended that additional doses of COVID-19 vaccine may be administered (with a minimum two-month interval) based on the clinical judgment of the individual’s healthcare provider and the recipient’s personal preference and circumstances. For the 2025–26 season, CDC has removed this general statement from its interim clinical considerations document (www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html). The CDC clinical considerations document now states, “On a case-by-case basis, providers caring for these patients may administer Moderna, Novavax, and Pfizer-BioNTech COVID-19 vaccines outside of the FDA and CDC dosing intervals when, based on their clinical judgment, the benefits of vaccination are deemed to outweigh the potential and unknown risks for the recipient who is immunocompromised.”
Last reviewed:
November 16, 2025
Janssen (Johnson & Johnson) COVID-19 vaccine is no longer produced. The last remaining doses expired May 7, 2023. The history of Janssen vaccine use is relevant only to evaluation of an adult with moderate or severe immunocompromise because such individuals are recommended to receive an initial series of COVID-19 vaccine. History of a single dose of Janssen COVID-19 vaccine constitutes a complete initial series. A person with this history should follow the vaccination schedule recommended for an immunocompromised person who has already completed an initial vaccination series.
Last reviewed:
November 16, 2025
Yes. Vaccination should be offered regardless of history of prior SARS-CoV-2 infection or long COVID.
Because COVID-19 illness temporarily boosts immunity, people who have recently had SARS-CoV-2 infection may consider delaying a 2025–2026 COVID-19 vaccine dose by up to 3 months following symptom onset or positive COVID-19 test (if asymptomatic). Studies have shown that a longer time between infection and vaccination may improve the immune response to vaccination. The likelihood of reinfection in the first few months following infection is low.
A recipient’s individual risks for severe disease and current COVID-19 conditions in the community should be taken into account when deciding whether to delay vaccination up to 3 months after infection. As with all vaccines, vaccination should be deferred until after recovery from moderate to severe illness.
Last reviewed:
November 16, 2025
Adults age 65 years and older have the highest rates of hospitalization and death from COVID-19 illness. Protection against severe COVID-19 disease wanes after a few months. Disease surveillance data from the United States shows that SARS-CoV-2 viruses circulate and cause illness at varying levels year-round, with waves of activity observed historically in winter and late summer. It is not known whether this pattern will continue. This pattern is not like influenza, which usually causes a single epidemic wave (sometimes with more than one peak) each winter.
The 2025 CDC adult immunization schedule shows that adults age 65 years and older who are vaccinated against COVID-19 are recommended to receive a second dose of any 2025–2026 Formula COVID-19 vaccine 6 months after their first 2025–2026 Formula COVID-19 vaccine dose (minimum interval of 2 months for Comirnaty, Spikevax, and Nuvaxovid; minimum interval of 3 months for mNexspike). The second dose does not have to be the same brand as the first.
Last reviewed:
November 16, 2025
CDC recommends waiting a minimum of 8 weeks (2 months) since the last 2024–2025 Formula COVID-19 vaccine to receive an age-appropriate 2025–2026 Formula COVID-19 vaccine, if using Comirnaty (Pfizer-BioNTech), Nuvaxovid (Sanofi-Novavax), or Spikevax (Moderna). They recommend a 3-month minimum interval when using mNexspike (Moderna); however, a dose of mNexspike administered at least 2 months after the most recent dose does not need to be repeated.
Any person who initiated a COVID-19 vaccination initial series (e.g., a child 6 months through 23 months of age or a person with moderate or severe immunocompromise) with a previous formulation should follow the age-appropriate recommended schedule for completion of their primary series with the current formulation of the same brand, if feasible. For the 2025–26 season, Spikevax is the only licensed and recommended option for children age 6 through 59 months, regardless of their vaccination history.
Last reviewed:
November 16, 2025
