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Ask the Experts: COVID-19: Vaccine Recommendations

Results (17)

Recommendations for the use of the 2026–2027 Formula COVID-19 vaccines were issued by the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), and the Infectious Diseases Society of America (IDSA) on September 2, 2026. Their recommendations were informed by the Vaccine Integrity Project (VIP) of the University of Minnesota and the American Medical Association (AMA), which conducted a systematic review of relevant scientific literature published since the previous season’s vaccination recommendations were made. There is no preference expressed for any product: Spikevax (mRNA, age 6 months and up), Comirnaty (mRNA, age 5 years and up), mNexspike (mRNA, age 12 years and up), and Nuvaxovid (protein subunit, age 12 years and up). 

In the 2025–26 season, CDC’s recommendation was for COVID-19 vaccination following shared clinical decision-making (a conversation about individual risks and benefits of vaccination) for all people, beginning at age 6 months.  

The 2026–27 recommendations from medical societies are summarized below: 

AAP (children through age 18 years):  

  • Age 6 through 23 months: routine use in all children.  
  • Age 2 through 18 years:  
    • at high risk of severe COVID-19, or 
    • who are residents of long-term care facilities or other congregate settings, or 
    • who have never been vaccinated against COVID-19, or 
    • whose household contacts are at high risk for severe COVID-19, or 
    • who meets none of the above conditions, but whose parent or guardian desires their protection. 

AAFP (immunocompetent adults and healthcare professionals):  

  • All adults age 19 years and older should receive a dose of 2026–2027 Formula COVID-19 vaccine.  
  • Adults age 65 years or older should receive a second dose of 2026–2027 Formula COVID-19 vaccine 6 months after the first dose to sustain protection. 
  • All healthcare personnel should be age-appropriately vaccinated. 

ACOG (pregnancy): 

  • A dose of 2026–2027 Formula COVID-19 vaccine is routinely recommended for all individuals who are pregnant, contemplating pregnancy, recently pregnant, or lactating. 

IDSA (immunocompromised people): 

  • A dose of 2026–2027 Formula COVID-19 vaccine is routinely recommended for people who are immunocompromised and, if they are moderately or severely immunocompromised, who have completed an initial vaccination series.  
  • A second booster dose can be given 2 to 6 months after dose one based on shared decision making and current levels of transmission. 
  • IDSA refers readers to previous guidance from CDC for the dosing schedules for an initial vaccination series recommended for a person with a moderate or severe immunocompromising condition. IDSA’s recommendations also give guidance for optimal timing of doses for certain subgroups based upon their disease or specific treatment. 
Last reviewed: September 23, 2026

In 2026, selected major professional medical societies chose to publish recommendations independent of CDC. Their recommendations divide up the population to ensure all people are covered.  Recommendations are available from:

CDC maintains a webpage with interim clinical considerations for vaccination of eligible recipients: www.cdc.gov/covid/hcp/vaccine-considerations/. This covers important clinical details about COVID-19 vaccination. As of October 13, 2026, CDC states that the recommendations from its July 2025 immunization schedule remain in effect for the 2026–27 season; its September 23, 2026, clinical considerations incorporate current vaccine products and identify CDC-recommended uses that are off-label.

Due to political interference with the work of CDC since early 2025, many healthcare professionals have favored medical society recommendations. Immunize.org continues to reference and support CDC guidance when the published information remains valid. Most of the content of the CDC clinical considerations is unchanged and remains relevant guidance for clinicians that may not readily be found elsewhere.

All of CDC’s Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published in MMWR can be accessed here: www.cdc.gov/acip-recs/hcp/vaccine-specific/covid-19.html. FDA provides current package inserts here: www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states.

Last reviewed: October 18, 2026

AAP routinely recommends vaccination for all children age 6 through 23 months. For ages 2 through 18 years, AAP recommends vaccination for children at increased risk of severe COVID-19, residents of congregate settings, children who have never been vaccinated, and those with high-risk household contacts. AAP recommends offering vaccination to other children whose parent or guardian desires protection. CDC uses shared clinical decision-making for children age 6 months through 17 years without moderate or severe immunocompromise; CDC recommends vaccination for all adults starting at age 18.

Both AAP and CDC recommend vaccination for children with moderate or severe immunocompromise. AAP’s 2026 schedule explicitly permits additional doses based on shared clinical decision-making at least 2 months after the last dose. AAP lists a 2-month minimum for post-initial-series doses in immunocompromised adolescents, including mNexspike; CDC lists 3 months for mNexspike and allows case-by-case dosing outside its intervals. For immunocompetent adolescents receiving mNexspike, AAP specifies at least 12 weeks after the last dose; CDC specifies 3 months (although in either case, a dose of mNexspike administered at least 2 months after the most recent dose should be considered valid and not repeated). See https://doi.org/10.1542/peds.2026-079045, www.aap.org/ImmunizationSchedule, and www.cdc.gov/covid/hcp/vaccine-considerations/routine-guidance.html.

Last reviewed: October 18, 2026

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

As of October 13, 2026, the American Academy of Family Physicians (AAFP) and CDC agree on routine updated vaccination of adults and on two seasonal doses 6 months apart for adults age 65 years and older. AAFP’s guidance covers nonpregnant immunocompetent adults beginning at age 19 years and specifically recommends vaccination of healthcare personnel. CDC’s adult recommendation begins at age 18 years.

AAFP recommends offering the updated vaccine as soon as it is available. See AFP guidance at www.aafp.org/assets/image/upload/v1788277985/pdf_2026_through_2027_influenza_rsv_sars_covid_2_guidance.pdf and CDC recommendations at www.cdc.gov/covid/hcp/vaccine-considerations/routine-guidance.html

Last reviewed: October 18, 2026

IDSA strongly recommends age-appropriate vaccination for adults and children with compromised immunity, and recommends that household members and close contacts be up to date. CDC also recommends vaccination for people age 6 months and older with moderate or severe immunocompromise. IDSA and CDC recommend an initial vaccination series for people with moderate or severe immunocompromise. IDSA references the schedule originally approved by ACIP in 2023–24 and which was the basis for the dosing tables published on CDC’s website at: www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html.

IDSA emphasizes timing by disease and treatment. For example, IDSA suggests vaccination at least 2 weeks before solid-organ transplantation or at least 3 months afterward, and consideration of at least 3–6 months after B-cell-depleting treatment in relevant groups. IDSA supports vaccination during treatment when optimal timing is not feasible. CDC provides detailed dose schedules, generally advises vaccination at least 2 weeks before starting or resuming immunosuppression, and advises approximately 4 weeks before the next ongoing B-cell-depleting treatment. These approaches require coordination with the treating clinician.

For people who have completed the initial series, CDC specifies two seasonal doses (generally spaced 6 months apart). IDSA does not explicitly recommend a second dose but it notes that a second current season dose may extend protection. See IDSA guidance at www.idsociety.org/practice-guideline/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/ and CDC guidance at www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html.

Last reviewed: October 18, 2026

A recommendation and an FDA-approved indication are different. FDA labeling regulates the marketing of a vaccine, but not the practice of medicine. Off-label vaccination recommendations made by CDC and medical societies are not rare and typically occur when available data outstrips the pace of regulatory changes (or when it is unlikely the manufacturer will go through the expense and process of changing the label). When a major medical society or CDC recommends off-label use, that is considered a standard of care and supports a clinician’s professional decision to follow that recommendation. Depending upon an individual state’s scope-of-practice regulations, pharmacists may or may not be able to independently administer vaccinations under off-label conditions without a prescription or a standing order signed by a prescribing healthcare professional.

FDA labeling limits use in age-eligible people younger than age 65 to those with at least one high-risk underlying condition. Vaccination without such a condition is off-label, although the range of underlying conditions that increase the risk of severe disease is extremely broad. Recommended multidose schedules, including the second seasonal dose for adults age 65 years and older, are also off-label.

Last reviewed: October 18, 2026

The American Academy of Pediatrics (AAP) recommends COVID-19 vaccination for all children age 6 through 23 months and for children age 2 through 18 years in specified risk groups. AAP also recommends offering vaccination to other children whose parent or guardian desires protection.

The American Academy of Family Physicians (AAFP) recommends updated vaccination for all nonpregnant immunocompetent adults age 19 years and older and healthcare personnel.

The American College of Obstetricians and Gynecologists (ACOG) recommends vaccination during pregnancy, including in any trimester.

The Infectious Diseases Society of America (IDSA) recommends age-appropriate vaccination for adults and children with compromised immunity.

CDC recommends vaccination for all adults age 18 years and older and children age 6 months through 17 years with moderate or severe immunocompromise. For other children, CDC recommends shared clinical decision-making. CDC’s schedule is available here: www.cdc.gov/covid/hcp/vaccine-considerations/routine-guidance.html.

AAP and CDC recommend an initial series for previously unvaccinated children age 6 through 23 months who are not moderately or severely immunocompromised; older immunocompetent children receive a single current-season dose when vaccinated. AAFP and CDC recommend a single current-season dose for immunocompetent adults younger than age 65 and two doses 6 months apart for adults age 65 years and older. CDC specifies minimum intervals of 2 months for Comirnaty, Spikevax, or Nuvaxovid and 3 months for mNexspike between the two seasonal doses.

People with moderate or severe immunocompromise follow a separate schedule that includes an initial vaccination series (CDC and IDSA agree on the initial vaccination series schedule). If the initial series has been completed in the past, CDC recommends two doses of current season COVID-19 vaccine 6 months apart (with a minimum interval of 3 months when using mFlusiva or 2 months for other products). IDSA recommends one dose and its guidance remarks that an additional current season dose may extend protection.

Additional details are provided in separate questions. See the medical society recommendations at the links below:

Last reviewed: October 18, 2026

People who are moderately or severely immunocompromised are at increased risk for severe COVID-19 illness. CDC recommends two current-season doses for those who completed an initial series before the current season. People who are unvaccinated or incompletely vaccinated need an initial series or its completion followed by a dose 6 months later. The number of doses and intervals depend on age, product, and vaccination history. Refer to detailed dosing tables at www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html.

IDSA strongly recommends administration of age-appropriate 2026–2027 COVID-19 vaccinations to all adults and children with compromised immunity and recommends that household members and close contacts be up to date with COVID-19 vaccination: www.idsociety.org/practice-guideline/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/. However, IDSA does not explicitly recommend a second current-season dose for people who have previously completed an initial series. Instead, IDSA remarks that a second current season dose may extend protection. AAP aligns with CDC by recommending two or more current-season doses for children age 6 months through 18 years with moderate or severe immunocompromise and permits additional doses based on shared clinical decision-making: www.aap.org/ImmunizationSchedule.

Last reviewed: October 18, 2026

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

AAP’s 2026 immunization schedule permits additional age-appropriate COVID-19 vaccine doses for moderately or severely immunocompromised children and adolescents based on shared clinical decision-making, at least 2 months after the most recent dose: www.aap.org/ImmunizationSchedule.

CDC recommends two 2026–2027 doses 6 months apart for people with moderate or severe immunocompromise who completed an initial series before the season (minimum interval 2 months for Comirnaty, Spikevax, and Nuvaxovid; 3 months for mNexspike). CDC does not specifically recommend additional doses, but advises clinicians to use vaccines off-label outside FDA and CDC dosing intervals on a case-by-case basis when benefits outweigh potential risks: www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html.

IDSA strongly recommends current-season vaccination and notes that a second current-season booster dose may extend protection. IDSA recommends individualizing timing around the patient’s condition and treatment: www.idsociety.org/practice-guideline/Seasonal-RTI-Vaccinations-in-Immunocompromised-Patients/.

Last reviewed: October 18, 2026

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: October 18, 2026

Yes. CDC recommends that vaccination be offered regardless of history of prior SARS-CoV-2 infection or long COVID.

Because COVID-19 illness temporarily boosts immunity, CDC states that people who have recently had SARS-CoV-2 infection may consider delaying a 2026–2027 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: October 18, 2026

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. This pattern is not like influenza, which usually causes a single epidemic wave (sometimes with more than one peak) each winter.

The American Academy of Family Physicians (AAFP) and CDC recommend that adults age 65 years and older receive a second dose of any 2026–2027 COVID-19 vaccine 6 months after their first 2026–2027 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. See CDC guidance at www.cdc.gov/covid/hcp/vaccine-considerations/routine-guidance.html and AAFP guidance at www.aafp.org/assets/image/upload/v1788277985/pdf_2026_through_2027_influenza_rsv_sars_covid_2_guidance.pdf.

Last reviewed: October 18, 2026

The minimum interval is 8 weeks if using Spikevax (Moderna), Comirnaty (Pfizer-BioNTech), or Nuvaxovid (Sanofi-Novavax), and 3 months if using mNexspike (Moderna). An early dose of mNexspike inadvertently administered at least 8 weeks after a previous dose does not need to be repeated.  

The exception to this standard interval is when the updated product dose is part of an initial vaccine series given to a young child or to a moderately or severely immunocompromised person. In those situations, simply continue with the series schedule using the updated product.  

Last reviewed: September 23, 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

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