What COVID-19 vaccine should we use in the 2025–26 season for children ages 6 through 59 months who received Pfizer-BioNTech COVID-19 vaccine in the past?

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