COVID-19 Vaccine Frequently Asked Questions

2025-2026 COVID-19 Vaccine Recommendations

What are the new COVID-19 vaccine recommendations for Fall 2025-2026? Who is eligible to receive the updated vaccine?

Each year, updated formulations of COVID vaccines are manufactured to provide better protection against currently circulating variants and prevent serious consequences of COVID-19, including severe disease, hospitalization, death, and long COVID.
 
The AAP recommends COVID-19 vaccination as follows:

• Completion of an initial vaccination series for everyone ages 6 -23 months of age, or a single dose for those under age 2 years who previously completed their initial series.
• Two or more doses for children 6 months – 18 years of age who are moderately or severely immunocompromised.
• A single dose for all children and adolescents 2-18 years of age who are at high risk for severe COVID-19, residents of long-term care facilities or other congregate settings, persons who have never been vaccinated against COVID-19, or persons whose household contacts are at high risk for severe COVID-19
• Children 2-18 years of age whose parent or guardian desires protection from COVID-19 for their child should be offered a single dose. 

There are two types of COVID-19 vaccines recommended for use in the United States – mRNA vaccines (Moderna, Pfizer-BioNTech) and the protein subunit vaccine (Novavax, authorized for people 12 years and older). There is no preferential recommendation when multiple vaccine options are available.

Please see the AAP Pediatric COVID-19 Vaccine Dosing Quick Reference Guide for more details, including recommendations on the intervals between doses.

The most updated formulations of COVID vaccines that are available should be used.

Additional Resources:

AAP Policy Statement: Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents (August 2025)

Who is considered at high risk for severe COVID-19?

AAP recommends a single dose of COVID-19 vaccine for all children and adolescents 2-18 years of age who are at high risk for severe COVID-19 (other than moderately or severely immune compromised children, who are recommended to receive multiple doses). These risk groups are described in the AAP Policy Statement as follows:

^a List of examples is not exhaustive.
^b Children who are moderately or severely immunocompromised require 2 or more doses of COVID-19 vaccine. Refer to AAP Recommended Child and Adolescent Immunization Schedule for dosing guidance.  

Why does AAP recommend universal COVID-19 vaccination for ages 6 through 23 months of age?

Children younger than 2 years old are at high risk for severe COVID-19 disease and hospitalization and COVID-19 vaccines have been shown to be safe and effective for 6 through 23 month old children.

How do AAP recommendations differ from CDC recommendations for COVID-19 vaccination?

CDC recommends children ages 6 months through 17 years can receive a COVID-19 vaccine through shared clinical decision-making.  AAP’s recommendations are noted above and in the AAP Policy Statement. 

The CDC does not make a recommendation for pregnant adolescents; AAP recommends COVID-19 vaccination for pregnant adolescents. 

Both organizations recommend COVID-19 vaccination for children 6 months of age and older who are moderately or severely immunocompromised. 

With the changes in FDA approval of the COVID-19 vaccine, provision of the vaccine to healthy children over 6 months of age pursuant to AAP guidance would constitute off-label use.  What legal protection will pediatricians have?  

The FDA approved label only allows for administration of COVID-19 vaccines to children 6 months of age and older with at least one underlying condition that puts them at high risk for severe outcomes from COVID-19. Therefore, administration to children and adolescents who are not considered high risk would be considered “off label”. 

Clinicians prescribing the COVID vaccine, even off-label, could have two layers of protection — malpractice coverage and provisions under the PREP Act. Under the principles of malpractice law, a plaintiff filing a lawsuit would have to show the physician deviated from the standard of care, which is not determined by the FDA and ACIP alone. Following AAP guidance or state guidance would be a strong defense that the physician acted within accepted standards. All pediatricians are strongly urged to check their malpractice insurance coverage to ensure that COVID-19 vaccination protections are not excluded.

In specific situations, the PREP Act provides broad immunity from state and federal liability for emergency measures, including vaccination. Some court decisions have narrowed these protections. It is unclear whether this immunity applies to off-label use of the COVID-19 vaccine, and thus the PREP Act protections may not be guaranteed.

Note that current CDC recommendations allow for shared clinical decision making for children who are not at high risk of severe COVID; however, the Advisory Committee on Immunization Practices is scheduled to meet on September 18-19 and plans to discuss COVID vaccine recommendations, so it is unclear if these recommendations will change. 

If COVID-19 vaccines will be administered off-label, obtaining informed consent is recommended. An AAP template is currently in development. 

The AAP will continue to monitor federal and state policy changes that impact liability protections for pediatricians and update this information regularly. Pediatricians are encouraged to report any liability-related concerns or issues related to vaccine administration to the AAP via this form. 

COVID Vaccine Dosing

What is the recommended interval between the doses of an mRNA COVID-19 vaccine series? How can I determine what my patient needs if they already received at least one COVID-19 dose?

Please the AAP Pediatric COVID-19 Vaccine Dosing Quick Reference Guide for dosing intervals. This resource offers the dosing intervals for unvaccinated children and previously vaccinated children. Also included is dosing information for children who are moderately or severely immunocompromised.

When a series of vaccines is recommended for a patient, an 8-week interval between the first and second doses (Moderna, Novavax, and Pfizer) doses might be optimal for some people as it might reduce the rare risk of myocarditis and pericarditis associated with these vaccines.

What are the vaccine recommendations for a child who turns 2 years old during their initial vaccine series?

A child should receive the recommended dosing based on their age at the START of their vaccine series. For example, a child who begins their initial series at age 23 months should receive two doses of Moderna Spikevax vaccine. 

Which vaccine dose should a child with moderate or severe immunocompromise receive if they have a birthday between doses?  

A child should receive age-appropriate vaccine product and dosage based on their age on the day of vaccination. For example, for children who turn 11 to 12 years of age , administer the recommended product/dosage for 12 year olds for all doses that are administered after the child turns 12 years of age See additional information in the AAP Pediatric COVID-19 Vaccine Dosing Guide. 

Can you “mix and match” vaccine products for one child?  

A multi-dose series is only recommended for children 6 -23 months of age, as well as for children who are moderately or severely immunocompromised. For these individuals, the same vaccine should be used to complete the initial series, whenever possible. 

Additional Resources:

• AAP Pediatric COVID-19 Vaccine Dosing Quick Reference Guide
• AAP Immunization Schedule

COVID Vaccine Products

Which COVID-19 vaccines have been approved for use in the US?

Moderna mRNA Vaccine

• Spikevax Package Insert (ages 6 months and up)
• mNEXSPIKE Package Insert (ages 12 years and up)

Pfizer-BioNTech mRNA Vaccine

• Comirnaty Package Insert (ages 5 years and up)

Novavax Protein Subunit Vaccine

• Nuvaxovid Package Insert (ages 12 years and up)

Can I still administer the 2024-2025 Pfizer-BioNTech, Moderna, and Novavax  COVID vaccine to my patients?

No. On August 27, 2025, FDA revoked the Emergency Use Authorizations (EUA) that were originally issued in December 2020 for pediatric COVID vaccine formulations (for < 12 year old patients) from Moderna and Pfizer-BioNTech, as well as the product for 12 years and up from Novavax.  Any products that were authorized under these EUAs may no longer be administered, including the 2024-2025 Pfizer-BioNTech COVID vaccine products for 6 month – 11 year olds; the 2024-2025 Moderna COVID vaccine for 6 month – 11 year olds; and the 2024-2025 Novavax COVID vaccine for 12 years and up. Please note that this relates to 2024-2025 COVID vaccine products and not to 2025-2026 COVID vaccine products.

What is the difference between Moderna’s Spikevax and mNEXSPIKE? Which should I administer to my patients who are 12 years of age and older?

mNEXSPIKE is a new formulation of the Moderna product designed to provide a more targeted immune response at a lower dose. It is approved for use in patients who are 12 years of age and older. While either Spikevax or mNEXSPIKE can be used in 2025-2026, only Moderna’s Spikevax will be available through the VFC program. 

Vaccinating Special Populations

What are the vaccine recommendations for children and adolescents who are moderately or severely immunocompromised?

Children and adolescents with certain immunocompromising medical conditions or who are receiving treatments that induce moderate or severe immune suppression should be vaccinated according to the schedule outlined in the AAP Pediatric Vaccine Dosing Quick Reference Guide.

Close contacts of immunocompromised individuals should also consider receiving COVID-19 vaccination to provide additional protection. 
 
Information on immunization and immunocompromised children and adolescents can be found in the Red Book chapter, Immunization and Other Considerations in Immunocompromised Children

Can I administer a COVID-19 vaccine to a patient who is currently sick with COVID-19? 

COVID-19 vaccination should be deferred for patients with a current SARS-CoV-2 infection until they recover from their acute illness.
 
Individuals who recently had SARS-CoV-2 infection may consider delaying COVID-19 vaccine by 3 months from symptom onset or positive test (if infection was asymptomatic). Studies have shown that increased time between infection and vaccination may result in an improved immune response to vaccination.

Side Effects/Safety

Are there any different side effects or safety concerns with the updated 2025-2026 formula mRNA vaccines?

No, the side effect and safety profile are the same as that of previous formulations. 

The side effects have been similar to other routine vaccines- sore arm or leg, redness, fatigue, fever, chills, headache, myalgia, and arthralgia. The side effects are temporary and mostly mild or moderate. Anaphylaxis has been observed following receipt of COVID-19 mRNA vaccines, but this has been rare. Rare cases of myocarditis or pericarditis have been reported – most often in males between 12-39 years of age.  Additional information on common side effects and rare adverse reactions can be found in the package inserts of the vaccine products:

Moderna mRNA Vaccine

• Spikevax Package Insert (ages 6 months and up)
• mNEXSPIKE Package Insert (ages 12 + years)

Pfizer-BioNTech mRNA Vaccine

• Comirnaty Package Insert (ages 5+ years)

Novavax Protein Subunit Vaccine

• Nuvaxovid Package Insert (ages 12+ years)

What is the safety testing that has been done on COVID-19 vaccines? How is vaccine safety monitored? How do we know it is safe long-term?

The safety follow-up during COVID-19 vaccine studies have been very similar to the follow-up done during other vaccine trials. All vaccines are determined to be safe and effective before they are licensed. 

Pediatric vaccine studies involve very close follow up and tracking of patient’s health status and medical care after vaccination (eg. monitoring side effects, medical visits, use of new medications or changes to previous medications, and other interactions post-vaccination). All reported medical events are recorded and reviewed by the study team, sponsor, an independent safety monitoring board, an ethics committee, and the FDA. Children in these studies are often being followed for one to two years post vaccination and their health status is monitored for vaccine safety. 
 
Even after licensure, safety data are collected through Vaccine Adverse Event Reporting System (VAERS), Vaccine Safety Datalink (VSD), Clinical Immunization Safety Assessment (CISA), and pharmacovigilance. VAERS and VSD are specifically designed to monitor safety signals from simultaneous administration of multiple vaccines (ie co-administration). These programs collect information on an even larger number of persons who get vaccinated than can be collected during clinical studies. 
 
Safety data beyond 2 years is captured through studies performed post licensure. No licensed vaccines have been found to have an unexpected long-term, or “delayed” safety problem that was found only years or decades after introduction. 

How do I report an adverse event related to administration of COVID-19 vaccine? 

Healthcare providers are required by law to report to Vaccine Adverse Event Reporting System (VAERS):

• Any adverse event listed in the VAERS Table of Reportable Events Following Vaccination that occurs within the specified time period after vaccination
• An adverse event listed by the vaccine manufacturer as a contraindication to further doses of the vaccine

Healthcare providers are strongly encouraged to report:

• Any adverse event that occurs after the administration of a vaccine licensed in the United States, whether or not it is clear that a vaccine caused the adverse event
• Vaccine administration errors

Co-Administration

Can COVID-19 vaccine be co-administered with other childhood or adolescent immunizations?

Yes, the AAP supports co-administration (or vaccination in the days before and after) of routine childhood and adolescent immunizations and seasonal immunization (such as RSV immunization and influenza vaccine), with COVID-19 vaccines for children and adolescents who are behind on or due for immunizations (based on the AAP Recommended Child and Adolescent Immunization Schedule). 

When co-administering with other vaccines, it is recommended that a different injection site (at least 1 inch apart) be used. If co-administered with a more reactogenic vaccine (eg, adjuvanted or high-dose influenza vaccine and COVID-19 vaccine), consider using a different limb. 

Is co-administration acceptable for all populations of children and adolescents, including those who are immunocompromised?

Since the mRNA COVID-19 vaccines are not live vaccines, it is expected that the safety and efficacy will be similar to other vaccines that are co-administered. Immunocompromising conditions are not contraindications to receipt of the mRNA COVID-19 vaccines. In general, simultaneously administered vaccines are recommended to ensure optimal age-specific protection and fewer medical visits. As with all vaccines, patients should be informed about the likely timing of potential side effects and adverse events related to each vaccine.

Are there any differences or concerns with co-administration of COVID-19 vaccine with live attenuated vaccines?

No. The mRNA COVID-19 vaccines are not live vaccines, and no additional safety or efficacy issues are expected with co-administration with live attenuated vaccines. Co-administration is particularly important for children and adolescents who are behind on routinely recommended vaccines because it promotes timely receipt of vaccines and reduces the number of medical visits for the patient.

Vaccine Coding and Payment

Which CPT codes should I use? Will I get paid for vaccine administration?

A full listing of COVID-19 vaccine codes can be found on the Getting Paid page. 
 

Talking to Families

How can pediatricians build trust with families who may express vaccine hesitancy

Parents and caregivers trust pediatricians. Pediatricians should listen to families’ questions and provide clear, consistent information. They should state what is currently known and unknown. They should not overemphasize “potentials” – neither potential risks nor potential benefits. More information on how to communicate effectively can be found at Communicating with Families and Promoting Vaccine Confidence. 

Pediatricians can also utilize resources in the AAP COVID-19 Vaccine Communications Toolkit to promote vaccine confidence. Consider ways that patients and families in your practice like to receive information and use these mechanisms to debunk common myths and answer frequently asked questions.