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Use of 2025 –2026 COVID -19 Vaccines:
Work Group Considerations
Lakshmi Panagiotakopoulos, MD, MPH
Advisory Committee on Immunization Practices
April 15, 2025National Center for Immunization and Respiratory Diseases
•Current recommendations for 2024 –2025 COVID -19 vaccines
•Policy options for 2025 –2026 COVID -19 vaccine recommendations
•Supporting data and Work Group interpretations
•Discussion questions for committee Overview
2
COVID -19 vaccine: ACIP Meeting Schedule
October
2024April 2025June 2025
(proposed)
•Additional dose of 2024 -
2025 COVID -19 vaccines
in adults ages ≥65 years
•Additional dose(s) of
2024 -2025 COVID -19
vaccines in moderately
to severely
immunocompromised
persons ages ≥6 months•Moderna mRNA -1283
COVID -19 vaccine
•Epidemiology and risk
factors for COVID -19
hospitalizations
•Vaccine effectiveness
update
•Work Group
Considerations
•No vote scheduled•Vote on 2025 –2026
COVID -19 vaccine
recommendations
(including additional
dose recommendations)
3
Review of 2024 –2025 COVID -19 vaccine policy
•Children ages 6 months –4 years
-Unvaccinated: Should receive a multidose initial series with a 2024 –2025 mRNA
vaccine
-Previously completed an initial series: Should receive 1 dose of a 2024 –2025
mRNA vaccine from the same manufacturer as the initial series
•People ages 5 –64 years:
-Should receive 1 dose of an age -appropriate 2024 –2025 COVID -19 vaccine*
•People ages 65 years and older:
-Should receive 2 doses of any 2024 –2025 COVID -19 vaccine, spaced 6 months
apart (minimum interval 2 months)**Overview of the current COVID -19 vaccination
schedule: Routine vaccination
*People ages 12 –64 years who are unvaccinated and receive the 2024 –2025 Novavax COVID -19 vaccine for initial vaccination should receive 2 doses of 2024 –2025 Novavax COVID -19 vaccine.
**People ages 65 years and older who are unvaccinated and receive Novavax COVID -19 Vaccine for initial vaccination should receiv e 2 doses of 2024 –2025 Novavax COVID -19 vaccine followed by a
third dose of any 2024 –2025 COVID -19 vaccine dose 6 months after the second dose (minimum interval 2 months).
https://www.cdc.gov/vaccines/covid -19/clinical -considerations/interim -considerations -us.html#routine -vaccination -guidance 5
•Unvaccinated:
-Should receive a multidose initial vaccination series with an age -appropriate
2024 –2025 vaccine and receive 1 dose of 2024 –2025 6 months after completing
the initial series (minimum interval 2 months)
•Previously completed an initial series:
-Should receive 2 doses of an age -appropriate 2024 –2025 COVID -19 vaccine,
spaced 6 months apart (minimum interval 2 months)
•May receive additional age -appropriate 2024 –2025 COVID -19 vaccine
doses under shared clinical decision -making (minimum interval 2
months) Overview of the current COVID -19 vaccination
schedule: Moderate or severe immunocompromise
6https://www.cdc.gov/vaccines/covid -19/clinical -considerations/interim -considerations -us.html#immunocompromised
Policy considerations for use of the 2025 –2026
COVID -19 vaccine
Policy Options for 2025 –2026 COVID -19 vaccines:
Multi -dose initial series
8•Currently a multi -dose initial series is recommended for people ages 6
months –4 years and people with immunocompromise
-Option 1: Maintain a universal vaccine policy for everyone ages ≥6 months that
includes the multi -dose initial series
-Option 2: Narrow current vaccine recommendations and only maintain this series
for certain populations within these groups who we determine should be
vaccinated
Policy Options for 2025 –2026 COVID -19 vaccines:
Annual COVID -19 vaccine doses
9•Currently annual vaccines are recommended for everyone ages ≥6
months
-Option 1: Maintain a universal vaccine policy for everyone ages ≥6 months
-Option 2: Risk-based recommendation only for groups at increased risk of severe
COVID -19
-Option 3: Combination of risk -based and universal vaccine recommendations
(e.g., risked -based recommendation for ages 6 months -64 years and universal
recommendations for ages ≥65 years.
•Persons ages ≥65 years
-2 doses per year for most; may be more if previously unvaccinated and receiving
Novavax or immunocompromised
•Persons ages ≥6 months who are moderately or severely
immunocompromised
-Initial series if unvaccinated or post -immune ablative therapy
-Initial series is followed by 2 doses per year
-Additional doses can be administered under shared clinical decision -makingPolicy Options for 2025 –2026 COVID -19 vaccines:
Semi -annual COVID -19 vaccine doses
10
•How much increased risk is needed to be included in a risk -based
recommendation?
•Increased risk of severe outcomes
-Age
-Underlying conditions
-Pregnancy (also protects infants <6 months of age)
•Risk of exposure
-Healthcare workers
-People living in long -term care facilities and other congregate settings
-Other groups at risk of increased exposure or transmission?How to define who is at increased risk?
11
•Asthma
•Cancer
-Hematologic Malignancies
•Cerebrovascular disease
•Chronic kidney disease*
-People receiving dialysis^
•Chronic lung diseases limited to:
•Bronchiectasis
•COPD (Chronic obstructive pulmonary disease)
•Interstitial lung disease
•Pulmonary embolism
•Pulmonary hypertension
• Chronic liver diseases limited to:
•Cirrhosis
•Non -alcoholic fatty liver disease•Alcoholic liver disease
•Autoimmune hepatitis
•Cystic fibrosis
•Diabetes mellitus, type 1
•Diabetes mellitus, type 2*
•Disabilities‡,**, including Down
syndrome
•Heart conditions (such as heart failure,
coronary artery disease, or
cardiomyopathies)
•HIV (Human immunodeficiency virus)
•Mental health conditions limited to:
•Mood disorders, including depression
•Schizophrenia spectrum disorders•Neurologic conditions limited to
dementia‡ and Parkinson’s Disease
•Obesity (BMI >30 kg/m2or
>95thpercentile in children)
•Physical inactivity
•Pregnancy and recent pregnancy
•Primary immunodeficiencies
•Smoking, current and former
•Solid organ or blood stem cell
transplantation
•Tuberculosis
•Use of corticosteroids or other
immunosuppressive medicationsHigher Risk of Severe Illness of COVID -19 (conclusive)
* Indicates presence of evidence for pregnant and non -pregnant women
‡ Underlying conditions for which there is evidence in pediatric patients
^ Risk may be further increased for people receiving dialysis
** Attention -deficit/hyperactivity disorder (ADHD), Autism, Cerebral palsy, Charcot foot, Chromosomal disorders, Chromosome 17 a nd 19 deletion, Chromosome 18q deletion, Cognitive impairment, Congenital
hydrocephalus, Congenital malformations, Deafness/hearing loss, Disability indicated by Barthel Index, Down syndrome, Fahr's syndrome, Fragile X syndrome, Gaucher disease, Hand and foot disorders, Learning
disabilities, Leber's hereditary optic neuropathy (LHON) or Autosomal dominant optic atrophy (ADOA), Leigh syndrome, Limitati ons with self -care or activities of daily living, Maternal inherited diabetes and
deafness (MIDD), Mitochondrial encephalopathy, lactic acidosis, and stroke -like episodes (MELAS) and risk markers, Mobility disa bility, Movement disorders, Multiple disability (referred to in research papers as
"bedridden disability"), Multisystem disease, Myoclonic epilepsy with ragged red fibers (MERRF), Myotonic dystrophy, Neurodev elopmental disorders, Neuromuscular disorders, Neuromyelitis optica spectrum
disorder (NMOSD), Neuropathy, ataxia, and retinitis pigmentosa (NARP), Perinatal spastic hemiparesis, Primary mitochondrial m yopathy (PMM), Progressive supranuclear palsy, Senior -Loken syndrome, Severe
and complex disability (referred to in research papers as " polyhandicap disability"), Spina bifida and other nervous system anomalies, Spinal cord injury, Tourette syndrome, Traumatic brain injury, Visual
impairment/blindness, Wheelchair use
https://www.cdc.gov/covid/hcp/clinical -care/underlying -conditions.html 12
•Asthma
•Cancer
-Hematologic Malignancies
•Cerebrovascular disease
•Chronic kidney disease *
-People receiving dialysis^
•Chronic lung diseases limited to:
•Bronchiectasis
•COPD (Chronic obstructive pulmonary disease)
•Interstitial lung disease
•Pulmonary embolism
•Pulmonary hypertension
• Chronic liver diseases limited to:
•Cirrhosis
•Non -alcoholic fatty liver disease•Alcoholic liver disease
•Autoimmune hepatitis
•Cystic fibrosis
•Diabetes mellitus, type 1
•Diabetes mellitus, type 2 *
•Disabilities‡,**, including Down
syndrome
•Heart conditions (such as heart failure,
coronary artery disease, or
cardiomyopathies)
•HIV (Human immunodeficiency virus)
•Mental health conditions limited to:
•Mood disorders, including depression
•Schizophrenia spectrum disorders•Neurologic conditions limited to
dementia‡ and Parkinson’s Disease
•Obesity (BMI >30 kg/m2or
>95thpercentile in children)
•Physical inactivity
•Pregnancy and recent pregnancy
•Primary immunodeficiencies
•Smoking, current and former
•Solid organ or blood stem cell
transplantation
•Tuberculosis
•Use of corticosteroids or other
immunosuppressive medicationsHigher Risk of Severe Illness of COVID -19 (conclusive)
* Indicates presence of evidence for pregnant and non -pregnant women
‡ Underlying conditions for which there is evidence in pediatric patients
^ Risk may be further increased for people receiving dialysis
** Attention -deficit/hyperactivity disorder (ADHD), Autism, Cerebral palsy, Charcot foot, Chromosomal disorders, Chromosome 17 a nd 19 deletion, Chromosome 18q deletion, Cognitive impairment, Congenital
hydrocephalus, Congenital malformations, Deafness/hearing loss, Disability indicated by Barthel Index, Down syndrome, Fahr's syndrome, Fragile X syndrome, Gaucher disease, Hand and foot disorders, Learning disabilities,
Leber's hereditary optic neuropathy (LHON) or Autosomal dominant optic atrophy (ADOA), Leigh syndrome, Limitations with self -care or activities of daily living, Maternal inherited diabetes and deafness (MIDD),
Mitochondrial encephalopathy, lactic acidosis, and stroke -like episodes (MELAS) and risk markers, Mobility disability, Movement disorders, Multiple disability (referred to in research papers as "bedridden disability"),
Multisystem disease, Myoclonic epilepsy with ragged red fibers (MERRF), Myotonic dystrophy, Neurodevelopmental disorders, Neu romuscular disorders, Neuromyelitis optica spectrum disorder (NMOSD), Neuropathy,
ataxia, and retinitis pigmentosa (NARP), Perinatal spastic hemiparesis, Primary mitochondrial myopathy (PMM), Progressive sup ranuclear palsy, Senior -Loken syndrome, Severe and complex disability (referred to in research
papers as " polyhandicap disability"), Spina bifida and other nervous system anomalies, Spinal cord injury, Tourette syndrome, Traumatic brain injury, Visual impairment/blindness, Wheelchair use
Bolded conditions were included in analysis on prevalence of risk conditions by the Center for Forecasting Analytics (unpubli shed data); those highlighted by the red boxes were not included
https://www.cdc.gov/covid/hcp/clinical -care/underlying -conditions.html 13
Estimates of adults in the United States with at least 1
condition that puts them at higher risk of severe illness from
COVID -19, by age group, October 2022 –September 2023
67%65% 65%81%83%86%
74%
0%10%20%30%40%50%60%70%80%90%100%
18-29 years 30-39 years 40-49 years 50-64 years 65-74 years ≥75 years ≥18 years
Unpublished results from September 2024 analysis of medical claims data, consumer data, Behavioral Risk Factors Surveillance System, and/or National Health Interview Survey to enumerate
the US population with conditions that put them at increased risk of severe illness from COVID -19 using multilevel regression mo deling, CDC Center for Forecasting and Outbreak Analytics
14
Summary of supporting evidence
COVID -19 Epidemiology
Weighted and Nowcast SARS -CoV-2 estimates in the United
States for 2 -week periods, December 2, 2024 –April 12, 2025
These data include Nowcast estimates, which are modeled predictions that may differ from weighted estimates generated at late r dates
https://covid.cdc.gov/covid -data -tracker/#variant -proportions Accessed April 14, 2025 17
Weekly rates of COVID -19–associated hospitalizations in the
United States by age group, October 2024 –March 2025
1802468101214161820
October November December January February MarchHospitalizations per 100,000 populationCrude Weekly Rates of COVID -19–Associated Hospitalizations, by Age Group —
COVID -NET, October 2024 –March 2025
5–17 years 18–49 years 50–64 years ≥65 years
Rates for SARS -CoV-2 are laboratory -confirmed.
Note that rates are not adjusted for testing or limited to admissions where the respiratory infection is the likely primary r eason for admission.
Data source: https://www.cdc.gov/resp -net/dashboard/ Accessed April 7, 2025
Weekly rates of respiratory virus -associated hospitalizations in
the United States among children ages 0 –17 years, 2023 –2025
19024681012
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug SepHospitalizations per 100,000 populationCrude Weekly Rates of COVID -19–, Influenza, and RSV -Associated Hospitalizations, by Surveillance Season* —
RESP -NET, October 2023 –March 2025
COVID 2024 –2025 COVID 2023 –2024
Influenza 2024 –2025 Influenza 2023 –2024
RSV 2024 –2025 RSV 2023 –2024
Rates for all three pathogens (COVID -19, influenza, and respiratory syncytial virus [RSV]) are laboratory -confirmed.
Note that rates are not adjusted for testing or limited to admissions where the respiratory infection is the likely primary r eason for admission.
Data source: https://www.cdc.gov/resp -net/dashboard/ accessed April 7, 2025
Weekly number of COVID -19 deaths reported to CDC,
United States, January 1, 2024 – March 29, 2025
The most recent 3 weeks of mortality counts are shaded grey because NVSS reporting is <95% during this period.
Provisional data are non -final counts of deaths based on reported mortality data in NVSS. Deaths include those with COVID -19, co ded as ICD –10 code U07.1, on the death certificate. Death data
are displayed by date of death (event). Data include underlying and contributing causes of death.
CDC COVID Data Tracker. National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS). https://covid.cdc.gov/covid -data -tracker/#trends_weeklydeaths_select_00 .
Accessed April 7, 2025 2005001,0001,5002,0002,5003,000
1/6/2024 3/6/2024 5/6/2024 7/6/2024 9/6/2024 11/6/2024 1/6/2025 3/6/2025Weekly DeathsProvisional COVID -19 Deaths, by Week, in The United States, Reported to CDC
Top 10 leading causes of death in the United States,
children and adolescents 0 –17 years
Unpublished data, CDC National Center for Health Statistics
211. Certain conditions originating in
the perinatal period
2. Accidents (unintentional injuries)
3. Congenital malformations,
deformations, and chromosomal
abnormalities
4. Homicide
5. Suicide
6. Cancer
7. Heart disease
8. COVID -19
9. Influenza and Pneumonia
10. Septicemia1. Certain conditions originating in
the perinatal period
2. Accidents (unintentional injuries)
3. Congenital malformations,
deformations, and chromosomal
abnormalities
4. Homicide
5. Suicide
6. Cancer
7. Heart disease
8. COVID -19
9. Influenza and Pneumonia
10. Septicemia1. Certain conditions originating in
the perinatal period
2. Accidents (unintentional injuries)
3. Congenital malformations,
deformations, and chromosomal
abnormalities
4. Homicide
5. Suicide
6. Cancer
7. Heart disease
8. Influenza and Pneumonia
9. Septicemia
10. Stroke…
12. COVID -19 2021 2022 2023
Top 10 leading causes of death in the United States,
adults ages ≥18 years
Influenza and pneumonia was ranked 9th pre-pandemic in 2019; ranked 13th in 2023
Unpublished data, CDC National Center for Health Statistics221. Heart disease
2. Cancer
3. COVID -19
4. Accidents
5. Chronic lower respiratory diseases
6. Stroke
7. Alzheimer’s disease
8. Diabetes mellitus
9. Chronic liver disease and cirrhosis
10. Kidney disease1. Heart disease
2. Cancer1. Heart disease
2. Cancer
3. Accidents
4. Chronic lower respiratory diseases
5. Stroke
6. Alzheimer’s disease
7. Diabetes mellitus
8. Kidney disease
9. Chronic liver disease and cirrhosis
10. COVID -193. Accidents
4. COVID -19
5. Chronic lower respiratory diseases
6. Stroke
7. Alzheimer’s disease
8. Diabetes mellitus
9. Kidney disease
10. Chronic liver disease and cirrhosis 2021 2022 2023
Total number of COVID -19 deaths,1,2 September 2023 –
August 2024, by age group, United States
53 43 561,0283,36436,357
05,00010,00015,00020,00025,00030,00035,00040,000
<1 year 1–4 years 5–17 years 18–49 years 50–64 years ≥65 yearsNumber of Deaths
1. Provisional data
2. Underlying cause of death Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Natio nal Vital Statistics System, Provisional Mortality on CDC WONDER Online
Database. Data are from the final Underlying Cause of Death Files, 2018 -2023, and from provisional data for 2024, as compiled fr om data provided by the 57 vital statistics jurisdictions through the Vital
Statistics Cooperative Program. Number of deaths includes COVID -19 code (U07.1) as the underlying cause of death. http://wonder.cdc.gov/mcd -icd10 -provisional.html , accessed January 16, 2025
23
Total number of COVID -19 and Influenza deaths1,2, among
ages 0 –17 years, September 2023 –August 2024, United States
53
4356
1861134
020406080100120140160
<1 year 1–4 years 5–17 yearsNumber of Deaths
COVID-19 Influenza
1. Provisional data
2. Underlying cause of death Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Natio nal Vital Statistics System, Provisional Mortality on CDC WONDER Online
Database Data are from the final Underlying Cause of Death Files, 2018 -2023, and from provisional data for 2024, as compiled fro m data provided by the 57 vital statistics jurisdictions through the Vital
Statistics Cooperative Program. Number of deaths includes influenza codes (J09 -J11) or COVID -19 code (U07.1) as the underlying c ause of death. http://wonder.cdc.gov/mcd -icd10 -provisional.html ,
accessed January 16, 2025
Note: Estimates of pediatric influenza deaths reported to CDC can be found here: https://www.cdc.gov/flu/weekly/index.htm . Estimates will vary due to differences in reporting methods and timeframes
used.24
COVID -19—associated changes from 2023 –2024 to
2024 –2025
2023 –2024 2024 –2025 Difference
Routine vaccine recommendation6 months and older
65 and older: 2 doses 6 months and older
65 and older: 2 doses No change
Vaccine coverage <18 years1 13.8% (13.4 –14.3)
(3/23/2024)12.8% (12.2 –13.4)
(3/22/2025)Similar
Vaccine coverage ≥18 years2 21.3% (21.0 –21.5)
(3/23/2024)23.1% (22.5 –23.7)
(3/22/2025)Similar
Vaccine coverage ≥65 years2 37.5% (36.7 –38.3)
(3/23/2024)44.0% (42.5 –45.4)
(3/22/2025)Increase
Vaccine effectiveness against
hospitalization, immunocompetent adults
≥65 yearsVISION: 42% (37 –47)3
IVY: 35% (20 –47)3VISION: 45% (36 –53)4
IVY: 46% (26 –60)4Similar
Cumulative hospitalization rates (week 13)5125.6/100,000 62.9/100,000 Decrease
1 https://www.cdc.gov/covidvaxview/weekly -dashboard/child -coverage -vaccination.html , accessed April 7, 2025
2 https://www.cdc.gov/covidvaxview/weekly -dashboard/adult -vaccination -coverage.html , accessed April 7, 2025
3 https://www.cdc.gov/acip/downloads/slides -2024 -06-26-28/03 -COVID -Link-Gelles -508.pdf ; median (IQR) days since dose: VISION: 84 (46 –127) IVY: 81 (43 –121)
4 Link-Gelles R, Chickery S, Webber A, et al. Interim Estimates of 2024 –2025 COVID -19 Vaccine Effectiveness Among Adults Aged ≥18 Years — VISION and IVY Networks, September 2024 –
January 2025. MMWR Morb Mortal Wkly Rep 2025;74:73 –82. M edian (IQR) days since dose – VISION: 53 (30 –77) IVY: 60 (31 –85)
5 https://covid.cdc.gov/covid -data -tracker/#covidnet -hospitalization -network , accessed April 7, 202525
Infection -induced SARS -CoV-2 seroprevalence among U.S.
children — September 2021 – December 2022
26
Infection -induced (nucleocapsid
antibody) seroprevalence
Month and Year
Shaded ranges depict 95% confidence intervals for the estimated seroprevalence shown by the dark line in the corresponding co lor.
Source: https://covid.cdc.gov/covid -data -tracker/#pediatric -seroprevalence
Accessed: March 20, 2025
Population SARS -CoV-2 spike antibody over time by the cumulative
number of combined infections and vaccinations - U.S. blood donors ages
≥16 years, September 2021 -December 2023
Solid lines represent mean anti -spike IgG levels; dotted lines represent model based 25th-75th% percentiles
Higher number of cumulative SARS -CoV-2 infections and COVID -19 vaccinations leads to
higher antibody levels, but with smaller incremental increases in antibodies with each
exposure
Spike IgG BAU/mL
Source: https://covid.cdc.gov/covid -data -tracker/#nationwide -blood -donor -seroprevalence -2022 , CDC unpublished data 27
Among adults aged ≥18 years, 3.6%
reported Long COVID
symptoms, and 8.4% reported ever
having Long COVID1
More than 3 in 5 adults with Long
COVID report activity limitations1
Among children aged 0 -17
years, 0.4% reported Long COVID
symptoms, and 1.4% reported ever
having Long COVID2Long COVID is a significant public health threat
1. Vahratian A,Saydah S, Bertolli J, Unger ER, Gregory CO. Prevalence of Post –COVID -19 Condition and Activity -Limiting Post –COVID -19 Condit ion Among Adults. JAMA Netw Open. 2024;7(12):e2451151.
2. Ford ND, Vahratian A,Pratt CQ, Yousaf AR, Gregory CO, Saydah S. Long COVID Prevalence and Associated Activity Limitation in US Children. JAMA Pediatr .Published online February 03, 2025.National surveys in 2023 estimated approximately 9.2 million adults and 0.3 million
children in the U.S. had Long COVID.
Almost 4 in 5 children with Long
COVID report activity limitations2
28
1. Yousaf AR, Mak J, Gwynn L, et al. COVID -19 Vaccination and Odds of Post –COVID -19 Condition Symptoms in Children Aged 5 to 17 Years. JAMA Netw Open. 2025;8(2):e2459672.
2. Mak J, Khan S, Britton A et al. Association of Messenger RNA Coronavirus Disease 2019 (COVID -19) Vaccination and Reductions i n Post COVID Conditions Following Severe Acute Respiratory Syndrome
Coronavirus 2 Infection in a US Prospective Cohort of Essential Workers, The Journal of Infectious Diseases, Volume 231, Issu e 3, 15 March 2025, Pages 665 –676COVID -19 mRNA vaccination associated with reduced occurrence of
Long COVID following COVID -19: June 2021 -September 2022
Among children aged 5 – 17 years:
Completion of the primary vaccine
series prior to infection associated
with reduced likelihood of Long
COVID symptoms1
•57% for 1 or more symptoms
•73% for 2 or more symptoms
•72% for respiratory symptomsAmong adults:
3 doses of original monovalent vaccine
prior to infection associated with
reduced likelihood of Long COVID
symptoms2
•63% for gastrointestinal symptoms
•44% for neurological symptoms
•52% for other non -specific symptoms
29
Multisystem Inflammatory Syndrome in Children (MIS -C)
U.S. Incidence Over Time
•US incidence of MIS -C by SARS -CoV-2 variant -predominant periods was previously
published1, updated data shown below
-Defined using surveillance data and allowing for 2 weeks to MIS -C onset from when a variant
exceeded 50% circulating lineages
1. Yousaf AR, et al, MMWR 2023
2. Shingleton J et al, Journal of Infection , 2022.
3. Cohen JM, et al. Clin Infect Dis . 2023
4. Whittaker R et al. Pediatrics. 2022Variant predominant
periodDates Number of
MIS-C casesIncidence per 1,000,000
(95% CI) person -yearsMedian age
(IQR), years
Pre-Delta Oct 15, 2020 –Apr 5, 2021 3,287 6.80 (6.57 –7.03) 9.2 (5.4 –13.1 )
Delta Jul 10 –Dec 24, 2021 2,305 4.91 (4.71 –5.11) 9.1 (5.5 –12.3)
Omicron BA.1/BA 1.1 Jan 1 –Apr 8, 2022 1,148 4.21 (3.97 –4.46) 7.5 (4.1 –11.5)
Omicron BA.2/BA.4/BA.5 Apr 9 –Dec 31, 2022 428 0.57 (0.52 –0.63) 5.4 (2.9 –9.7)
Omicron XBB.1.5 Jan 1 –Dec 31, 2023 141 0.14 (0.12 –0.16) 6.9 (3.7 –11.5)
Omicron JN.1/others Jan 1 -Dec 31, 2024 79 0.08 (0.06 - 0.10) 9.1 (4.7 -14.3)
•Similarly decreased incidence was observed in other countries2-4
30
COVID -19 Vaccination Status of 2023 and 2024 U.S. Multisystem
Inflammatory Syndrome in Children (MIS -C) Cases
•Although 95% of children with MIS -C in 2023 and 99% in 2024 were eligible to receive a COVID -19
vaccine ≥16 weeks before their MIS -C illness, only 19% in 2023 and 26% in 2024 of eligible children
received any vaccine dose
•Of the 25 vaccinated children in 2023 with information on timing, 65% in 2023 received their last
vaccine dose more than 12 months prior to MIS -C onset
•All vaccinated children in 2024 received their last vaccine dose > 12 months prior to MIS -C onset
Yousaf AR et al, MMWR 2023 and unpublished data2023 Illness Onset
N=141 (%)2024 Illness Onset
N=79 (%)
Vaccine age -eligible¹ at time of MIS -C onset 134 (95) 78 (99)
No vaccination 108/134 (81) 58/78 (74)
Vaccinated (at least one dose received) 26/134 (19) 20/78 (26)
Last vaccine dose >12 months before MIS -C onset 17/26 (65) 20/20 (100)
¹10 months of age at onset considered the minimum age by which a child could plausibly have completed an mRNA primary vaccina tion series, with 6 months
being the earliest possible age at first dose and ≥12 weeks from first dose required to complete a 3 -dose primary series, and 4 weeks between time since last
dose and hospitalization
31
COVID -19 Vaccine and Myocarditis
COVID -19 vaccine prescribing information or fact sheet
warnings and precautions about myocarditis and pericarditis
https://www.fda.gov/emergency -preparedness -and-response/coronavirus -disease -2019 -covid -19/covid -19-vaccines -2024 -2025 Manufacturer Precaution
Pfizer Post marketing data with authorized or approved mRNA COVID -19
vaccines demonstrate increased risks of myocarditis and pericarditis,
particularly within the first week following vaccination. For COMIRNATY ,
the observed risk is highest in males 12 through 17 years of age.
Moderna Post marketing data with authorized or approved mRNA COVID -19
vaccines demonstrate increased risks of myocarditis and pericarditis,
particularly within the first week following vaccination. For SPIKEVAX,
the observed risk is highest in males 18 years through 24 years of age.
Novavax Clinical trials data provide evidence for increased risks of myocarditis and
pericarditis following administration of Novavax COVID -19 Vaccine,
Adjuvanted.
33
Myocarditis following mRNA COVID -19 vaccination among
people ages 12 –39 years in the Vaccine Safety Datalink
*Statistically significant increased rate ratio in vaccinated concurrent comparator analysis
Source: CDC Immunization Safety Office, unpublished data 638
25
25
2
Dose 1
Original monovalentDose 2
Original monovalentBooster
Original monovalentBivalent
2020-2021 2021-2022 2022-2023 2023-2024 2024-202538
6
22Incidence of myocarditis within 7 days of vaccination per million mRNA vaccine doses administered
34**
*
•The VSD has not detected a statistical signal for myocarditis/pericarditis following
the 2024 -2025 COVID -19 vaccine to dateVaccine DosesCases in
Risk
Interval
(Days 1 -21)Cases in
Comparison
Interval
(Days 22 -42)Adjusted Rate Ratio1
(95% Confidence Interval)
Pfizer 530,095 5 5 0.61 (0.11 – 2.88)
Moderna 35,194 0 0 n/a
Novavax 1,576 0 0 n/a
351 Adjusted for outcome calendar date, age group, sex, race/ethnicity, VSD site
Source: CDC Immunization Safety Office, unpublished data through March 22, 2025 Myocarditis/pericarditis concurrent comparator analysis in
Vaccine Safety Datalink (VSD) after COVID -19 vaccine doses
among people ages 12 -39 years, 2024 -2025
Vaccine Adverse Event Reporting System (VAERS) reports of
myocarditis within 7 days of COVID -19 vaccination among
people ages 12 -39 years , 2024 -2025
•The reporting rates are similar to the expected
background rates of <2 cases per million dosesAge group
(years)Verified casesReporting rate per
million doses
12-17 3 0.74
18-29 0 0
30-39 1 0.14
Source: CDC Immunization Safety Office, unpublished data through March 22, 2025 36
MOVING Study: Outcomes after myocarditis following COVID -19 vaccine:
Cardiologist/healthcare provider assessment of recovery in persons ages 12 –29 years
at least 90 days since onset of myocarditis after COVID -19 vaccination, 2021 -2022
•81% (320/393) of
patients were
considered fully or
probably recovered by
their cardiologist or
other healthcare
provider
Kracalik I, Oster ME, Broder KR et al. Outcomes at least 90 days since onset of myocarditis after mRNA COVID -19 vaccination in adolescen ts and young adults in the USA: a follow -up
surveillance study. Lancet Child & Adolescent Health, 2022.
MOVING: Myocarditis Outcomes after COVID -19 Vaccine INvestiGation 371%16% 15%66%
0%10%20%30%40%50%60%70%80%90%100%
Same cardiac status
as initial diagnosisImproved but not
fully recoveredProbaby fully recovered
but awaiting infoFully recoveredPercent of respondents
Provider -reported recovery status from myocarditis after mRNA COVID -19 vaccination
MOVING* study: Outcomes after myocarditis following COVID -19 vaccine: Patient -
reported assessment of recovery in persons ages 12 –29 years at least 90 days since
onset of myocarditis after COVID -19 vaccination, 2021 -2022
•50% (178/357) of
patients self -report
at least 1 lingering
symptom at 3
months
*MOVING: Myocarditis Outcomes after COVID -19 Vaccine INvestiGation
Kracalik I, Oster ME, Broder KR et al. Outcomes at least 90 days since onset of myocarditis after mRNA COVID -19 vaccination in adolescen ts and young adults in the USA: a follow -up
surveillance study. Lancet Child & Adolescent Health, 2022. 38
Composite outcome 1: rehospitalization for myopericarditis, cardiovascular event, or death from any cause.
Composite outcome 2: rehospitalization for myopericarditis, cardiovascular event, hospitalization for any cause (>1 night sta y), or death
from any cause.Comparison of myocarditis attributed to COVID -19 mRNA
vaccination, SARS -CoV-2 infection or conventional
etiologies, 2020 -2022
Semenzato L, Le Vu S, Botton J et al. Long -term prognosis of patients with myocarditis attributed to COVID -19 mRNA vaccination, SARS -CoV-2 infection, or con ventional etiologies. JAMA.
2024 . https://jamanetwork.com/journals/jama/fullarticle/2822933 39
Summary: myocarditis after COVID -19 vaccine
•An increased risk of myocarditis following COVID -19 vaccines was
observed during 2020 -2022 following the primary series and first
booster doses
•No increased risk was observed in VSD and VAERS with the 2022 -2023
and 2023 -2024 vaccines or the 2024 -25 vaccine to date
•Acute clinical picture following myocarditis after COVID -19 vaccine
tends to resolve quickly
•Post -COVID -19 vaccine myocarditis associated with less severe
cardiovascular events than post -COVID -19 myocarditis and
conventional myocarditis
VSD: Vaccine Safety Datalink | VAERS: Vaccine Adverse Event Reporting System 40
Risk-based v. universal vaccine
recommendations and vaccine coverage
Influenza vaccination coverage among adults 18 -64 years with and
without high -risk medical conditions, 2008 –09 through 2015 –16
influenza seasons, Behavioral Risk Factor Surveillance System
Vertical line denotes timing of universal influenza vaccination recommendation
Selected high risk conditions include asthma, diabetes or heart disease (before the 2013 -14 season) or asthma, diabetes, heart d isease, chronic obstructive pulmonary disease or cancers
other than skin cancer (2013 -14 season through present)
Source: CDC Immunization Services Division, unpublished0102030405060708090100
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16Percent vaccinated
Influenza season18-49 with high risk conditions 18-49 without high risk conditions
50-64 with high risk conditions 50-64 without high risk conditions
42
Vaccination coverage:
risk-based vs. universal recommendations
•Influenza vaccination coverage among adults with high -risk conditions increased
slightly after the universal recommendation in the 2010 -11 season, but it was
already trending upward and plateaued shortly after the change in
recommendation.
•Hepatitis B vaccination coverage among adults with risk factors remained below
pre-pandemic coverage after the universal recommendation in 2022.
•Coverage among adults universally recommended for zoster vaccination was
approaching pneumococcal vaccination coverage among high -risk adults by 2023,
despite longstanding pneumococcal vaccination recommendations for high -risk
adults.
•It is unclear how a change from a universal to risk -based recommendations may
impact COVID -19 vaccine coverage
43 Source: CDC Immunization Services Division, unpublished data
Parental vaccine confidence
COVID -19 vaccination coverage among children 6 months –
17 years, United States, 2023 -2024 through 2024 -2025
Current season week ending date refers to the 2024 -2025 season only. For the 2023 -2024 season, the corresponding week is represe nted
Data source: National immunization survey – Flu https://www.cdc.gov/covidvaxview/weekly -dashboard/child -coverage -vaccination.html
Accessed April 7, 2025 45▪As of March 22, 2025, 12.8% of children 6 months -17 years reported having received the 2024─25 COVID -19 vaccine.
66
61
48
38
35
35
33
24
2221
27
27
17
29
32
30
21
149
9
17
17
21
21
21
20
184
4
9
29
15
12
17
35
46
0 25 50 75 100Get child vaccinated for COVID -19Have child mask with increased illness in communityTalk to child's doctor about prevention optionsDo my own research on prevention optionsLimit child's contact with others with increased illness in
communityGet child vaccinated for fluGive child vitamins or supplementsFeed child healthy foodsHave child wash hands more
Weighted %Very likely Somewhat likely A little likely Not likely"How likely are you to take the following actions to help prevent your child
from getting sick from a respiratory illness?" Results Among Parents of Child
Ages 0 –17Years, Omnibus Surveys, November 7 —29, 2024 (N=1,141)
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to
survey a nationally representative sample of U.S. adults ages 18 years and older. CDC fields questions about vaccination status, intent, knowledge, attitudes, beliefs, and
behaviors on each survey for 2 waves each month, for a combined sample size of ~4,000 respondents. These slides present resul ts from November (N=4,240). Data were
weighted to represent the non -institutionalized U.S. population and mitigate possible non -response bias. All responses are self -reported. 46
26 60 15 Safety (N=956)More confident now About the same confidence now Less confident now
24 61 15
0 25 50 75 100Effectiveness (N=948)
Weighted %More confident now About the same confidence now Less confident now"Are you more or less confident in the safety/effectiveness of COVID -19 vaccines for children now
compared to when they first came out?" Results Among Parents of Child Ages 0 –17 Years Who Received
at Least 1 Dose of aCOVID -19 Vaccine , Omnibus Surveys, December 5 , 2024–January 27, 2025
47Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to survey
a nationally representative sample of U.S. adults ages 18 years and older. CDC fields questions about vaccination status, int ent, knowledge, attitudes, beliefs, and behaviors on
each survey for 2 waves each month, for a combined sample size of ~4,000 respondents. These slides present results from December 2024 & January 2025 (N=8,536). Data were
weighted to represent the non -institutionalized U.S. population and mitigate possible non -response bias. All responses are self -reported.
"Are you more or less confident in the safety/effectiveness of COVID -19 vaccines for children now
compared to when they first came out?" Results Among Parents of Child Ages 0 –17Years Who Have
Never Received a COVID -19 Vaccine , Omnibus Surveys, December 5 , 2024 —January 27, 2025
48Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to survey a nationally representative sample of
U.S. adults ages 18 years and older. CDC fields questions about vaccination status, intent, knowledge, attitudes, beliefs, an d behaviors on each survey for 2 waves each month, for a combined sample size of ~4,000
respondents. These slides present results from December 2024 & January 2025 (N=8,536). Data were weighted to represent the no n-institutionalized U.S. population and mitigate possible non -response bias. All
responses are self -reported.6 49 45 Safety (N=1,308)More confident now About the same confidence now Less confident now
4 51 45
0 25 50 75 100Effectiveness (N=1,296)
Weighted %More confident now About the same confidence now Less confident now
Child’s 2024 -2025 COVID -19 Vaccination Status And Parental Intent to Get Their Child
Vaccinated, Results Among Parents of Child ren Ages 0 –17Years ,by Receipt of Prior COVID -19
Vaccine(s), Omnibus Surveys, December 5 , 2024—January 27, 2025 (N=2,312)
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to survey a nationally
representative sample of U.S. adults ages 18 years and older. CDC fields questions about vaccination status, intent, knowledg e, attitudes, beliefs, and behaviors on each survey for 2 waves each
month, for a combined sample size of ~4,000 respondents. These slides present results from December 2024 & January 2025 (N=8, 536). Data were weighted to represent the non -institutionalized
U.S. population and mitigate possible non -response bias. All responses are self -reported.4911 4 8 18 17 42
26 8
215
323
1518
1611
65
0 25 50 75 100All parents (N=2,307)
Child did NOT have 1+ doses (N=1,334)Child had 1+ doses (N=962)
Weighted %Child received a COVID -19 vaccine since August 22, 2024 Definitely will get child vaccinated Probably will
Not sure Probably will not Definitely will not
43%
31%
30%
13%
12%
4%
8%
0%
3%
1%
25%
0 20 40 60 80 100Concerned about safety
Concerned about effectiveness
Concerned about bad reaction
Not/no longer a requirement
No recommendation from
provider
Haven't had time
Child has antibodies from
recent infection
Child received enough doses *
Worried about related cost
Do not know where to get it
None of the above
Weighted % (95% confidence interval)Child never vaccinated against COVID -19 (N=1,323)
18%
11%
4%
18%
12%
16%
7%
15%
4%
3%
29%
0 20 40 60 80 100
Weighted % (95% confidence interval)Child received ≥1dose COVID -19 vaccine (N=695)Reasons for Not Getting Child a 2024 -2025 COVID -19 Vaccine , Among
Parents of Child Ages 0 –17, by Receipt of Prior COVID -19 Vaccine(s),
Omnibus Surveys, December 5, 2024 —January 27, 2025
*Option "Child received enough doses" only offered to parents of children who have received at least one dose of any COVID -19 vaccine .
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to survey a nationally
representative sample of U.S. adults ages 18 years and older. CDC fields questions about vaccination status, intent, knowledg e, attitudes, beliefs, and behaviors on each survey for 2 waves each
month, for a combined sample size of ~4,000 respondents. These slides present results from December 2024 & January 2025 (N=8, 536). Data were weighted to represent the non -institutionalized
U.S. population and mitigate possible non -response bias. All responses are self -reported. 50
Recommendations in other countries
Summary of international COVID -19 booster* recommendations
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf 2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html 3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown in this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
52
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf 2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html 3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
53
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf 2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html 3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
54
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf 2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html 3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
55
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf 2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html 3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
56
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf 2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html 3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
57
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf 2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html 3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
58
Work Group Interpretations
•When initially presented with 2025 –2026 COVID -19 vaccine policy options
in November 2024, the Work Group appreciated pros and cons of both
risk-based and universal vaccine recommendations.
•At that time, there was not yet a consensus on what the recommendation
for the 2025 –2026 COVID -19 vaccine should be.
•The Work Group requested additional information to help inform the
decision -making process on risk -factors for severe COVID -19, transmission
and immunity, vaccine implementation and access, and cost -effectiveness. Initial Work Group interpretations
60
When polled on February 13, 2025, the majority of the work group
supported a non -universal (risk -based) recommendation for 2025 –2026
COVID -19 vaccination
14%19%67%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Don't knowUniversal recommendation for
everyone aged ≥6 months Non-universal recommendation
Percent of work group2025 –2026 Vaccination Policy
61
When polled on February 13, 2025, the Work Group supported
all non -universal policy options *
86%93%79%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Allowance for anyone wanting protection
from vaccinationCertain age groups (e.g., persons aged ≥65 years)Specific high-risk conditions and exposures
Percent of COVID -19 vaccine Work Group members who selected a non -universal vaccine policy
recommendationGroups to be included in 2025 –2026 COVID -19 vaccine recommendation
* More than one response option could be selected. 62
•2024 -2025 COVID -19 vaccine effectiveness
•Seroprevalence of SARS -CoV-2
•Long COVID
•COVID -19 vaccine coverage update
•Multisystem Inflammatory Syndrome in Children (MIS -C)
•Liaison feedback (see next slide)Additional data presented to the Work Group
(March – April 2025)
63
•American Academy of Family Physicians (AAFP)
•American Academy of Pediatrics (AAP)
•Association of Immunization Managers (AIM)
•American College of Physicians (ACP)
•American Pharmacists Association ( APhA )
•American College of Obstetricians and Gynecologists (ACOG)
•Concerns were raised regarding implementation, communication, confidence in
recommendations and equitable access to vaccination with a potential risk -based
recommendation Liaison feedback on a potential risk -based recommendation
obtained from the following organizations (March – April 2025)
64
When polled on April 3, 2025 , the majority of the work group continued
to support a non -universal (risk -based) recommendation for 2025 –2026
COVID -19 vaccination
0%24%76%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Don't knowUniversal recommendation for
everyone aged ≥6 months Non-universal recommendation
Percent of work group2025 –2026 Vaccination Policy
65
When polled on April 3, 2025, the Work Group continued to
support all non -universal policy options*
89%84%84%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Allowance for anyone wanting protection
from vaccinationCertain age groups (e.g., persons aged ≥65 years)Specific high-risk conditions and exposures
Percent of COVID -19 vaccine Work Group members who selected a non -universal vaccine policy
recommendationGroups to be included in 2025 –2026 COVID -19 vaccine recommendation
* More than one response option could be selected. 66
Risk for COVID -19–associated hospitalization is increased
among community -dwelling adults ages ≥18 years with
underlying medical conditions.
Abbreviations: RR, rate ratio; CI, confidence interval; COPD, chronic obstructive pulmonary disease.
* “None” refers to having none of the conditions examined in this analysis ( asthma, COPD, diabetes, chronic kidney disease, coronary artery disease, stroke, severe obesity, and current smoking).
** “Any condition” refers to having at least 1 of these conditions. Notes: Non -severe obesity is defined as BMI 30 –39kg/m². Severe obesity is defined as BMI ≥40kg/m². “Any condition” includes
asthma, COPD, diabetes, chronic kidney disease, coronary artery disease, stroke, severe obesity, and current smoking. Rate ra tios were estimated using multivariable Poisson models adjusted for sex,
and race/ethnicity. “Smoker (current)” Includes people who quit smoking within the past 12 months. Data are limited to hospit alizations where COVID -19 is the likely reason for admission. 67Patterned bars indicate CIs that include 1.0.
0.1110100
None* Any
condition**Asthma COPD Chronic
kidney
diseaseCoronary
artery
diseaseDiabetes Stroke
(history of)Obesity
(non-severe)Obesity
(severe)Smoker
(current)Adjusted RR (log scale)Adjusted Rate Ratios for COVID -19–associated Hospitalizations among Community -Dwelling Adults Ages ≥18 Years,
by Age Group — October 2022 –September 2023
18–49 50–64 65–74≥75
•General thoughts on universal vs. risk -based recommendation for COVID -19 vaccination
•Are there groups that clearly should not be recommended for vaccination with the 2025 –2026
vaccine ?
•What data would be helpful in your decision making?
•Is it still helpful to have a risk -based recommendation if most of thepopulation (>74%) is
considered “at risk”?
•Should people at higher risk of infection and transmission (e.g., healthcare workers) be included in
a risk -based recommendations?
•Will stable (i.e., universal) recommendations increase uptake with time?
•Concerns about implementation challenges with risk -based recommendations?
•Any potential unintended implications or consequences of a recommendation change?
•Are there key decision points we have not captured here?Discussion
68
Acknowledgements
•Lauren Roper
•Farida Ahmad
•Carla Black
•Kayla Calhoun
•Angela Campbell
•Mary Chamberland
•Nicole Dowling
•Jonathan Duffy
•Monica Godfrey
•Susan Goldstein
•Fiona Havers
•Jefferson Jones•Ruth Link -Gelles
•Meredith McMorrow
•Sarah Meyer
•Pedro Moro
•Danielle Moulia
•Matthew Oster
•Hilda Razzaghi
•Sharon Saydah
•Sierra Scarbrough
•Zachary Schneider
•Benjamin Silk
•Christopher Taylor•Natalie Thornburg
•Evelyn Twentyman
•Eric Weintraub
•Anna Yousef
•Coronavirus and other Respiratory
Viruses Division
•COVID -NET Team
•Immunization Safety Office
•Immunization Services Division
•National Center for Immunization and
Respiratory Diseases
69