At a glance
- Additional considerations may apply to people with prior SARS-CoV-2 infection, a history of multisystem inflammatory syndrome, or people who were vaccinated outside the United States.
- COVID-19 vaccination is recommended for women who are pregnant, trying to get pregnant, might become pregnant in the future, and who are breastfeeding.
COVID-19 vaccination and prior SARS-CoV-2 infection
COVID-19 vaccination is recommended for everyone ages 6 months and older, regardless of prior symptomatic or asymptomatic SARS-CoV-2 infection, including people with Long COVID.
People who recently had SARS-CoV-2 infection may consider delaying a COVID-19 vaccine dose by 3 months from symptom onset or positive test (if infection was asymptomatic). have shown that increased time between infection and vaccination might result in an improved immune response to vaccination. Also, a low risk of reinfection has generally been observed in the months following infection. Individual factors such as risk of severe COVID-19 and should be taken into account when determining whether to delay getting a COVID-19 vaccination after infection.
Pregnancy, lactation, and fertility
COVID-19 vaccination is recommended for women who are pregnant, trying to get pregnant, might become pregnant in the future, and who are breastfeeding. A growing body of evidence on the safety and effectiveness of COVID-19 vaccination indicates that the benefits of vaccination outweigh any potential risks of COVID-19 vaccination during pregnancy. Maternal vaccination has also been shown to be safe and effective, and protects infants younger than age 6 months from severe COVID-19 and hospitalization.
Side effects can occur after COVID-19 vaccination in pregnant women, similar to those among non-pregnant women. Acetaminophen can be offered as an option for fever during pregnancy (fever has been associated with adverse pregnancy outcomes) or other post-vaccination symptoms.
COVID-19 vaccination and MIS-C and MIS-A
Multisystem inflammatory syndrome in children (MIS-C) and multisystem inflammatory syndrome in adults (MIS-A) are rare and potentially serious post-infectious complications of SARS-CoV-2 infection. Both are associated with a dysregulated immune response to SARS-CoV-2 infection. MIS-C incidence has declined by more than 90% since the start of the pandemic despite continued SARS-CoV-2 infections and re-infections.
There have been rare of multisystem inflammatory syndrome (MIS)-like illness after COVID-19 vaccination identified from U.S. surveillance without laboratory evidence of SARS-CoV-2 infection). However, the contribution of COVID-19 vaccination to an MIS-like illness is unknown.
Considerations for initiating COVID-19 vaccination in people with a history of MIS-C or MIS-A
Experts consider the benefits of COVID-19 vaccination for people with a history of MIS-C or MIS-A (i.e., a reduced risk of severe disease including potential recurrence of MIS-C after reinfection) to outweigh a theoretical risk of an MIS-like illness or the rare risk of myocarditis following COVID-19 vaccination for those who meet the following two recovery criteria:
- Clinical recovery has been achieved, including return to baseline cardiac function; and
- It has been at least 90 days after the diagnosis of MIS-C or MIS-A
COVID-19 vaccination may also be considered for people who had MIS-C or MIS-A and do not meet both criteria, at the discretion of their clinical care team. Experts view clinical recovery, including return to baseline cardiac function, as an important factor when considering COVID-19 vaccination. Additional factors, such as the risk of severe COVID-19 due to age or certain medical conditions, may also be considered.
Considerations for administration of subsequent COVID-19 doses in people diagnosed with MIS-C or MIS-A after COVID-19 vaccination
Onset of MIS more than 60 days after most recent COVID-19 vaccine dose
Administration of subsequent COVID-19 vaccine doses should be considered for those who meet the two recovery criteria described in the section immediately above.
Onset of MIS 60 days or fewer after most recent COVID-19 vaccine dose
For persons in this category who meet the recovery criteria described in the section immediately above, the decision whether or not to administer subsequent COVID-19 vaccine doses should be made on an individual basis by the clinical care team and patient or parent or guardian. Subsequent COVID-19 vaccine doses should especially be considered if there is strong evidence that the MIS-C or MIS-A was a complication of a recent SARS-CoV-2 infection.
People who received COVID-19 vaccine outside the United States
Everyone ages 6 months and older vaccinated outside the United States should receive at least 1 dose of 2024–2025 COVID-19 vaccine regardless of past COVID-19 vaccination history (e.g., vaccine type[s], vaccine manufacturer[s], number of doses) unless they received a 2024–2025 COVID-19 vaccine that is Food and Drug Administration (FDA)-approved or FDA-authorized (i.e., Moderna, Novavax, or Pfizer-BioNTech), or or by the World Health Organization (WHO.) COVID-19 vaccines that are pre-qualified or listed for emergency use by WHO, but are not approved or authorized by FDA, have not been evaluated for efficacy or safety by ob体育 or the Advisory Committee on Immunization Practices (ACIP).
Recommendations for people who were vaccinated outside the United States, but have not received a 2024–2025 COVID-19 vaccine are as follows:
People ages 5 years and older
- Previously received doses of COVID-19 vaccines that are FDA-approved, FDA-authorized or pre-qualified or listed for emergency use by WHO: Administer 1 age-appropriate dose of a 2024–2025 COVID-19 vaccine at least 8 weeks after the last COVID-19 vaccine dose (Table 1). NOTE: People ages 65 years and older should receive 2 doses of any 2024–2025 COVID-19 vaccine (Table 1).
- Previously received doses of COVID-19 vaccines that are not FDA-approved, FDA-authorized, or prequalified or listed for emergency use by WHO: The doses do not count towards vaccination in the United States and these people are considered unvaccinated; initiate vaccination at least 8 weeks after the last COVID-19 vaccine dose (Table 1).
Children ages 6 months–4 years and people who are moderately or severely immunocompromised
- Previously received doses of COVID-19 vaccines that are FDA-approved, FDA-authorized, or prequalified or listed for emergency use by WHO: The doses count towards vaccination in the United States; administer the number of age-appropriate doses of a 2024–2025 COVID-19 vaccine based on the schedule in Table 1 or Table 2.
- Previously received doses of COVID-19 vaccines that are not FDA-approved, FDA-authorized, or prequalified or listed for emergency use by WHO: The doses do not count towards vaccination in the United States and these people are considered unvaccinated; initiate vaccination at least 8 weeks after the last COVID-19 vaccine dose Table 1 or Table 2.
Special situation: If unable to determine if a previously received vaccine dose was a 2024–2025 COVID-19 vaccine, do not count the dose and follow guidance for administering a 2024–2025 COVID-19 vaccine dose.