CDC Updates Vaccination Schedule for Children and Adolescents, Includes COVID-19 Vaccine

The CDC’s Advisory Committee on Immunization Practices (ACIP) announced the updated 2023 immunization schedule for children and adolescents under 18 years of age. The published new recommendations for families and clinicians are part of routine vaccinations as well as inclusion of the COVID-19 vaccine.

“The routine vaccination section describes the recommendations for primary series in the general population, and the special situations section describes the recommendations for primary series in persons who are moderately or severely immunocompromised,” the authors wrote about the COVID-19 vaccine schedule.

The changes were published in the most recent MMWR.

According to the CDC, the following are the COVID-19 vaccine recommendations for the primary series:

• Age 6 months–4 years: 2-dose series at 0, 4-8 weeks (Moderna) or 3-dose series at 0, 3-8, 11-16 weeks (Pfizer-BioNTech)
• Age 5–11 years: 2-dose series at 0, 4-8 weeks (Moderna) or 2-dose series at 0, 3-8 weeks (Pfizer-BioNTech)
• Age 12–18 years: 2-dose series at 0, 4-8 weeks (Moderna) or 2-dose series at 0, 3-8 weeks (Novavax, Pfizer-BioNTech)

For boosters they recommended the following:

“People ages 6 months and older are recommended to receive 1 bivalent mRNA booster dose after completion of any FDA-approved or FDA-authorized primary series or previously received monovalent booster dose(s) with the following exception: children 6 months–4 years who receive a 3-dose Pfizer-BioNTech primary series are not authorized to receive a booster dose at this time regardless of which Pfizer-BioNTech vaccine (i.e., a monovalent or bivalent) was administered for the third primary series dose,” the authors wrote. “Monovalent mRNA vaccines are not authorized as a booster dose.”

The CDC makes the point that all vaccines for children and adolescents be given the age-appropriate vaccine and dosage based on their age at the time of their vaccination. However the federal agency also makes the distinction that there are FDA-authorized exceptions when children’s ages are transitioning and they offer guidance for those circumstances.

Other Important Changes to the Schedule

The extensive schedule includes changes for other routine vaccines.

For the pneumococcal conjugate vaccine: “This dose is only necessary for children aged 12–59 months regardless of risk, or aged 60–71 months with any risk, who received 3 doses before age 12 months.”

For the influenza vaccine: “Language was added to the “Special situations” section to clarify that live attenuated influenza vaccine should not be administered to close contacts of immunosuppressed persons who require a protected environment. In addition, the language for persons with egg allergy with symptoms other than hives was moved from the appendix to the “Special situations” section.”

For the MMR vaccine: "The “Special situations” section was updated to include recommendations for additional MMR doses in a mumps outbreak setting."

Other interesting changes include poliovirus and dengue vaccine recommendations in those special circumstances.

The full vaccine schedule can be found here.