At a glance
- Two types of COVID-19 vaccines are recommended for use in the United States: mRNA vaccines (Moderna and Pfizer-BioNTech) and a protein subunit vaccine (Novavax; now manufactured by Sanofi US Inc).
- A 2026-2027 COVID-19 vaccine is recommended for all adults ages 18 years and older.
- A 2026-2027 COVID-19 vaccine is also recommended for all children ages 6 months–17 years with moderate to severe immunocompromise; for all other children in this age group, a COVID-19 vaccine is recommended through shared clinical decision-making.
- Where a recommendation on this page describes use that is not within the FDA-approved indication, the page identifies it as off-label.
- Schedules for the updated COVID-19 vaccines are based on age and immune status.
Introduction
These clinical considerations provide guidance to healthcare professionals and public health officials on use of 2026-2027 COVID-19 vaccines. They are informed by:
- Recommendations of the Advisory Committee on Immunization Practices (ACIP) and CDC
- COVID-19 vaccine approval by the U.S. Food and Drug Administration (FDA)
- The General Best Practices for Immunization
- COVID-19 vaccination is not guaranteed to prevent infection with or spread of SARS-CoV-2.
Types of COVID-19 vaccines
Two different types of COVID-19 vaccines are recommended for use and FDA-approved for specific populations in the United States. There are three mRNA-based vaccines and one protein subunit vaccine currently on the market:
- mRNA vaccines
- Moderna COVID-19 Vaccines:
- Spikevax
- FDA approved for use in: individuals 65 years of age or older; individuals 6 months – 64 years of age with at least one underlying condition that puts them at high risk for severe outcomes from COVID-19.
- mNexspike
- FDA approved for use in: individuals 65 years of age or older; individuals 12 – 64 years of age with at least one underlying condition that puts them at high risk for severe outcomes from COVID-19.
- These vaccines are hereafter referred to collectively as Moderna COVID-19 Vaccine unless the specific vaccine name is relevant.
- Spikevax
- Pfizer-BioNTech COVID-19 Vaccine: Comirnaty
- FDA approved for use in: individuals 65 years of age or older; individuals 5 – 64 years of age with at least one underlying condition that puts them at high risk for severe outcomes from COVID-19.
- This vaccine is hereafter referred to as Pfizer-BioNTech COVID-19 Vaccine.
- There is currently no FDA-approved or FDA-authorized Pfizer-BioNTech COVID-19 vaccine for individuals ages 6 months–4 years.
- Moderna COVID-19 Vaccines:
- Protein subunit vaccine
- Novavax COVID-19 Vaccine: Nuvaxovid (now manufactured by Sanofi US Inc.)
- FDA approved for use in: individuals 65 years of age or older; individuals 12 – 64 years of age with at least one underlying condition that puts them at high risk for severe outcomes from COVID-19.
- This vaccine is hereafter referred to as Novavax COVID-19 Vaccine.
- Novavax COVID-19 Vaccine: Nuvaxovid (now manufactured by Sanofi US Inc.)
Recommendations for an age-appropriate COVID-19 vaccination in persons ages 6 months–64 years without at least one underlying high-risk condition are based on off-label use. As with all medical decision making between patients and their healthcare providers, patients should discuss the benefits and risks of COVID-19 vaccination to make informed and personalized decisions about vaccination.
There is no preferential recommendation for the use of any one COVID-19 vaccine over another when more than one recommended and age-appropriate vaccine is available.
The 2025-2026 Moderna, Novavax, and Pfizer-BioNTech COVID-19 vaccines should not be used once 2026-2027 COVID-19 vaccines are available.
COVID-19 vaccine composition
The 2026–2027 formulations for COVID-19 vaccines in the United States are based on the Omicron JN.1-lineage of SARS-CoV-2, as follows:
- Moderna and Pfizer-BioNTech: XFG strain
- Novavax: XFG strain
COVID-19 vaccine-specific package inserts and U.S. COVID-19 Vaccine Product Information can be consulted for a full list of ingredients and information on the conditions of use, storage and handling, preparation, and administration procedures.
Overview of recommendations for the use of COVID-19 vaccines
Groups recommended for vaccination
COVID-19 vaccination is recommended for the prevention of COVID-19 disease and its complications as follows:
- Adults ages 18 years and older: A 2026-2027 COVID-19 vaccine is recommended for all persons ages 18 years and older.
- Children ages 6 months–17 years with moderate to severe immunocompromise: A 2026-2027 COVID-19 vaccine is recommended for all children ages 6 months-17 years with moderate to severe immunocompromise.
- All other children ages 6 months–17 years:A 2026-2027 COVID-19 vaccine is recommended based on shared clinical decision-making with an emphasis that the risk-benefit of vaccination is most favorable for individuals who are at an increased risk for severe COVID-19 disease and least favorable for individuals who are not at an increased risk, according to the CDC list of COVID-19 risk factors.
In addition to the CDC list of risk factors for severe COVID-19, the Moderna (Spikevax) package insert states that prematurity (birth at <37 weeks gestational age) has been associated with COVID-19-related hospitalizations in children ages 6–23 months.
The vaccination schedules for the 2026-2027 COVID-19 vaccines vary based on vaccination history, age group, and immune status. Detailed schedules, including age-appropriate vaccines, dosages, and intervals between doses for the 2026-2027 COVID-19 vaccines can be found in Table 1; a modified schedule for people who are moderately or severely immunocompromised can be found in Table 2.
Pfizer-BioNTech COVID-19 Vaccine is no longer authorized in the United States for children ages 6 months–4 years. Children in this age group who began vaccination with Pfizer-BioNTech COVID-19 Vaccine and have not completed the recommended number of doses cannot complete the series with the same product. CDC advises completing vaccination with an available age-appropriate product, consistent with CDC guidance on interchangeability of COVID-19 vaccines. This guidance is issued to prevent children from remaining with an incomplete series. It is based on CDC interchangeability guidance and the judgment of CDC clinical and public health experts.
Vaccine dosage and administration
General Best Practices for Immunization apply to COVID-19 vaccination unless otherwise noted. People may receive an age-appropriate vaccine product and dosage based on their age on the day of vaccination and follow the recommended dosing intervals (Table 1 and Table 2).
COVID-19 vaccine doses should be administered by the intramuscular route.
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The information on this page was last reviewed by subject matter experts to ensure accuracy.