COVID-19 vaccine information

***For established patients only***

On this page we will discuss recommendations for COVID-19 vaccination in the 2025-2026 season specifically for the pediatric patients at our clinic. It is divided into three sections:

  1. AAP recommendations

  2. Discussion of the primary series (the first season a child is vaccinated in)

  3. Discussion of annual boosters (all subsequent doses after the primary series)

IMPORTANT: this discussion only applies to children under our care, the risks/benefits are quite different for adults.

1) American Academy of Pediatrics recommendations:

In brief, the AAP recommends vaccination this year for A) any child who’s never had a vaccine, and B) a seasonal booster for anyone < 2 years old, at high risk for severe COVID, or children “whose parent or guardian desires protection from COVID-19”. Here is the official guideline:

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. 

As many of you may know, these are unprecedented times, where the recommendations of many physicians and official medical organizations like the AAP may end up differing from the positions of the current administration’s federal agencies such as the Advisory Committee on Immunization Practices (ACIP), and the Food and Drug Administration (FDA). As board-certified pediatricians, our physicians plan to generally adhere to the guidance set forth by the AAP—our nation’s best recognized resource on pediatric guidelines.

2) Primary series

We agree that there is ample evidence for children of all ages to receive the primary series, and recommend it for all our patients. The data indicate that it reduces hospitalization, severe illness, and complications from COVID infection in children. This benefit is in addition to natural immunity, so the hybrid combination of vaccine immunity + natural immunity together are likely better than either alone. Even healthy children are at risk from complications due to COVID, and it is worth mitigating that risk with a vaccine that has demonstrated a very good safety profile, with far fewer risks than the illness itself. While we would ideally like to see updated clinical trials with more recent strains for a more precise estimate of how dramatic the benefit is, it is most likely that the benefits will continue to far outweigh the risks in these situations.

It is optimally started at 6 months given the higher hospitalization rate in infants less than 2 years old, but any age is appropriate if your child has not yet had their primary series. For infants less than 6 months old, those around them (parents, caregivers) should receive the vaccine to protect the infant until they are old enough to get their own vaccine. 

3) Annual boosters

Let’s start with a brief summary since this topic is more complicated:

Summary and recommendations

  • We continue to recommend annual boosters for children with any high-risk medical conditions. The consensus in support of this recommendation is high. While again more data would help clarify the precise degree of benefit, it is most likely that the benefits far outweigh the risks in such situations.

  • We are continuing to offer annual boosters to healthy, vaccinated children in alignment with the AAP recommendations for families wishing to maximize their protection against COVID-19. In all likelihood the benefits outweigh the risks. However, due to the limited clinical trials, less scientific consensus, and possibly small observed benefit, we are not going so far as to say we feel strongly that all children must get a new booster every year. Each family needs to take into account your situation and values, your child’s health, how well they tolerate shots, risk of exposure, and how disruptive the illness vs. vaccine would be to your family. We particularly recommend considering a booster for kids who have not had any known COVID vaccine or infection in the past 6-12+ months and are expecting an upcoming increase in exposure (e.g. major travel), as such children are likely to see the greatest benefit. See discussion below for more thorough explanation.


Details and explanation

Once a child has been vaccinated for COVID-19, the additional benefit from annual booster doses is not well documented. That doesn’t mean it isn’t there, just that no one has performed a study yet to answer the question. So the remainder of this page will review some of the main considerations.

Potential limitations of annual boosters among previously vaccinated children:

  • Serious illness and hospitalization in children 2+ years old is already quite low once initial vaccination combines with wild type immunity from ongoing exposure. We have no conclusive evidence yet how much these outcomes could be improved with another booster, with some evidence suggesting it might not be much. Immunity doesn’t always need to be a perfect match to prevent severe outcomes—most children hospitalized from COVID were simply not vaccinated at all. Common sense would expect there would still be some reduction from additional doses, but it’s possible that it may not be a huge amount. (Because the hospitalization rate in infants < 2 years old is higher, it is reasonable to do a booster for this age range in alignment with the AAP recommendation, though the specific degree of risk reduction in such a situation is not known.)

  • Minor illness is hard to prevent. To prevent an infection from occurring at all you need a much closer match. But COVID’s lack of a predictable pattern make this challenging. Boost too soon and you get a weaker response, too late and you catch COVID while waiting. Theoretically, if you didn’t catch COVID for 12+ months before your shot, and you do catch COVID within 3-6 months after your shot, you’d see the optimal immunity measured in trials, but such perfect timing is hard to accomplish in real life. Many will have had COVID exposure in the past few months, and/or not catch COVID until a year later when their immunity has waned and the active strains have already changed.

  • The strains change quickly. There are so many variants which change so quickly that by the time a vaccine is ready to administer, its chosen variant is no longer the predominant strain in the wild. In fact, it usually makes up < 5% of circulating strains by the time people receive it. That doesn’t mean it’s ineffective—it has still been shown to induce antibodies for several other circulating strains. But it goes to show how complicated it would be to try to stop all illness.

All of this doesn’t make getting a booster pointless, it just makes the actual benefits a child might experience less than a booster’s theoretical effectiveness. But sometimes the timing will work in your favor, and even when it doesn’t there’s still probably some reduction in illness. Even a small benefit would outweigh the even smaller risks of a vaccine. So the question isn’t as much do the benefits outweigh the risks, but rather if that is by a large enough margin to exceed your threshold for coming in and giving your child a shot.

The benefits of annual boosters

The benefits include the potential to reduce risk of adverse outcomes such as long COVID, hospitalization, missed school, death, and more. Unfortunately we don’t have specific data enumerating the degree of reduction. For example, we have evidence that COVID vaccination reduces the risk of long COVID in children, but the study didn’t report the difference between those getting an annual booster and those getting their first shot. Since it does reduce long COVID risk, you would assume a more recent booster would further reduce that risk, but no one has studied that yet.

What safety and efficacy data is there for current boosters?

Direct safety and efficacy data on current strains will always be more limited than older vaccines, particularly when it comes to children. Most of the safety and efficacy is extrapolated from previous versions of the vaccine, for which there is ample data. After updating the strain, they will demonstrate the new vaccine can produce neutralizing antibodies against currently circulating strains, and confirm that on average at least in the small number tested, side effects were comparable to previous vaccines.

Typically, when there are minor changes to a proven vaccine, and it produces the antibodies desired, it’s unlikely that it will differ significantly from prior versions in terms of safety or effectiveness. There is a small risk that a different antigen could trigger an unwanted immune response, though this is rare. All vaccines undergo very close post-marketing surveillance to monitor for such a possibility just in case. But if we waited until a large trial with 100,000 children and adults could be observed over a long enough period, that strain would be so different from the strains currently in circulation that it really isn’t a feasible option.

Summary

In summary, it's usually a pretty safe bet that an updated vaccine will be as well tolerated and effective as previous versions, even without new clinical trials in children. That makes it fairly easy to recommend in settings where we know the benefits are substantial, as with the primary series. But it makes a decisive recommendation for annual boosters more challenging until the benefits of that approach are better established.

Additional resources:

We hope this information is useful.

Last updated 9/15/2025