COVID-19 Vaccination in Adults Who Received a Pediatric Dose

Rationale for Additional Dose

The Advisory Committee on Immunization Practices (ACIP) recommends that adults receive the appropriate adult formulation of COVID-19 vaccines to ensure optimal protection against severe disease and hospitalization 1

Adults who received a pediatric dose of the Moderna COVID-19 vaccine should receive a full adult dose of an approved 2024-2025 COVID-19 vaccine (Moderna, Pfizer-BioNTech, or Novavax if ≥12 years) at least 8 weeks after the pediatric dose was received 1
The choice of vaccine manufacturer for the additional dose does not necessarily need to match the previously received pediatric Moderna vaccine, but the adult should receive an age-appropriate dose 1

If the adult is immunocompromised, they may require specific dosing considerations according to current ACIP guidelines 1
The vaccination error (pediatric dose administered to an adult) should be reported to the Vaccine Adverse Event Reporting System (VAERS) as required for vaccination errors 1

The pediatric dose should not be counted as a valid adult dose in the vaccination series, and an additional age-appropriate dose should be administered 1
The additional dose should not be delayed beyond the recommended timeframe (8 weeks after the incorrect dose), as this may prolong the period of suboptimal protection 1
The vaccination error should not be skipped from being reported to VAERS, as this information helps improve vaccination safety protocols 1

The Advisory Committee on Immunization Practices (ACIP) recommends that all individuals 6 months and older receive a dose of the 2024-2025 COVID-19 vaccine, regardless of prior vaccinations 2
For individuals who have already received at least one COVID-19 vaccine dose (including Pfizer-BioNTech), a single dose of the 2024-2025 COVID-19 vaccine is recommended 3
The recommended minimum interval between the last COVID-19 vaccine dose and the 2024-2025 vaccination is 8 weeks 4

The 2024-2025 COVID-19 vaccines are updated monovalent vaccines developed specifically against current virus variants (Omicron JN.1-line, including JN.1 and KP.2) 5

Individuals can choose from various vaccines, including Moderna (monovalent, KP.2-strain) 2, Pfizer-BioNTech (monovalent, KP.2-strain) 2, and Novavax (monovalent, JN.1-strain) for individuals 12 years and older 2
The choice of vaccine manufacturer does not need to match prior vaccinations 4

For individuals with moderate or severe immunocompromise, special recommendations apply, with possible additional doses 3
For individuals who have recently had a SARS-CoV-2 infection, a delay in vaccination of 3 months after symptom onset or positive test may be considered 6

Consider delaying the booster dose by 3 months from symptom onset or positive test result if an individual recently had COVID-19, allowing their natural immune response to mature before additional vaccination, as recommended by the Centers for Disease Control and Prevention 7
The vaccine manufacturer does not need to match prior vaccinations, and individuals can choose from available vaccine options, but the Janssen (Johnson & Johnson) vaccine should not be used except in very limited situations due to thrombosis with thrombocytopenia syndrome risk, as advised by the Centers for Disease Control and Prevention 7