Table 2.

Clinical considerations for use of COVID-19 vaccines.

Coadministration with other vaccines	COVID-19 vaccines and other vaccines may be administered on the same day, as well as any interval without respect to timing. When deciding to administer COVID-19 vaccine with other vaccines, providers should consider whether the patient is behind or at risk of becoming behind on recommended vaccines, patient's risk of acquiring vaccine-preventable diseases (e.g., during an outbreak), and the reactogenicity profile of the vaccines being administered. If multiple vaccines are administered at a single visit, administer each injection in a different injection site.
Persons with prior or current COVID-19	COVID-19 vaccines can be administered safely to persons with prior SARS-CoV-2 infection. Defer vaccination until the individual has recovered from the acute illness and criteria have been met for discontinuation of isolation
Vaccination of people with a history of multisystem inflammatory syndrome in children (MIS-C)	Children with MIS-C have antibodies to SARS-CoV-2. However, it is unknown if this correlates with protection against reinfection and for how long protective antibody levels persist. The benefits of COVID-19 vaccination for children and adolescents (i.e., a reduced risk of severe disease including potential recurrence of MIS-C after reinfection) may outweigh a theoretical risk of an MIS-like illness or the risks of myocarditis following COVID-19 vaccination for people who meet all of the following criteria: •Clinical recovery from MIS-C has been achieved, including return to normal cardiac function; •It has been ≥90 days since the diagnosis of MIS-C; •The individual resides in an area of high or substantial transmission of SARS-CoV-2 or otherwise has an increased risk for SARS-CoV-2 exposure and transmission; AND •Onset of MIS-C occurred before any COVID-19 vaccination. Clinical recovery, including return to normal cardiac function, is an important factor when considering COVID-19 vaccination.
Persons who received monoclonal antibodies or convalescent plasma for COVID-19	Passive antibody product used for post-exposure prophylaxis: defer vaccine for 30 days Passive antibody product used for COVID-19 treatment: defer vaccine for 90 days
Persons with a known SARS-CoV-2 exposure	Individuals in community or outpatient settings should defer vaccination until the quarantine period has ended. Residents in congregate settings may be vaccinated if they do not have symptoms consistent with COVID-19.
Persons with underlying conditions	May receive COVID-19 vaccine
Individuals with moderate to severe immune compromise	Moderately and severely immunocompromised people may not mount a protective immune response after initial vaccination. Protection after primary vaccination may wane over time making them susceptible to severe COVID-19. Such persons aged ≥12 years (Pfizer-BioNTech recipients) or ≥18 years (Moderna recipients) should receive an additional primary dose of the same mRNA COVID-19 vaccine administered for the primary series. •2-doses of an mRNA vaccine; administer an additional COVID-19 vaccine at least 28 days after completion of the initial 2-dose series. •J & J/Janssen COVID-19 vaccine; currently no recommendation for an additional dose. Vaccinated immunocompromised individuals should continue to follow additional multilayered preventive measures. As more data become available, this vaccine recommendation may be updated to include younger age groups.
Interchangeability of COVID-19 vaccine products	Any currently FDA-approved or FDA-authorized COVID-19 vaccine can be used when indicated. The CDC does not state a product preference. In general, primary series and additional primary doses should be with the same vaccine product. However, the use of heterologous booster doses is authorized.
Persons with history of myocarditis or pericarditis	There are no data on the safety of administering a subsequent dose of any COVID-19 vaccine to people who have had myocarditis or pericarditis after a dose of an mRNA COVID-19 vaccine. It is unclear if these persons are at increased risk of further adverse cardiac effects following a subsequent dose of the vaccine. Until additional safety data are available, if myocarditis or pericarditis occurred after a dose of an mRNA COVID-19 vaccine, one should not receive a subsequent dose of any COVID-19 vaccine. •A subsequent dose, however, may be considered in certain circumstances (assess personal risk of severe COVID-19 and level of community transmission). A person with a history of myocarditis or pericarditis unrelated to an mRNA vaccine may receive COVID-19 vaccine •Administer after the episode has completely resolved.
History of Guillain-Barré syndrome	Can receive any COVID-19 vaccine. However, discuss the availability of mRNA vaccines to offer protection against COVID-19.
Vaccination of children and adolescents	Children and adolescents aged 5–17 years should receive the age-appropriate formulation of a COVID-19 primary vaccine series. At this time, the 2-dose Pfizer-BioNTech primary series is the only FDA-approved or FDA-authorized vaccine for persons aged 5–17 years. Vaccination is recommended for everyone aged ≥5 years, regardless of a history of underlying medical conditions, previous symptomatic or asymptomatic SARS-CoV-2 infection, or seropositivity. Children should receive the age-appropriate COVID-19 vaccine formulation regardless of their size or weight. Children aged 5–11 years should receive the 10 µg Pfizer-BioNTech vaccine (ORANGE cap) formulation and adolescents aged ≥12 years should receive the 30 µg Pfizer-BioNTech vaccine (purple or gray cap) formulation. Vaccine dosages (for COVID-19 vaccines and for other routinely recommended vaccines) are based on age and not size or weight. Vaccine recommendations for young children may be updated as more data become available.
Booster dose	All persons ≥12 years of age should receive a booster dose of COVID-19 vaccine, even if they were <11 years of age at the time of the primary series. Currently, CDC does not recommend a booster dose in children aged 5–11 years, regardless of other characteristics or medical conditions. Booster dose recommendations may be updated as more data from studies on long term protection become available. •People ≥18 years of age who received an mRNA primary series should receive a single COVID-19 vaccine booster dose at least 5 months after completion of the primary series. •Presently, only the Pfizer-BioNTech COVID-19 vaccine can be used for booster vaccination for those aged 12-17 years at least 5 months after completion of the primary series. •See CDC guidance for boosting with heterologous vaccines.

Materials developed by: National Center for Immunization and Respiratory Diseases (NCIRD). (2022, January 7). Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Contraindications. Accessed 17 January 2022. The authors’ use of this material, including any links to materials on the CDC website, does not imply endorsement by the CDC, Department of Health and Human Services, or the United States government. Reference to specific commercial products, manufacturers, companies or trademarks does not constitute its endorsement or recommendation by the U.S. Government, Department of Health and Human Services, or Centers for Disease Control and Prevention. The referenced material is otherwise available on the noted website for no charge, and this material is continually updated as more information becomes available.