KEY POINTS FOR PRACTICE
• The AAFP, aligning with the American Academy of Pediatrics but differing from the CDC, recommends universal COVID-19 vaccination for children 6 to 23 months of age and risk-based vaccination for those 2 to 18 years of age. The CDC recommends COVID-19 immunization for children 6 months to 17 years of age who are not immunocompromised and whose parents want their child to receive vaccination after discussion with their physician.
• The AAFP recommends COVID-19 vaccination during pregnancy, whereas the CDC recommends shared clinical decision-making for it in pregnant patients.
• Routine pneumococcal vaccination is now recommended at 50 years of age rather than the previous recommendation of 65 years.
From the AFP Editors
Although the American Academy of Family Physicians (AAFP) has usually endorsed the immunization schedule published by the Centers for Disease Control and Prevention (CDC), which is typically based on the recommendation of the Advisory Committee of Immunization Practices (ACIP), the AAFP published its own 2025 recommendations with a few substantive differences. The AAFP's currently recommended immunization schedules are available online. This summary covers the differences from the current CDC recommendations as well as the updates since the 2024 CDC recommendations, which were endorsed by the AAFP.
DIFFERENCES BETWEEN 2025 AAFP AND CDC RECOMMENDATIONS
COVID-19
The AAFP aligns with the American Academy of Pediatrics and recommends universal vaccination for COVID-19 in children 6 to 23 months of age. The AAFP recommends COVID-19 vaccination for those 2 to 18 years of age who are at high risk of severe COVID-19 or who have household contacts at high risk of severe COVID-19; the AAFP also recommends COVID-19 vaccination for children in this age cohort who are residents of long-term care facilities or who have never been vaccinated against COVID-19. The AAFP recommends vaccination in children 2 to 18 years when parents request immunization.
For children who are partially vaccinated or completed an initial vaccination series before the current vaccine, the AAFP recommends one dose of the Moderna vaccine if younger than 5 years and one dose of Pfizer-BioNTech or Moderna vaccine if 5 years or older at least 8 weeks after the most recent dose. The Novavax vaccine may be used in children 12 years or older.
For those not previously vaccinated against COVID-19, the AAFP recommends that children 6 months to 23 months of age receive two doses of Moderna vaccine; those 2 to 5 years of age receive one dose of the Moderna vaccine; those 5 to 11 years of age receive one dose of Pfizer-BioNTech or Moderna; and individuals 12 to 18 years of age receive one dose of Pfizer-BioNTech or Moderna or one dose of the Novavax vaccine.
The CDC recommends COVID-19 vaccination following shared clinical decision-making for children 6 months to 17 years of age who are not moderately or severely immunocompromised. The CDC defines shared clinical decision-making as a discussion between the clinician and a parent who presents with a desire for their child to be vaccinated that is informed by the clinical judgment of their physician, personal preference, and circumstances.
The AAFP recommends the COVID-19 vaccine during pregnancy, whereas the CDC recommends shared clinical decision-making for COVID-19 vaccination during pregnancy.
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