CDC Adolescents, Children, & Adult Immunization Schedule: 2025 Update

The Centers for Disease Control and Prevention (CDC) recently updated the adolescents and children 2025 vaccine schedule as well as the adult 2025 vaccine schedule. This update comes as a reflection of recommendations made by the Advisory Committee on Immunization Practices (ACIP). Notable changes include the addition of COVID-19 and RSV vaccine, inclusion of only the trivalent influenza vaccine, and an update to the Haemophilus influenzae type B (Hib) and meningococcal serogroup B Vaccine (MenB) series.^1,2 This new schedule reflects key revisions that may have implications on the clinical practice of pharmacists.

Relevant Changes: Influenza, COVID-19, and Others

1. COVID-19:
   1. This section was updated to now state, “1 or more doses of 2024–2025 vaccine” and provides guidance by age and immunocompromised status.
   2. The COVID-19 notes state the recommendations for those who are moderately or severely immunocompromised. Additionally, each section has outlined age groups and history of previous COVID-19 vaccinations recommendations.
2. RSV-mAb:
   1. The RSV-mAb notes stated revisions for infants born during October–March should be immunized within 1 week of birth (during hospitalization preferably). For infants born in April-September, the optimal time of year to give the vaccine is October-November following their birth. Infants born to mothers who received an RSV vaccination from a prior pregnancy should be administered nirsevimab.
   2. It is now clarified that additional doses are not recommended in future pregnancies.
3. Influenza:
   1. The recommended influenza vaccines were changed from the quadrivalent to trivalent formulation to be consistent with the vaccine products approved by the FDA for the 2024–2025 season.
   2. The “Solid organ transplant: 18 years” change was intended to guide healthcare providers to review the influenza vaccine notes section that recommends the trivalent high-dose inactivated vaccine (HD-IIV3) or the trivalent adjuvanted inactivated influenza vaccine (aIIV3). These 2 vaccines are preferred over other trivalent inactivated or recombinant influenza vaccines for 18-year-olds and those on immunosuppressive agents for solid organ transplant.
4. Hib:
   1. Vaxelis was added as a second preferred option for the primary doses in American Indian and Alaska Native infants.
   2. In the “Special situations” section for Haemophilus influenzae type b vaccine (Hib), early component complement inhibitor use was added as an indication for vaccination if the patient age is deemed appropriate.

• MenB:
  • Meningococcal serogroup B now includes the new Bexsero vaccination schedule.
  • Healthy individuals aged 16-23 should receive a 2-dose series separated by 6 months. Those 10 years and older and at increased risk for infection are now recommended to receive a 3-dose series (0 months, 1-2 months, and 6 months).
• Measles, Mumps, and Rubella (MMR):
  • Recommendations regarding travel are updated for age groups and MMR vaccination history. International travelers greater than 12 months old with 1 dose should receive a second dose at least 4 weeks later when traveling.
  • Additional updates include a contraindication for those infected with HIV and a precaution to review the Varicella/MMRV row if using MMRV.
• Varicella:
  • The only update includes stating those with HIV are not recommended and is contraindicated to receive MMRV, plus “the name for the ‘Varicella’ row has been changed to ‘Varicella/MMRV.’”
• DTaP:
  • The DTaP notes, now includes guidance for the tetanus and diphtheria vaccine (Td) in children aged <7 years with a contraindication due to a pertussis ingredient of DTaP.
• Hepatitis B:
  • PreHevBrio is no longer recommended during pregnancy due to insufficient safety evidence.
• Pneumococcal:
  • The CDC no longer recommends “pneumococcal conjugate vaccines or 23-valent pneumococcal polysaccharide vaccine during pregnancy.”

What Do Pharmacists Need to Know?

Pharmacists must continue to carefully review immunization history and participate in shared decision-making with patients. Updates to the new schedule mostly include changes to vaccination recommendations during pregnancy and the inclusion of the new Bexsero and Vaxelis immunizations. Other changes are mostly clarifying edits to help optimize the guidelines. The pharmacist must take a holistic approach and assess the benefits and risks of immunization for each patient with the support of guidelines. As a leader in immunization, the profession must continue to advocate for evidence-based guidelines and schedules for optimal patient care.

The Controversy: A Pharmacist’s Perspective

A vaccine advisory panel within the CDC has postponed a controversial change involving the administration of hepatitis B vaccines to newborns and access to COVID-19 vaccines.³ These changes may be pivotal as they undermine the role of the pharmacist and place more pressure on primary care physicians, which are in shortage.

In the current 3-dose series for hepatitis B, one of the vaccines is given within 24 hours of birth. This ACIP recommendation has been in place since 1991 and has resulted in a 99% decrease in infections between 1990 and 2019.⁴ The proposed change would delay the first immunization until 30 days after birth for children whose mothers test negative for Hepatitis B. Currently, no evidence exists regarding delaying the birth dose. A change in the dosing schedule was ultimately tabled.

The proposed changes would have included required prescriptions for COVID-19 immunization in some states and a new emphasis on its risks. This vaccination requirement may overwhelm physician offices and impede the vital role that pharmacists play in preventive care. Importantly, the underserved populations would have less access to immunizations. The general population may also experience greater barriers to immunization with this new process. Discussion and controversy surround the proposed guidance and the risks of COVID-19 vaccination. The CDC’s data highlighted reductions in serious disease and emergency department visits following COVID-19 vaccination.⁵ This data drives confusion as to why COVID-19 vaccination is now facing barriers.

REFERENCES

1. Centers for Disease Control and Prevention. Adult Immunization Schedule. Immunization schedules for health care providers. Published 2025. Accessed September 22, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/downloads/adult/adult-combined-schedule.pdf

2. Homan M. CDC panel opts against requiring COVID shot prescription, but wants greater emphasis on its risks. Georgia Recorder. September 19, 2025. Accessed September 22, 2025. https://georgiarecorder.com/2025/09/19/cdc-panel-opts-against-requiring-covid-shot-prescription-but-wants-greater-emphasis-on-its-risks/

3. Bixler D, Roberts H, Panagiotakopoulos L, Nelson NP, Spradling PR, Teshale EH. Progress and unfinished business: Hepatitis B in the United States, 1980-2019. Public Health Reports. 2023;138(6):707-718. doi:10.1177/00333549231175548

4. Srinivasan A; Advisory Committee on Immunization Practices. Updates to COVID-19 Vaccine Effectiveness [presentation]. Presented September 18-19, 2025. Centers for Disease Control and Prevention. https://www.cdc.gov/acip/downloads/slides-2025-09-18-19/04-Srinivasan-covid-508.pdf. Accessed September 22, 2025.

5. Issa AN, Wodi AP, Moser CA, Cineas S. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2025. MMWR Morb Mortal Wkly Rep. 2025;74(2):26-29. Published 2025 Jan 16. doi:10.15585/mm