05 Panagiotakopoulos COVID 508

Use of 2025 –2026 COVID -19 Vaccines:
Work Group Considerations
Lakshmi Panagiotakopoulos, MD, MPH
Advisory Committee on Immunization Practices
April 15, 2025National Center for Immunization and Respiratory Diseases

•Current recommendations for 2024 –2025 COVID -19 vaccines
•Policy options for 2025 –2026 COVID -19 vaccine recommendations
•Supporting data and Work Group interpretations
•Discussion questions for committee Overview
2
COVID -19 vaccine: ACIP Meeting Schedule
October
2024April 2025June 2025
(proposed)
•Additional dose of 2024 -
2025 COVID -19 vaccines
in adults ages ≥65 years
•Additional dose(s) of
2024 -2025 COVID -19
vaccines in moderately
to severely
immunocompromised
persons ages ≥6 months•Moderna mRNA -1283
COVID -19 vaccine
•Epidemiology and risk
factors for COVID -19
hospitalizations
•Vaccine effectiveness
update
•Work Group
Considerations
•No vote scheduled•Vote on 2025 –2026
COVID -19 vaccine
recommendations
(including additional
dose recommendations)
3
Review of 2024 –2025 COVID -19 vaccine policy
•Children ages 6 months –4 years
-Unvaccinated: Should receive a multidose initial series with a 2024 –2025 mRNA
vaccine
-Previously completed an initial series: Should receive 1 dose of a 2024 –2025
mRNA vaccine from the same manufacturer as the initial series
•People ages 5 –64 years:
-Should receive 1 dose of an age -appropriate 2024 –2025 COVID -19 vaccine*
•People ages 65 years and older:
-Should receive 2 doses of any 2024 –2025 COVID -19 vaccine, spaced 6 months
apart (minimum interval 2 months)**Overview of the current COVID -19 vaccination
schedule: Routine vaccination
*People ages 12 –64 years who are unvaccinated and receive the 2024 –2025 Novavax COVID -19 vaccine for initial vaccination should receive 2 doses of 2024 –2025 Novavax COVID -19 vaccine.
**People ages 65 years and older who are unvaccinated and receive Novavax COVID -19 Vaccine for initial vaccination should receiv e 2 doses of 2024 –2025 Novavax COVID -19 vaccine followed by a
third dose of any 2024 –2025 COVID -19 vaccine dose 6 months after the second dose (minimum interval 2 months).
https://www.cdc.gov/vaccines/covid -19/clinical -considerations/interim -considerations -us.html#routine -vaccination -guidance  5
•Unvaccinated:
-Should receive a multidose initial vaccination series with an age -appropriate
2024 –2025 vaccine and receive 1 dose of 2024 –2025 6 months after completing
the initial series (minimum interval 2 months)
•Previously completed an initial series:
-Should receive 2 doses of an age -appropriate 2024 –2025 COVID -19 vaccine,
spaced 6 months apart (minimum interval 2 months)
•May receive additional age -appropriate 2024 –2025 COVID -19 vaccine
doses under shared clinical decision -making (minimum interval 2
months) Overview of the current COVID -19 vaccination
schedule: Moderate or severe immunocompromise
6https://www.cdc.gov/vaccines/covid -19/clinical -considerations/interim -considerations -us.html#immunocompromised
Policy considerations for use of the 2025 –2026
COVID -19 vaccine
Policy Options for 2025 –2026 COVID -19 vaccines:
Multi -dose initial series
8•Currently a multi -dose initial series is recommended for people ages 6
months –4 years and people with immunocompromise
-Option 1: Maintain a universal vaccine policy for everyone ages ≥6 months that
includes the multi -dose initial series
-Option 2: Narrow current vaccine recommendations and only maintain this series
for certain populations within these groups who we determine should be
vaccinated
Policy Options for 2025 –2026 COVID -19 vaccines:
Annual COVID -19 vaccine doses
9•Currently annual vaccines are recommended for everyone ages ≥6
months
-Option 1: Maintain a universal vaccine policy for everyone ages ≥6 months
-Option 2: Risk-based recommendation only for groups at increased risk of severe
COVID -19
-Option 3: Combination of risk -based and universal vaccine recommendations
(e.g., risked -based recommendation for ages 6 months -64 years and universal
recommendations for ages ≥65 years.
•Persons ages ≥65 years
-2 doses per year for most; may be more if previously unvaccinated and receiving
Novavax or immunocompromised
•Persons ages ≥6 months who are moderately or severely
immunocompromised
-Initial series if unvaccinated or post -immune ablative therapy
-Initial series is followed by 2 doses per year
-Additional doses can be administered under shared clinical decision -makingPolicy Options for 2025 –2026 COVID -19 vaccines:
Semi -annual COVID -19 vaccine doses
10
•How much increased risk is needed to be included in a risk -based
recommendation?
•Increased risk of severe outcomes
-Age
-Underlying conditions
-Pregnancy (also protects infants <6 months of age)
•Risk of exposure
-Healthcare workers
-People living in long -term care facilities and other congregate settings
-Other groups at risk of increased exposure or transmission?How to define who is at increased risk?
11
•Asthma
•Cancer
-Hematologic Malignancies
•Cerebrovascular disease
•Chronic kidney disease*
-People receiving dialysis^
•Chronic lung diseases limited to:
•Bronchiectasis
•COPD (Chronic obstructive pulmonary disease)
•Interstitial lung disease
•Pulmonary embolism
•Pulmonary hypertension
• Chronic liver diseases limited to:
•Cirrhosis
•Non -alcoholic fatty liver disease•Alcoholic liver disease
•Autoimmune hepatitis
•Cystic fibrosis
•Diabetes mellitus, type 1
•Diabetes mellitus, type 2*
•Disabilities‡,**, including Down
syndrome
•Heart conditions (such as heart failure,
coronary artery disease, or
cardiomyopathies)
•HIV (Human immunodeficiency virus)
•Mental health conditions limited to:
•Mood disorders, including depression
•Schizophrenia spectrum disorders•Neurologic conditions limited to
dementia‡ and Parkinson’s Disease
•Obesity (BMI >30 kg/m2or
>95thpercentile in children)
•Physical inactivity
•Pregnancy and recent pregnancy
•Primary immunodeficiencies
•Smoking, current and former
•Solid organ or blood stem cell
transplantation
•Tuberculosis
•Use of corticosteroids or other
immunosuppressive medicationsHigher Risk of Severe Illness of COVID -19 (conclusive)
* Indicates presence of evidence for pregnant and non -pregnant women
‡ Underlying conditions for which there is evidence in pediatric patients
^ Risk may be further increased for people receiving dialysis
** Attention -deficit/hyperactivity disorder (ADHD), Autism, Cerebral palsy, Charcot foot, Chromosomal disorders, Chromosome 17 a nd 19 deletion, Chromosome 18q deletion, Cognitive impairment, Congenital
hydrocephalus, Congenital malformations, Deafness/hearing loss, Disability indicated by Barthel Index, Down syndrome, Fahr's  syndrome, Fragile X syndrome, Gaucher disease, Hand and foot disorders, Learning
disabilities, Leber's hereditary optic neuropathy (LHON) or Autosomal dominant optic atrophy (ADOA), Leigh syndrome, Limitati ons with self -care or activities of daily living, Maternal inherited diabetes and
deafness (MIDD), Mitochondrial encephalopathy, lactic acidosis, and stroke -like episodes (MELAS) and risk markers, Mobility disa bility, Movement disorders, Multiple disability (referred to in research papers as
"bedridden disability"), Multisystem disease, Myoclonic epilepsy with ragged red fibers (MERRF), Myotonic dystrophy, Neurodev elopmental disorders, Neuromuscular disorders, Neuromyelitis optica  spectrum
disorder (NMOSD), Neuropathy, ataxia, and retinitis pigmentosa (NARP), Perinatal spastic hemiparesis, Primary mitochondrial m yopathy (PMM), Progressive supranuclear palsy, Senior -Loken  syndrome, Severe
and complex disability (referred to in research papers as " polyhandicap  disability"), Spina bifida and other nervous system anomalies, Spinal cord injury, Tourette syndrome, Traumatic brain injury,  Visual
impairment/blindness, Wheelchair use
https://www.cdc.gov/covid/hcp/clinical -care/underlying -conditions.html  12
•Asthma
•Cancer
-Hematologic Malignancies
•Cerebrovascular disease
•Chronic kidney disease *
-People receiving dialysis^
•Chronic lung diseases limited to:
•Bronchiectasis
•COPD (Chronic obstructive pulmonary disease)
•Interstitial lung disease
•Pulmonary embolism
•Pulmonary hypertension
• Chronic liver diseases limited to:
•Cirrhosis
•Non -alcoholic fatty liver disease•Alcoholic liver disease
•Autoimmune hepatitis
•Cystic fibrosis
•Diabetes mellitus, type 1
•Diabetes mellitus, type 2 *
•Disabilities‡,**, including Down
syndrome
•Heart conditions (such as heart failure,
coronary artery disease, or
cardiomyopathies)
•HIV (Human immunodeficiency virus)
•Mental health conditions  limited to:
•Mood disorders, including depression
•Schizophrenia spectrum disorders•Neurologic conditions limited to
dementia‡ and Parkinson’s Disease
•Obesity (BMI >30 kg/m2or
>95thpercentile in children)
•Physical inactivity
•Pregnancy  and recent pregnancy
•Primary immunodeficiencies
•Smoking, current and former
•Solid organ or blood stem cell
transplantation
•Tuberculosis
•Use of corticosteroids or other
immunosuppressive medicationsHigher Risk of Severe Illness of COVID -19 (conclusive)
* Indicates presence of evidence for pregnant and non -pregnant women
‡ Underlying conditions for which there is evidence in pediatric patients
^ Risk may be further increased for people receiving dialysis
** Attention -deficit/hyperactivity disorder (ADHD), Autism, Cerebral palsy, Charcot foot, Chromosomal disorders, Chromosome 17 a nd 19 deletion, Chromosome 18q deletion, Cognitive impairment, Congenital
hydrocephalus, Congenital malformations, Deafness/hearing loss, Disability indicated by Barthel Index, Down syndrome, Fahr's  syndrome, Fragile X syndrome, Gaucher disease, Hand and foot disorders, Learning disabilities,
Leber's hereditary optic neuropathy (LHON) or Autosomal dominant optic atrophy (ADOA), Leigh syndrome, Limitations with self -care or activities of daily living, Maternal inherited diabetes and deafness (MIDD),
Mitochondrial encephalopathy, lactic acidosis, and stroke -like episodes (MELAS) and risk markers, Mobility disability, Movement disorders, Multiple disability (referred to in research papers as "bedridden disability"),
Multisystem disease, Myoclonic epilepsy with ragged red fibers (MERRF), Myotonic dystrophy, Neurodevelopmental disorders, Neu romuscular disorders, Neuromyelitis optica  spectrum disorder (NMOSD), Neuropathy,
ataxia, and retinitis pigmentosa (NARP), Perinatal spastic hemiparesis, Primary mitochondrial myopathy (PMM), Progressive sup ranuclear palsy, Senior -Loken  syndrome, Severe and complex disability (referred to in research
papers as " polyhandicap  disability"), Spina bifida and other nervous system anomalies, Spinal cord injury, Tourette syndrome, Traumatic brain injury,  Visual impairment/blindness, Wheelchair use
Bolded conditions were included in analysis on prevalence of risk conditions by the Center for Forecasting Analytics (unpubli shed data); those highlighted by the red boxes were not included
https://www.cdc.gov/covid/hcp/clinical -care/underlying -conditions.html  13
Estimates of adults in the United States with at least 1
condition that puts them at higher risk of severe illness from
COVID -19, by age group, October 2022 –September 2023
67%65% 65%81%83%86%
74%
0%10%20%30%40%50%60%70%80%90%100%
18-29 years 30-39 years 40-49 years 50-64 years 65-74 years ≥75 years ≥18 years
Unpublished results from September 2024 analysis of medical claims data, consumer data, Behavioral Risk Factors Surveillance System, and/or National Health Interview Survey to enumerate
the US population with conditions that put them at increased risk of severe illness from COVID -19 using multilevel regression mo deling, CDC Center for Forecasting and Outbreak Analytics
14
Summary of supporting evidence
COVID -19 Epidemiology
Weighted and Nowcast SARS -CoV-2 estimates in the United
States for 2 -week periods, December 2, 2024 –April 12, 2025
These data include Nowcast estimates, which are modeled predictions that may differ from weighted estimates generated at late r dates
https://covid.cdc.gov/covid -data -tracker/#variant -proportions  Accessed April 14, 2025 17

Weekly rates of COVID -19–associated hospitalizations in the
United States by age group, October 2024 –March 2025
1802468101214161820
October November December January February MarchHospitalizations per 100,000 populationCrude Weekly Rates of COVID -19–Associated Hospitalizations, by Age Group —
COVID -NET, October 2024 –March 2025
5–17 years 18–49 years 50–64 years ≥65 years
Rates for SARS -CoV-2 are laboratory -confirmed.
Note that rates are not adjusted for testing or limited to admissions where the respiratory infection is the likely primary r eason for admission.
Data source: https://www.cdc.gov/resp -net/dashboard/  Accessed April  7, 2025
Weekly rates of respiratory virus -associated hospitalizations in
the United States among children ages 0 –17 years, 2023 –2025
19024681012
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug SepHospitalizations per 100,000 populationCrude Weekly Rates of COVID -19–, Influenza, and RSV -Associated Hospitalizations, by Surveillance Season* —
RESP -NET, October 2023 –March 2025
COVID 2024 –2025 COVID 2023 –2024
Influenza 2024 –2025 Influenza 2023 –2024
RSV 2024 –2025 RSV 2023 –2024
Rates for all three pathogens (COVID -19, influenza, and respiratory syncytial virus [RSV]) are laboratory -confirmed.
Note that rates are not adjusted for testing or limited to admissions where the respiratory infection is the likely primary r eason for admission.
Data source: https://www.cdc.gov/resp -net/dashboard/  accessed April  7, 2025
Weekly number of COVID -19 deaths reported to CDC,
United States, January 1, 2024 – March 29, 2025
The most recent 3 weeks of mortality counts are shaded grey because NVSS reporting is  <95% during this period.
Provisional data are non -final counts of deaths based on reported mortality data in NVSS. Deaths include those with COVID -19, co ded as ICD –10 code U07.1, on the death certificate. Death data
are displayed by date of death (event). Data include underlying and contributing causes of death.
CDC COVID Data Tracker. National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS). https://covid.cdc.gov/covid -data -tracker/#trends_weeklydeaths_select_00  .
Accessed April 7, 2025 2005001,0001,5002,0002,5003,000
1/6/2024 3/6/2024 5/6/2024 7/6/2024 9/6/2024 11/6/2024 1/6/2025 3/6/2025Weekly DeathsProvisional COVID -19 Deaths, by Week, in The United States, Reported to CDC
Top 10 leading causes of death in the United States,
children and adolescents 0 –17 years
Unpublished data, CDC National Center for Health Statistics
211. Certain conditions originating in
the perinatal period
2. Accidents (unintentional injuries)
3. Congenital malformations,
deformations, and chromosomal
abnormalities
4. Homicide
5. Suicide
6. Cancer
7. Heart disease
8. COVID -19
9. Influenza and Pneumonia
10. Septicemia1. Certain conditions originating in
the perinatal period
2. Accidents (unintentional injuries)
3. Congenital malformations,
deformations, and chromosomal
abnormalities
4. Homicide
5. Suicide
6. Cancer
7. Heart disease
8. COVID -19
9. Influenza and Pneumonia
10. Septicemia1. Certain conditions originating in
the perinatal period
2. Accidents (unintentional injuries)
3. Congenital malformations,
deformations, and chromosomal
abnormalities
4. Homicide
5. Suicide
6. Cancer
7. Heart disease
8. Influenza and Pneumonia
9. Septicemia
10. Stroke…
12. COVID -19      2021                        2022                                       2023
Top 10 leading causes of death in the United States,
adults ages ≥18 years
Influenza and pneumonia was ranked 9th pre-pandemic in 2019; ranked 13th in 2023
Unpublished data, CDC National Center for Health Statistics221. Heart disease
2. Cancer
3. COVID -19
4. Accidents
5. Chronic lower respiratory diseases
6. Stroke
7. Alzheimer’s disease
8. Diabetes mellitus
9. Chronic liver disease and cirrhosis
10. Kidney disease1. Heart disease
2. Cancer1. Heart disease
2. Cancer
3. Accidents
4. Chronic lower respiratory diseases
5. Stroke
6. Alzheimer’s disease
7. Diabetes mellitus
8. Kidney disease
9. Chronic liver disease and cirrhosis
10. COVID -193. Accidents
4. COVID -19
5. Chronic lower respiratory diseases
6. Stroke
7. Alzheimer’s disease
8. Diabetes mellitus
9. Kidney disease
10. Chronic liver disease and cirrhosis   2021                          2022                                          2023
Total number of COVID -19 deaths,1,2 September 2023 –
August 2024, by age group, United States
53 43 561,0283,36436,357
05,00010,00015,00020,00025,00030,00035,00040,000
<1 year 1–4 years 5–17 years 18–49 years 50–64 years ≥65 yearsNumber of Deaths
1. Provisional data
2. Underlying cause of death Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Natio nal Vital Statistics System, Provisional Mortality on CDC WONDER Online
Database. Data are from the final Underlying Cause of Death Files, 2018 -2023, and from provisional data for 2024, as compiled fr om data provided by the 57 vital statistics jurisdictions through the Vital
Statistics Cooperative Program. Number of deaths includes COVID -19 code (U07.1) as the underlying cause of death. http://wonder.cdc.gov/mcd -icd10 -provisional.html , accessed January 16, 2025
23
Total number of COVID -19 and Influenza deaths1,2, among
ages 0 –17 years, September 2023 –August 2024, United States
53
4356
1861134
020406080100120140160
<1 year 1–4 years 5–17 yearsNumber of Deaths
COVID-19 Influenza
1. Provisional data
2. Underlying cause of death Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Natio nal Vital Statistics System, Provisional Mortality on CDC WONDER Online
Database Data are from the final Underlying Cause of Death Files, 2018 -2023, and from provisional data for 2024, as compiled fro m data provided by the 57 vital statistics jurisdictions through the Vital
Statistics Cooperative Program. Number of deaths includes influenza codes (J09 -J11) or COVID -19 code (U07.1) as the underlying c ause of death. http://wonder.cdc.gov/mcd -icd10 -provisional.html ,
accessed January 16, 2025
Note: Estimates of pediatric influenza deaths reported to CDC can be found here: https://www.cdc.gov/flu/weekly/index.htm . Estimates will vary due to differences in reporting methods and timeframes
used.24
COVID -19—associated changes from 2023 –2024 to
2024 –2025
2023 –2024 2024 –2025 Difference
Routine vaccine recommendation6 months and older
65 and older: 2 doses 6 months and older
65 and older: 2 doses No change
Vaccine coverage <18 years1 13.8% (13.4 –14.3)
(3/23/2024)12.8% (12.2 –13.4)
(3/22/2025)Similar
Vaccine coverage ≥18 years2 21.3% (21.0 –21.5)
(3/23/2024)23.1% (22.5 –23.7)
(3/22/2025)Similar
Vaccine coverage ≥65 years2 37.5% (36.7 –38.3)
(3/23/2024)44.0% (42.5 –45.4)
(3/22/2025)Increase
Vaccine effectiveness against
hospitalization, immunocompetent adults
≥65 yearsVISION: 42% (37 –47)3
IVY: 35% (20 –47)3VISION: 45% (36 –53)4
IVY: 46% (26 –60)4Similar
Cumulative hospitalization rates (week 13)5125.6/100,000 62.9/100,000 Decrease
1 https://www.cdc.gov/covidvaxview/weekly -dashboard/child -coverage -vaccination.html , accessed April 7, 2025
2 https://www.cdc.gov/covidvaxview/weekly -dashboard/adult -vaccination -coverage.html , accessed April 7, 2025
3 https://www.cdc.gov/acip/downloads/slides -2024 -06-26-28/03 -COVID -Link-Gelles -508.pdf ; median (IQR) days since dose: VISION: 84 (46 –127)  IVY: 81 (43 –121)
4 Link-Gelles R, Chickery S, Webber A, et al. Interim Estimates of 2024 –2025 COVID -19 Vaccine Effectiveness Among Adults Aged ≥18 Years — VISION and IVY Networks, September 2024 –
January 2025. MMWR Morb  Mortal Wkly  Rep 2025;74:73 –82. M edian (IQR) days since dose – VISION: 53 (30 –77)  IVY: 60 (31 –85)
5 https://covid.cdc.gov/covid -data -tracker/#covidnet -hospitalization -network , accessed April  7, 202525
Infection -induced SARS -CoV-2 seroprevalence among U.S.
children — September 2021 – December 2022
26
Infection -induced (nucleocapsid
antibody) seroprevalence
Month and Year
Shaded ranges depict 95% confidence intervals for the estimated seroprevalence shown by the dark line in the corresponding co lor.
Source: https://covid.cdc.gov/covid -data -tracker/#pediatric -seroprevalence
Accessed: March 20, 2025
Population SARS -CoV-2 spike antibody over time by the cumulative
number of combined infections and vaccinations - U.S. blood donors ages
≥16 years, September 2021 -December 2023
Solid lines represent mean anti -spike IgG levels; dotted lines represent model based 25th-75th% percentiles
Higher number of cumulative SARS -CoV-2 infections and COVID -19 vaccinations leads to
higher antibody levels, but with smaller incremental increases in antibodies with each
exposure
Spike IgG BAU/mL
Source: https://covid.cdc.gov/covid -data -tracker/#nationwide -blood -donor -seroprevalence -2022 , CDC unpublished data 27
Among  adults  aged ≥18 years, 3.6%
reported Long COVID
symptoms, and 8.4%  reported ever
having Long COVID1
More than 3 in 5 adults with Long
COVID report activity limitations1
Among  children aged 0 -17
years, 0.4% reported Long COVID
symptoms, and 1.4% reported ever
having Long COVID2Long COVID is a significant public health threat
1. Vahratian  A,Saydah S, Bertolli J, Unger ER, Gregory CO. Prevalence of Post –COVID -19 Condition and Activity -Limiting Post –COVID -19 Condit ion Among Adults. JAMA Netw  Open. 2024;7(12):e2451151.
2. Ford ND, Vahratian  A,Pratt CQ, Yousaf AR, Gregory CO, Saydah S. Long COVID Prevalence and Associated Activity Limitation in US Children. JAMA Pediatr .Published online February 03, 2025.National surveys in 2023 estimated  approximately 9.2 million adults and 0.3 million
children in the U.S. had Long COVID.

Almost 4 in 5 children with Long
COVID report activity limitations2
28
1. Yousaf AR, Mak J, Gwynn L, et al. COVID -19 Vaccination and Odds of Post –COVID -19 Condition Symptoms in Children Aged 5 to 17 Years. JAMA Netw Open. 2025;8(2):e2459672.
2. Mak J, Khan S, Britton A et al. Association of Messenger RNA Coronavirus Disease 2019 (COVID -19) Vaccination and Reductions i n Post COVID Conditions Following Severe Acute Respiratory Syndrome
Coronavirus 2 Infection in a US Prospective Cohort of Essential Workers, The Journal of Infectious Diseases, Volume 231, Issu e 3, 15 March 2025, Pages 665 –676COVID -19 mRNA vaccination associated with reduced occurrence of
Long COVID following COVID -19: June 2021 -September 2022
Among children aged 5 – 17 years:
Completion of the primary vaccine
series prior to infection associated
with reduced likelihood of Long
COVID symptoms1
•57% for 1 or more symptoms
•73% for 2 or more symptoms
•72% for respiratory symptomsAmong adults:
3 doses of original monovalent vaccine
prior to infection associated with
reduced likelihood of Long COVID
symptoms2
•63% for gastrointestinal symptoms
•44% for neurological symptoms
•52% for other non -specific symptoms
29
Multisystem Inflammatory Syndrome in Children (MIS -C)
U.S. Incidence Over Time
•US incidence of MIS -C by SARS -CoV-2 variant -predominant periods was previously
published1, updated data shown below
-Defined using surveillance data and allowing for 2 weeks to MIS -C onset from when a variant
exceeded 50% circulating lineages
1. Yousaf AR, et al,  MMWR 2023
2. Shingleton  J et al, Journal of Infection , 2022.
3. Cohen JM, et al. Clin Infect Dis . 2023
4. Whittaker R et al. Pediatrics.  2022Variant predominant
periodDates Number of
MIS-C casesIncidence per 1,000,000
(95% CI) person -yearsMedian age
(IQR), years
Pre-Delta Oct 15, 2020 –Apr 5, 2021 3,287 6.80 (6.57 –7.03) 9.2 (5.4 –13.1 )
Delta Jul 10 –Dec 24, 2021 2,305 4.91 (4.71 –5.11) 9.1 (5.5 –12.3)
Omicron BA.1/BA 1.1 Jan 1 –Apr 8, 2022 1,148 4.21 (3.97 –4.46) 7.5 (4.1 –11.5)
Omicron BA.2/BA.4/BA.5 Apr 9 –Dec 31, 2022 428 0.57 (0.52 –0.63) 5.4 (2.9 –9.7)
Omicron XBB.1.5 Jan 1 –Dec 31, 2023 141 0.14 (0.12 –0.16) 6.9 (3.7 –11.5)
Omicron JN.1/others Jan 1 -Dec 31, 2024 79 0.08 (0.06 - 0.10) 9.1 (4.7 -14.3)
•Similarly decreased incidence was observed in other countries2-4
30
COVID -19 Vaccination Status of 2023 and 2024 U.S. Multisystem
Inflammatory Syndrome in Children (MIS -C) Cases
•Although 95% of children with MIS -C in 2023 and 99% in 2024 were eligible to receive a COVID -19
vaccine ≥16 weeks before their MIS -C illness, only 19% in 2023 and 26% in 2024 of eligible children
received any vaccine dose
•Of the 25 vaccinated children in 2023 with information on timing, 65% in 2023 received their last
vaccine dose more than 12 months prior to MIS -C onset
•All vaccinated children in 2024 received their last vaccine dose > 12 months prior to MIS -C onset
Yousaf AR et al, MMWR 2023 and unpublished data2023 Illness Onset
N=141 (%)2024 Illness Onset
N=79 (%)
Vaccine age -eligible¹ at time of MIS -C onset 134 (95) 78 (99)
No vaccination 108/134 (81) 58/78 (74)
Vaccinated (at least one dose received) 26/134 (19) 20/78 (26)
Last vaccine dose >12 months before MIS -C onset 17/26 (65) 20/20 (100)
¹10 months of age at onset considered the minimum age by which a child could plausibly have completed an mRNA primary vaccina tion series, with 6 months
being the earliest possible age at first dose and ≥12 weeks from first dose required to complete a 3 -dose primary series, and 4 weeks between time since last
dose and hospitalization
31
COVID -19 Vaccine and Myocarditis
COVID -19 vaccine prescribing information or fact sheet
warnings and precautions about myocarditis and pericarditis
https://www.fda.gov/emergency -preparedness -and-response/coronavirus -disease -2019 -covid -19/covid -19-vaccines -2024 -2025     Manufacturer Precaution
Pfizer Post marketing data with authorized or approved mRNA COVID -19
vaccines demonstrate increased risks of myocarditis and pericarditis,
particularly within the first week following vaccination. For COMIRNATY ,
the observed risk is highest in males 12 through 17 years of age.
Moderna Post marketing data with authorized or approved mRNA COVID -19
vaccines demonstrate increased risks of myocarditis and pericarditis,
particularly within the first week following vaccination. For SPIKEVAX,
the observed risk is highest in males 18 years through 24 years of age.
Novavax Clinical trials data provide evidence for increased risks of myocarditis and
pericarditis following administration of Novavax COVID -19 Vaccine,
Adjuvanted.
33
Myocarditis following mRNA COVID -19 vaccination among
people ages 12 –39 years in the Vaccine Safety Datalink
*Statistically significant increased rate ratio in vaccinated concurrent comparator analysis
Source: CDC Immunization Safety Office, unpublished data 638
25
25
2
Dose 1
Original monovalentDose 2
Original monovalentBooster
Original monovalentBivalent
2020-2021 2021-2022 2022-2023 2023-2024 2024-202538
6
22Incidence of myocarditis within 7 days of vaccination per million mRNA vaccine doses administered
34**
*
•The VSD has not detected a statistical signal for myocarditis/pericarditis following
the 2024 -2025 COVID -19 vaccine to dateVaccine DosesCases in
Risk
Interval
(Days 1 -21)Cases in
Comparison
Interval
(Days 22 -42)Adjusted Rate Ratio1
(95% Confidence Interval)
Pfizer 530,095 5 5 0.61 (0.11 – 2.88)
Moderna 35,194 0 0 n/a
Novavax 1,576 0 0 n/a
351 Adjusted for outcome calendar date, age group, sex, race/ethnicity, VSD site
Source: CDC Immunization Safety Office, unpublished data through March 22, 2025 Myocarditis/pericarditis concurrent comparator analysis in
Vaccine Safety Datalink (VSD) after COVID -19 vaccine doses
among people ages 12 -39 years, 2024 -2025
Vaccine Adverse Event Reporting System (VAERS) reports of
myocarditis within 7 days of COVID -19 vaccination  among
people ages 12 -39 years , 2024 -2025
•The reporting rates are similar to the expected
background rates of <2 cases per million dosesAge group
(years)Verified casesReporting rate per
million doses
12-17 3 0.74
18-29 0 0
30-39 1 0.14
Source: CDC Immunization Safety Office, unpublished data  through March 22, 2025  36
MOVING Study: Outcomes after myocarditis following COVID -19 vaccine:
Cardiologist/healthcare provider assessment of recovery in persons ages 12 –29 years
at least 90 days since onset of myocarditis after COVID -19 vaccination, 2021 -2022
•81% (320/393) of
patients were
considered fully or
probably recovered by
their cardiologist or
other healthcare
provider
Kracalik  I, Oster ME, Broder KR et al. Outcomes at least 90 days since onset of myocarditis after mRNA COVID -19 vaccination in adolescen ts and young adults in the USA: a follow -up
surveillance study. Lancet Child & Adolescent Health, 2022.
MOVING: Myocarditis Outcomes after COVID -19 Vaccine INvestiGation 371%16% 15%66%
0%10%20%30%40%50%60%70%80%90%100%
Same cardiac status
as initial diagnosisImproved but not
 fully recoveredProbaby fully recovered
but awaiting infoFully recoveredPercent of respondents
Provider -reported recovery status from myocarditis after mRNA COVID -19 vaccination
MOVING* study: Outcomes after myocarditis following COVID -19 vaccine: Patient -
reported assessment of recovery in persons ages 12 –29 years at least 90 days since
onset of myocarditis after COVID -19 vaccination, 2021 -2022
•50% (178/357) of
patients self -report
at least 1 lingering
symptom at 3
months
*MOVING: Myocarditis Outcomes after COVID -19 Vaccine INvestiGation
Kracalik  I, Oster ME, Broder KR et al. Outcomes at least 90 days since onset of myocarditis after mRNA COVID -19 vaccination in adolescen ts and young adults in the USA: a follow -up
surveillance study. Lancet Child & Adolescent Health, 2022. 38
Composite outcome 1: rehospitalization for myopericarditis, cardiovascular event, or death from any cause.
Composite outcome 2: rehospitalization for myopericarditis, cardiovascular event, hospitalization for any cause (>1 night sta y), or death
from any cause.Comparison of myocarditis attributed to COVID -19 mRNA
vaccination, SARS -CoV-2 infection or conventional
etiologies, 2020 -2022
Semenzato  L, Le Vu S, Botton  J et al. Long -term prognosis of patients with myocarditis attributed to COVID -19 mRNA vaccination, SARS -CoV-2 infection, or con ventional etiologies. JAMA.
2024 . https://jamanetwork.com/journals/jama/fullarticle/2822933  39
Summary: myocarditis after COVID -19 vaccine
•An increased risk of myocarditis following COVID -19 vaccines was
observed during 2020 -2022 following the primary series and first
booster doses
•No increased risk was observed in VSD and VAERS with the 2022 -2023
and 2023 -2024 vaccines or the 2024 -25 vaccine to date
•Acute clinical picture following myocarditis after COVID -19 vaccine
tends to resolve quickly
•Post -COVID -19 vaccine myocarditis associated with less severe
cardiovascular events than post -COVID -19 myocarditis and
conventional myocarditis
VSD: Vaccine Safety Datalink | VAERS: Vaccine Adverse Event Reporting System 40
Risk-based v. universal vaccine
recommendations and vaccine coverage
Influenza vaccination coverage among adults 18 -64 years with and
without high -risk medical conditions, 2008 –09 through 2015 –16
influenza seasons, Behavioral Risk Factor Surveillance System
Vertical line denotes timing of universal influenza vaccination recommendation
Selected high risk conditions include asthma, diabetes or heart disease (before the 2013 -14 season) or asthma, diabetes, heart d isease, chronic obstructive pulmonary disease or cancers
other than skin cancer (2013 -14 season through present)
Source: CDC Immunization Services Division, unpublished0102030405060708090100
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16Percent vaccinated
Influenza season18-49 with high risk conditions 18-49 without high risk conditions
50-64 with high risk conditions 50-64 without high risk conditions
42
Vaccination coverage:
risk-based vs. universal recommendations
•Influenza vaccination coverage among adults with high -risk conditions increased
slightly after the universal recommendation in the 2010 -11 season, but it was
already trending upward and plateaued shortly after the change in
recommendation.
•Hepatitis B vaccination coverage among adults with risk factors remained below
pre-pandemic coverage after the universal recommendation in 2022.
•Coverage among adults universally recommended for zoster vaccination was
approaching pneumococcal vaccination coverage among high -risk adults by 2023,
despite longstanding pneumococcal vaccination recommendations for high -risk
adults.
•It is unclear how a change from a universal to risk -based recommendations may
impact COVID -19 vaccine coverage
43 Source: CDC Immunization Services Division, unpublished data
Parental vaccine confidence
COVID -19 vaccination coverage among children 6 months –
17 years, United States, 2023 -2024 through 2024 -2025
Current season week ending date refers to the 2024 -2025 season only. For the 2023 -2024 season, the corresponding week is represe nted
Data source: National immunization survey – Flu https://www.cdc.gov/covidvaxview/weekly -dashboard/child -coverage -vaccination.html
Accessed April 7, 2025  45▪As of March 22, 2025, 12.8% of children 6 months -17 years reported having received the 2024─25 COVID -19 vaccine.

66
61
48
38
35
35
33
24
2221
27
27
17
29
32
30
21
149
9
17
17
21
21
21
20
184
4
9
29
15
12
17
35
46
0 25 50 75 100Get child vaccinated for COVID -19Have child mask with increased illness in communityTalk to child's doctor about prevention optionsDo my own research on prevention optionsLimit child's contact with others with increased illness in
communityGet child vaccinated for fluGive child vitamins or supplementsFeed child healthy foodsHave child wash hands more
Weighted %Very likely Somewhat likely A little likely Not likely"How likely are you to take the following actions to help prevent your child
from getting sick from a respiratory illness?" Results Among Parents of Child
Ages 0 –17Years, Omnibus Surveys, November 7 —29, 2024 (N=1,141)
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to
survey a nationally representative sample of U.S. adults ages 18 years and older. CDC fields questions about vaccination status,  intent, knowledge, attitudes, beliefs, and
behaviors on each survey for 2 waves each month, for a combined sample size of ~4,000 respondents. These slides present resul ts from November (N=4,240). Data were
weighted to represent the non -institutionalized U.S. population and mitigate possible non -response bias. All responses are self -reported. 46
26 60 15 Safety (N=956)More confident now About the same confidence now Less confident now
24 61 15
0 25 50 75 100Effectiveness (N=948)
Weighted %More confident now About the same confidence now Less confident now"Are you more or less confident in the safety/effectiveness of COVID -19 vaccines for children now
compared to when they first came out?" Results Among Parents of Child Ages 0 –17 Years Who Received
at Least 1 Dose of aCOVID -19 Vaccine , Omnibus Surveys, December 5 , 2024–January 27, 2025
47Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to survey
a nationally representative sample of U.S. adults ages 18 years and older. CDC fields questions about vaccination status, int ent, knowledge, attitudes, beliefs, and behaviors on
each survey for 2 waves each month, for a combined sample size of ~4,000 respondents. These slides present results from December  2024 & January 2025 (N=8,536). Data were
weighted to represent the non -institutionalized U.S. population and mitigate possible non -response bias. All responses are self -reported.
"Are you more or less confident in the safety/effectiveness of COVID -19 vaccines for children now
compared to when they first came out?" Results Among Parents of Child Ages 0 –17Years Who Have
Never Received a COVID -19 Vaccine , Omnibus Surveys, December 5 , 2024 —January 27, 2025
48Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel  and NORC AmeriSpeak  Omnibus Surveys, which use probability -based panels to survey a nationally representative sample of
U.S. adults ages 18 years and older. CDC fields questions about vaccination status, intent, knowledge, attitudes, beliefs, an d behaviors on each survey for 2 waves each month, for a combined sample size of ~4,000
respondents. These slides present results from December 2024 & January 2025 (N=8,536). Data were weighted to represent the no n-institutionalized U.S. population and mitigate possible non -response bias. All
responses are self -reported.6 49 45 Safety (N=1,308)More confident now About the same confidence now Less confident now
4 51 45
0 25 50 75 100Effectiveness (N=1,296)
Weighted %More confident now About the same confidence now Less confident now
Child’s 2024 -2025 COVID -19 Vaccination Status And Parental Intent to Get Their Child
Vaccinated, Results Among Parents of Child ren Ages 0 –17Years ,by Receipt of Prior COVID -19
Vaccine(s), Omnibus Surveys, December 5 , 2024—January 27, 2025  (N=2,312)
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel  and NORC AmeriSpeak  Omnibus Surveys, which use probability -based panels to survey a nationally
representative sample of U.S. adults ages 18 years and older. CDC fields questions about vaccination status, intent, knowledg e, attitudes, beliefs, and behaviors on each survey for 2 waves each
month, for a combined sample size of ~4,000 respondents. These slides present results from December 2024 & January 2025 (N=8, 536). Data were weighted to represent the non -institutionalized
U.S. population and mitigate possible non -response bias. All responses are self -reported.4911 4 8 18 17 42
26 8
215
323
1518
1611
65
0 25 50 75 100All parents (N=2,307)
Child did NOT have 1+ doses (N=1,334)Child had 1+ doses (N=962)
Weighted %Child received a COVID -19 vaccine since August 22, 2024 Definitely will get child vaccinated Probably will
Not sure Probably will not Definitely will not
43%
31%
30%
13%
12%
4%
8%
0%
3%
1%
25%
0 20 40 60 80 100Concerned about safety
Concerned about effectiveness
Concerned about bad reaction
Not/no longer a requirement
No recommendation from
provider
Haven't had time
Child has antibodies from
recent infection
Child received enough doses *
Worried about related cost
Do not know where to get it
None of the above
Weighted % (95% confidence interval)Child never vaccinated against COVID -19 (N=1,323)
18%
11%
4%
18%
12%
16%
7%
15%
4%
3%
29%
0 20 40 60 80 100
Weighted % (95% confidence interval)Child received ≥1dose COVID -19 vaccine (N=695)Reasons for Not Getting Child a 2024 -2025 COVID -19 Vaccine , Among
Parents of Child Ages 0 –17, by Receipt of Prior COVID -19 Vaccine(s),
Omnibus Surveys, December 5, 2024 —January 27, 2025
*Option "Child received enough doses" only offered to parents of children  who have received at least one dose of any COVID -19 vaccine .
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel  and NORC AmeriSpeak  Omnibus Surveys, which use probability -based panels to survey a nationally
representative sample of U.S. adults ages 18 years and older. CDC fields questions about vaccination status, intent, knowledg e, attitudes, beliefs, and behaviors on each survey for 2 waves each
month, for a combined sample size of ~4,000 respondents. These slides present results from December 2024 & January 2025 (N=8, 536). Data were weighted to represent the non -institutionalized
U.S. population and mitigate possible non -response bias. All responses are self -reported. 50
Recommendations in other countries
Summary of international COVID -19 booster* recommendations
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf  2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html  3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown in this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
52
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf  2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html  3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
53
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf  2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html  3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children  at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
54
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf  2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html  3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children  at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
55
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf  2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html  3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
56
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf  2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html  3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children at  increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
57
UK1Canada2Australia3WHO US
Older adults ≥65 years: 12 months
≥75 years and long -term
care facility residents: 6
months≥80 years and long -term care
facility residents: 6 months
65-79 years: 12 months; may
receive every 6 months≥75 years: 6 months
≥65 years: 12 months , may
receive every 6 monthsCountry dependent, often ≥75 or
≥80 years: 6–12-month interval
Country dependent, often 50 or
60 years : 12-month interval≥65 years: 6 months
Adults (routine) Not recommended May receive every 12 months May receive every 12
monthsNot routinely recommended
Pregnant adults and adolescents:
dose in each pregnancy***12 months
High -risk adults** 12 months 12 months May receive every 12
months12 months 12 months
Immunocompromised
adults6 months 6 months 12 months, may receive
every 6 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervals
Children (routine) Not recommended May receive every 12 months Not recommended Not routinely recommended 12 months
High -risk children** 12 months 12 months Not recommended Not routinely recommended 12 months
Immunocompromised
children6 months 6 months Under 5 years: not
recommended
5-17 years: May receive
every 12 months6-12 months 6 months, plus may
receive additional doses
at 2-month intervalsSummary of international COVID -19 booster* recommendations
1 https://assets.publishing.service.gov.uk/media/66e7fbf624c4f1826d81bb32/Greenbook -chapter -14a-20240916.pdf  2 https://www.canada.ca/en/public -health/services/publications/vaccines -
immunization/national -advisory -committee -immunization -summary -guidance -covid -19-vaccines -2025 -summer -2026.html  3 https://www.health.gov.au/our -work/covid -19-vaccines/getting -your -
vaccination/booster -doses
* Booster refers to people who have already completed an initial series. For people who are unvaccinated, more doses may be n eeded than are shown on this table
** Adults and children  at increased risk of SARS -CoV-2 exposure or severe COVID -19 disease.
*** Ideally during in the second trimester or at any opportunity
Italics indicate discretionary/shared clinical decision -making recommendations
58
Work Group Interpretations
•When initially presented with 2025 –2026 COVID -19 vaccine policy options
in November 2024, the Work Group appreciated pros and cons of both
risk-based and universal vaccine recommendations.
•At that time, there was not yet a consensus on what the recommendation
for the 2025 –2026 COVID -19 vaccine should be.
•The Work Group requested additional information to help inform the
decision -making process on risk -factors for severe COVID -19, transmission
and immunity, vaccine implementation and access, and cost -effectiveness. Initial Work Group interpretations
60
When polled on February 13, 2025, the majority of the work group
supported a non -universal (risk -based) recommendation for 2025 –2026
COVID -19 vaccination
14%19%67%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Don't knowUniversal recommendation for
everyone aged ≥6 months Non-universal recommendation
Percent of work group2025 –2026 Vaccination Policy
61
When polled on February 13, 2025, the Work Group supported
all non -universal policy options *
86%93%79%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Allowance for anyone wanting protection
 from vaccinationCertain age groups (e.g., persons aged ≥65 years)Specific high-risk conditions and exposures
Percent of COVID -19 vaccine Work Group members who selected a non -universal vaccine policy
recommendationGroups to be included in 2025 –2026 COVID -19 vaccine recommendation
* More than one response option could be selected. 62
•2024 -2025 COVID -19 vaccine effectiveness
•Seroprevalence of SARS -CoV-2
•Long COVID
•COVID -19 vaccine coverage update
•Multisystem Inflammatory Syndrome in Children (MIS -C)
•Liaison feedback (see next slide)Additional data presented to the Work Group
(March – April 2025)
63
•American Academy of Family Physicians (AAFP)
•American Academy of Pediatrics (AAP)
•Association of Immunization Managers (AIM)
•American College of Physicians (ACP)
•American Pharmacists Association ( APhA )
•American College of Obstetricians and Gynecologists (ACOG)
•Concerns were raised regarding implementation, communication, confidence in
recommendations and equitable access to vaccination with a potential risk -based
recommendation Liaison feedback on a potential risk -based recommendation
obtained from the following organizations (March – April 2025)
64
When polled on April 3, 2025 , the majority of the work group continued
to support a non -universal (risk -based) recommendation for 2025 –2026
COVID -19 vaccination
0%24%76%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Don't knowUniversal recommendation for
everyone aged ≥6 months Non-universal recommendation
Percent of work group2025 –2026 Vaccination Policy
65
When polled on April 3, 2025, the Work Group continued to
support all non -universal policy options*
89%84%84%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Allowance for anyone wanting protection
 from vaccinationCertain age groups (e.g., persons aged ≥65 years)Specific high-risk conditions and exposures
Percent of COVID -19 vaccine Work Group members who selected a non -universal vaccine policy
recommendationGroups to be included in 2025 –2026 COVID -19 vaccine recommendation
* More than one response option could be selected. 66
Risk for COVID -19–associated hospitalization is increased
among community -dwelling adults ages ≥18 years with
underlying medical conditions.
Abbreviations: RR, rate ratio; CI, confidence interval; COPD, chronic obstructive pulmonary disease.
* “None” refers to having none of the conditions examined in this analysis ( asthma, COPD, diabetes, chronic kidney disease, coronary artery disease, stroke, severe obesity, and current smoking).
** “Any condition” refers to having at least 1 of these conditions. Notes: Non -severe obesity is defined as BMI 30 –39kg/m². Severe obesity is defined as BMI ≥40kg/m². “Any condition” includes
asthma, COPD, diabetes, chronic kidney disease, coronary artery disease, stroke, severe obesity, and current smoking. Rate ra tios were estimated using multivariable Poisson models adjusted for sex,
and race/ethnicity. “Smoker (current)” Includes people who quit smoking within the past 12 months. Data are limited to hospit alizations where COVID -19 is the likely reason for admission. 67Patterned bars indicate CIs that include 1.0.
0.1110100
None* Any
condition**Asthma COPD Chronic
kidney
diseaseCoronary
artery
diseaseDiabetes Stroke
(history of)Obesity
(non-severe)Obesity
(severe)Smoker
(current)Adjusted RR (log scale)Adjusted Rate Ratios for COVID -19–associated Hospitalizations among Community -Dwelling Adults Ages ≥18 Years,
by Age Group — October 2022 –September 2023
18–49 50–64 65–74≥75
•General thoughts on universal vs. risk -based recommendation for COVID -19 vaccination
•Are there groups that clearly should not be recommended for vaccination with the 2025 –2026
vaccine ?
•What data would be helpful in your decision making?
•Is it still helpful to have a risk -based recommendation if most of thepopulation (>74%) is
considered “at risk”?
•Should people at higher risk of infection and transmission (e.g., healthcare workers) be included in
a risk -based recommendations?
•Will stable (i.e., universal) recommendations increase  uptake with time?
•Concerns about implementation challenges with risk -based recommendations?
•Any potential unintended implications or consequences of a recommendation change?
•Are there key decision points we have not captured here?Discussion
68
Acknowledgements
•Lauren Roper
•Farida Ahmad
•Carla Black
•Kayla Calhoun
•Angela Campbell
•Mary Chamberland
•Nicole Dowling
•Jonathan Duffy
•Monica Godfrey
•Susan Goldstein
•Fiona Havers
•Jefferson Jones•Ruth Link -Gelles
•Meredith McMorrow
•Sarah Meyer
•Pedro Moro
•Danielle Moulia
•Matthew Oster
•Hilda Razzaghi
•Sharon Saydah
•Sierra Scarbrough
•Zachary Schneider
•Benjamin Silk
•Christopher Taylor•Natalie Thornburg
•Evelyn Twentyman
•Eric Weintraub
•Anna Yousef
•Coronavirus and other Respiratory
Viruses Division
•COVID -NET Team
•Immunization Safety Office
•Immunization Services Division
•National Center for Immunization and
Respiratory Diseases
69

Summary: Use of 2025 –2026 COVID -19 Vaccines: Work Group Considerations Lakshmi Panagiotakopoulos, MD, MPH Advisory Committee on Immunization Practices April 15, 2025National Center for Immunization and Respiratory Diseases   •Current recommendations for 2024 –2025 COVID -19 vaccines •Policy options for 2025 –2026 COVID -19 vaccine recommendations •Supporting data and Work Group interpretations •Discussion questions for committee Overview 2 COVID -19 vaccine: ACIP Meeting Schedule October  2024April…


01 Kobayashi Pneumococcal 508

Pneumococcal Vaccines Work Group
April 2025, ACIP meeting
April 15, 2025
Miwako Kobayashi
National Center for Immunization and Respiratory Diseases
1U.S. Centers for Disease Control and Prevention
Pneumococcal Vaccines Work Group
ACIP Members
•Jamie Loehr (Chair)
•Mini Kamboj
•George Kuchel
•Robert Schechter

Ex Officio Members
•Tina Mongeau   (FDA)
•Nick Geagan       (FDA)
•Uzo Chukwuma (IHS)
•Mamodikoe Makhene (NIH, primary)
•Meenu Upadhyay (NIH, alternate)
•Risa Claytor                (HRSA)
Liaison Representatives
•  Lynn Fisher                (AAFP)
•  Monica Ardura        (AAP/COID)•Jason Goldman         (ACP)
•Saba Hasan                (ACP , alternate)
•James McAuley         (IDSA)
•Eva Wong                    (NACI)
•Robert Hopkins         (NFID, primary)
•William Schaffner     (NFID, alternate)
•Michelle Floris -Moore   (NMA)
•Mary Hayney             ( APhA )
Consultants
•Monica Farley            (Emory)
•Keith Klugman          (Gates Foundation)
•Kathy Poehling         (Wake Forest)
•Arthur Reingold        (UC Berkley)
•Lorry Rubin                 (CCMC)
•Richard Zimmerman (U. of Pittsburgh)
CDC Contributors
Arctic Investigations Program
•Heather Scobie
CDC Lead
•Miwako KobayashiDivision of Bacterial Diseases
•Adam Cohen
•Ryan Gierke
•Noele Nelson
Immunization Safety Office
•Pedro Moro
Immunization Services Division
•Nancy Wong
Pneumococcal Work Group Terms of Reference
•Review evidence to inform use of new pneumococcal conjugate vaccines in
U.S. adults and children
ACIP Work Groups | ACIP | CDC 4
History of US Pneumococcal Vaccine Program,
1984 –2024
1984PPSV23:  adults aged
≥65 years and
individuals with
underlying conditions
2000 2010 2019 2014 2012
PCV7: Children PCV13:  Children
(replaced PCV7)PCV13:  Adults with
immunocompromising
conditionsPCV13:  All adults
aged ≥65PCV13 based on SCDM for all adults aged ≥65 years
PCV=pneumococcal conjugate vaccine, PPSV23=23 -valent pneumococcal polysaccharide vaccine, SCDM=shared clinical decision -making2021/2022
PCV15: Adults/childrenPCV20 : Adults2023
PCV20:
Children2024PCV21:
Adults
Current gaps in pneumococcal vaccine
recommendations
•Pregnant women
-Currently no recommendation

Adult Immunization Schedule by Medical Condition and Other Indication | Vaccines & Immunizations | CDC

Current gaps in pneumococcal vaccine
recommendations
•Hematopoietic Stem Cell Transplant (HSCT) recipients
-Different vaccination schedule compared with other risk conditions (last updated
in 2023)
-No clinical guidance for PCV21 use
Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United S tates, 2023 | MMWR
Proposed work plan
•Review of literature on pneumococcal vaccine use in pregnant women
and HSCT recipients focusing on data on:
-Pneumococcal disease incidence and serotype distribution
-Vaccine efficacy, effectiveness, and impact
-Immunogenicity
-Safety
•Plan to present summary of findings and proposed language for updated
clinical guidance on pneumococcal vaccine use at the June 2025 ACIP
meeting
8
Thank you!
For more information, contact CDC
1-800- CDC- INFO (232 -4636)
TTY:  1 -888- 232- 6348    cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U. S. Centers for Disease Control and Prevention.
9

Summary: Pneumococcal Vaccines Work Group April 2025, ACIP meeting April 15, 2025 Miwako Kobayashi National Center for Immunization and Respiratory Diseases 1U.S. Centers for Disease Control and Prevention Pneumococcal Vaccines Work Group ACIP Members •Jamie Loehr (Chair) •Mini Kamboj •George Kuchel •Robert Schechter    Ex Officio Members •Tina Mongeau   (FDA) •Nick Geagan       (FDA) •Uzo Chukwuma (IHS) •Mamodikoe Makhene (NIH, primary) •Meenu Upadhyay (NIH, alternate) •Risa Claytor               …


01 Brooks HPV 508

Introduction to the HPV Vaccines Work Group
Oliver Brooks, MD
Chair, HPV Vaccines Work Group
Advisory Committee on Immunization Practices
April 15, 2025
National Center for Immunization & Respiratory Diseases
•HPV can cause cancer of the cervix, vagina, vulva, penis, anus, and oropharynx
•HPV vaccination provides lasting protection against the HPV types that most
commonly cause cancer
•In the 19 years since HPV vaccine licensure, we have seen:
-High vaccine efficacy in clinical trials
-High population impact in real -world settings
-Strong herd effects of vaccination programsHPV vaccine is a critical public health tool
2
•An ACIP HPV Vaccines Work Group met previously for many years, but
had been inactive since 2019
•Re-formed ACIP HPV Vaccines Work Group was announced during June
2024 ACIP meeting and began meeting monthly in July 2024
•First presentation by new Work Group during October 2024 ACIP meetingBackground
3
•Routine vaccination
-Age 11 or 12 years
-Can be started at age 9 years
•Catch -up vaccination
-Through age 26 years
•Shared clinical decision -making
-Age 27 –45 yearsCurrent HPV vaccination recommendations,
United States
Recommendations of the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices
https://www.cdc.gov/vaccines/hcp/acip -recs/vacc -specific/hpv.html  Number of doses
2 doses  (0, 6 -12 months)
if starting series before 15th birthday
3 doses  (0,1-2, 6 months)
if starting series on or after 15th birthday or if
immunocompromising condition
4
•Wording of the age for routine HPV vaccination
-Some stakeholders interested in starting vaccination at age 9 years
-Current ACIP recommendations are consistent with vaccination at age 9 years
-Work Group is considering m odification of wording to “ HPV vaccination is routinely
recommended at age 9 to 12 years”  to allow more flexibility Work Group Terms of Reference
5
•Number of doses in the recommended HPV vaccination series
-Accumulating evidence on efficacy of HPV vaccination with fewer doses
-Work Group is reviewing data to inform policy for:
•two doses for persons aged 15 years and older
•one dose for persons aged 9 years and olderWork Group Terms of Reference
6
•2022: WHO recommended a 2 -dose schedule for ages 9 and older, with an option for a 1 -dose
schedule in girls and boys aged 9 –20 years
•Some of the first countries to change to a routine 1-dose recommendation
–UK and Australia
•Some countries did not change to a 1 -dose schedule, but changed from a 3-dose to a 2 -dose schedule
for persons ages >14 years
–e.g., Netherlands and Sweden
•1-dose recommendations  have been made  by regional advisory groups
–PAHO in 2023 and AFRO in 2024
•As of April 2025: in some age groups, 67 countries have adopted 1 -dose  and 77 countries have
adopted 2 -dose HPV vaccination schedulesGlobal HPV vaccine policy recommendations
7Pan American Health Organization (PAHO): https://www.paho.org/fr/node/92810
WHO African Region (AFRO): https://www.afro.who.int/news/africa -immunization -advisory -group -urges -single -dose -hpv -vaccine -adoption -advance -vaccination
•Introduction to reduced number of HPV vaccine doses
-Summary of evidence on 1 -dose HPV vaccination
•Introduction to wording of age for routine HPV vaccination
-Interest in vaccination at age 9 years
•Systematic review and narrative summary of literature about HPV
vaccination at ages 9 –10 years to increase coverageSummary of October 2024 presentation
8
Today’s agenda
Reduced number of doses for HPV vaccination:
Work Group progress and literature updateDr. Carla DeSisto
CDC/NCIRD
KEN  SHE trial Dr. Ruanne  Barnabas
Harvard University
HPV vaccination coverage Ms. Cassandra Pingali
CDC/NCIRD
Modeling of reduced number of doses for HPV
vaccinationDr. Jane Kim
Harvard University
Modified EtR: Wording of the age for routine HPV
vaccinationDr. Ruth Stefanos
CDC/NCIRD
Next steps  and Work Group considerations Dr. Lauri Markowitz
CDC/NCIRD
9
ACIP HPV Vaccines Work Group
ACIP voting members
Oliver Brooks (chair)
Noel Brewer
Sybil Cineas
Robert Schechter
CDC Co -Leads
Carla DeSisto
Lauri MarkowitzLiaison members
Robin O'Meara (AAFP)
Angela Myers (AAP)
Linda Eckert (ACOG)
Alfonso Iorio  (ACP)
Jamilia Sherls (AIM)
Sandra Fryhofer (AMA)
Sean O'Leary (IDSA)
Nicole Forbes (NACI)
Kevin Ault (NFID)
Alexandra Yonts (PIDS)
Nneka Holder (SAHM)
10Ex-Officio members
Sixun Yang (FDA)
Aimée  R. Kreimer (NIH)
Eleanore Chuang (NIH)
Consultant members
Deana Baptiste (ACS)
Peter Szilagyi
Rachel Winer
Elizabeth Moore (consumer rep)
Julia Gargano (DVD)
Ruth Stefanos (DVD)
Virginia Senkomago (DCPC)
Patrick Clay (DSTDP)
Harrell Chesson (DSTDP)
Shannon Stokley (ISD)
Cassandra Pingali (ISD)ACIP HPV Vaccines Work Group - CDC Staff
Elizabeth R. Unger (DHCPP)
Gitika Panicker (DHCPP)
Christine Olson (ISO)
Julianne Gee (ISO)
Hannah Rosenblum (ACIP Secretariat)
11

Summary: Introduction to the HPV Vaccines Work Group Oliver Brooks, MD Chair, HPV Vaccines Work Group Advisory Committee on Immunization Practices April 15, 2025 National Center for Immunization & Respiratory Diseases •HPV can cause cancer of the cervix, vagina, vulva, penis, anus, and oropharynx •HPV vaccination provides lasting protection against the HPV types that most  commonly cause cancer •In the 19 years since HPV vaccine licensure, we have seen: -High vaccine efficacy in clinical trials -High…


02 DeSisto HPV 508

Reduced number of doses for HPV vaccination series:
Work Group progress and literature update
Carla L. DeSisto, PhD, MPH
Co-Lead, HPV Vaccines Work GroupNational Center for Immunization and Respiratory Diseases
Advisory Committee on Immunization Practices
April 15, 2025
•PICO and outcomes
•Introduction to systematic review
•Updated data from studies of interest
•Observational studies of HPV vaccine effectiveness
•Outstanding questions for reduced  number of HPV vaccine dosesOutline
2
PICOs and outcomes
PICO questions1
Policy question Should 1 dose of HPV vaccine be used for
prevention of HPV infection and HPV attributable
disease, instead of the currently recommended
vaccination schedule? Should 2 doses of HPV vaccine be used
for prevention of HPV infection and
HPV attributable disease, instead of the
currently recommended vaccination
schedule?
Population Persons aged 9 –14 yrs
Except persons with
immunocompromising
conditionsPersons aged 15 –X yrs2
Except persons with
immunocompromising
conditionsPersons aged 15 –X yrs2
Except persons with immunocompromising
conditions
Intervention 1 dose of HPV vaccine 2 doses of HPV vaccine
Comparison
(current
recommendation )2 doses for persons who
initiate at ages 9–14 yrs3 doses for persons who
initiate at age ≥15 yrs3 doses for persons who initiate at age
≥15 yrs
1We are not intending this to change the recommendation of shared clinical decision -making for persons aged 27 -45 years,
although the number of recommended doses in this age group may change.
2Upper age to be discussed by Work Group after we review data
Note: We will review  data on 1 vs 2 doses in persons aged 15+, but are focusing PICOs on comparing to current recommendations4
Outcomes
Outcome Importance
HPV -associated cancers Critical
Pre-cancers (CIN2+ or AIN2+) Critical
Serious adverse events related to vaccination Critical
Incident -persistent HPV infection Critical
Prevalent HPV infection Important
Incident HPV infection Important
Immunogenicity Important
Anogenital warts Important
Low -grade histological abnormalities (CIN1 or AIN1) Important
Recurrent respiratory papillomatosis Important
5
Introduction to systematic review
•Cochrane reviewed the global literature on HPV vaccination schedules
with reduced number of doses in 2022
-59 studies (73 publications) were included in review; 49 studies were later
excluded due to serious risk of bias
•We are starting with Cochrane’s review but putting it into U.S. context
-Only including studies of vaccines that are licensed in the United States
-Using 18 publications from Cochrane’s systematic review
•Updated Cochrane’s literature search for publications during 2022 –2024
-Yielded 22 additional publications; 3 excluded due to serious risk of bias
-37 total included publicationsSystematic review of the literature
7
Included studies in alphabetical order
8Study name or first author Study design Population and age at vaccination Vaccine
Batmunkh  2020 (Mongolia) Retrospective cohort Females, 11 -17y 4vHPV
Berenson 2024 (USA) RCT Females, 15 -26y 9vHPV
Bornstein 2021 (global) RCT Girls and boys, 9 -14y 9vHPV
Costa Rica Vaccine Trial (CVT) Post -hoc analysis of RCT Females,18 -25y 2vHPV
CVT/PATRICIA Post -hoc analysis of 2 RCTs Females,15 -25y 2vHPV
DoRIS  (Tanzania) RCT Females, 9 -14y 2vHPV and 9vHPV
Hariri 2018 (USA) Retrospective cohort Females, age NR 4vHPV
HOPE (South Africa) Repeat cross -sectional Females, 15 -16y 2vHPV
IARC -India Post -hoc analysis of RCT Females, 10 -18y 4vHPV
Jiamsiri  2024 (Thailand) Repeat cross -sectional Females, 13 -14y 2vHPV
KEN SHE (Kenya) RCT Females,15 -20y 2vHPV and 9vHPV
Klein 2024 (USA) Cohort Girls and boys, 9 -14y 9vHPV
Moss 2024 (USA) Cohort Females, 15 -45y 9vHPV
Reyburn  2023 (Fiji) Retrospective cohort Females, 9 -12y 4vHPV
Wu 2025 (Sweden) Retrospective cohort Females, 10 -35y 4vHPV
Zeng 2023 (USA) Cohort Girls and boys, 9 -11y 9vHPV
Outcome # of studies RCTs Post -hoc analysis of
RCTsObservational
studies
HPV -associated
cancers1 IARC -India (15y; 0 cases)
Pre-cancers (CIN2+
or AIN2+)2 IARC -India (15y) Wu-Sweden (8 -12y)
Incident -persistent
HPV infection3 KEN SHE (4.5y) IARC -India (15y),
CVT/PATRICIA (4y)
Serious adverse
events related to
vaccinationn/a - data to be summarized in narrative review
9Critical outcomes: Studies contributing data and time
since vaccination
Outcome # of
studiesRCTs Post -hoc
analysis of RCTsObservational studies
Prevalent HPV infection 5 CVT (11y) Reyburn -Fiji (8y), Batmunkh -
Mongolia (6y), Jiamsiri -Thailand (4y),
HOPE -South Africa (2y)
Incident HPV infection 2 IARC -India (15y),
CVT (11y)
Immunogenicity 11 DoRIS -Tanzania (5y),
KEN SHE (2y),
Bornstein -global (1y),
Berenson -USA (1m)CVT (16y),
IARC -India (10y)Batmunkh -Mongolia (6y),
Jiamsiri -Thailand (4y),
Zeng -USA (6m),  Moss -USA (1m),
Klein -USA (follow -up varied)
Anogenital warts 2 Reyburn -Fiji (8y),
Hariri -USA (follow -up NR)
Low -grade histological
abnormalities (CIN1 or
AIN1)1 IARC -India (15y)
Recurrent respiratory
papillomatosisn/a
10Important outcomes: Studies contributing data and time since vaccination
Updated data from studies of interest
Trial/country Evidence VaccineAge ( yrs) at
vaccinationDescription
CVT
Costa RicaEfficacy/
Immunogenicity2vHPV 18–25 Post -hoc analyses
Original trial: randomized to 3 doses or
control, but analyzed as 1 -, 2-, 3-dose groups
IARC -India
IndiaEfficacy/
Immunogenicity4vHPV 10–18 Post -hoc analyses
Original trial: randomized to 2 or 3 doses
but analyzed as 1 -, 2-, 3-dose groups
KEN SHE
KenyaEfficacy 2vHPV
9vHPV15–20 Randomized trial
1 dose 2vHPV, 9vHPV or MCV
DoRIS
TanzaniaImmunogenicity 2vHPV
9vHPV9–14 Randomized trial
1-, 2-, 3-dose groups
122vHPV, Cervarix;  9vHPV, Gardasil 9; CVT, Costa Rica Vaccine Trial; IARC, International Agency for Research on CancerTrials with data on single -dose HPV vaccination
considered by the World Health Organization in 2022
•Women aged 18 –25 years were randomly assigned to receive 3 doses of
2vHPV or hepatitis A vaccine
•Some women did not receive all 3 doses due to pregnancy, colposcopy
referral, a medical condition, participant refusal, or missing a study visit
-Reasons for receiving fewer doses were balanced within each dosage group
between women receiving the HPV and control vaccines
•Data evaluated as cohort study of women who received 1, 2, or 3 doses
•We previously reviewed data on protection against prevalent infection
and immunogenicity through 11 yearsCosta Rica Vaccine Trial (CVT)
13
•16 years after vaccination, HPV 16/18 seropositivity was very high (>98%)
•During years 11 –16 after vaccination, small but statistically significant
declines in antibodies observed in women who received 3 doses and 1 doseCosta Rica Vaccine Trial (CVT): 2024 update
14 Porras et al 2024 https://academic.oup.com/jncimono/article/2024/67/329/7821493

•Unmarried girls aged 10 –18 years were randomly assigned to receive
either 2 or 3 doses of 4vHPV
•A ministerial decree to halt vaccination in trials resulted in the creation of
cohorts of women who received 1, 2, or 3 doses
•Cervical screening with an HPV test was initiated at age 25 years for
married participants
-Positive screening → colposcopy; negative screening → repeat in 5 years
•Age- and site -matched unvaccinated married women recruited as controls
•We previously reviewed data on protection against persistent infection
through 10 yearsIARC -India Trial
15
•Median follow -up time = 12 years; time since study began = 15 years
-Currently aged 25 –33 years
•VE against persistent HPV 16/18 infection by number of doses:
-1 dose: 92.0% (95% CI: 87.0% –95.0%)
-2 doses: 94.8% (95% CI: 90.0% –97.3%)
-3 doses: 95.3% (95% CI: 90.9% –97.5%)
•No CIN2+ associated with HPV 16/18 detected among vaccinated
participants (compared with 8 among unvaccinated women)
•No cases of invasive cervical cancer associated with HPV 16/18 in studyIARC -India Trial: 2024 update
16 Malvi et al 2024 https://academic.oup.com/jncimono/article/2024/67/317/7821485
•Dose Reduction Immunobridging  & Safety Study
•Girls aged 9 –14 years were randomly assigned to 1, 2, or 3 doses of either
2vHPV or 9vHPV
•All participants followed until month 36; 1 - and 2 -dose groups invited to
join long -term extension (through 9 years)
•Objective was to demonstrate noninferiority:
-HPV 16 and 18 antibody response after 1 vs 2 or 3 doses of same vaccine
-HPV 16 and 18 GMCs: 1 dose in DoRIS  vs 1 dose in studies that evaluated efficacy
•We previously reviewed data on immunogenicity (seropositivity and
GMCs) and immunobridging  to KEN SHE through 2 yearsDoRIS  (Tanzania)
17
•Seropositivity:
-HPV 16: 100% seropositive in 1 -dose and 2 -dose arms
-HPV 18: 93% seropositive in 1 -dose arm, 98% seropositive in 2 -dose arm
-Non -inferiority of HPV 18 seropositivity was not metDoRIS : 2025 update (9vHPV results) – 5 years after
vaccination
18 Watson -Jones et al 2025 https://pubmed.ncbi.nlm.nih.gov/39890232/
DoRIS : 2025 update (9vHPV results) – 5 years after
vaccination
19
•GMCs:
-1-dose arm: plateaued at month 12, relatively constant through month 60
-2-dose arm: declined after peak at month 7
-Lower in 1 -dose arm than in 2 -dose arm, as expected
Observational studies of vaccine effectiveness
•Most important sources of bias:
-Differences between dose groups in risk of prevalent infection at time of vaccination
-Differences between dose groups in risk of HPV acquisition during follow -up
-Potential impact of interval between 1st and 2nd dose on vaccine effectiveness
•Serious bias would likely result in lower effectiveness with fewer doses
•Ways investigators attempt to control for biases:
-Using buffer periods to exclude outcomes caused by prevalent infections at vaccination
-Stratifying results for age at vaccination or restricting the population to younger ages
-Adjusting for indicators of sexual activity and socio -demographic characteristics
-Stratifying results for 2 doses by the interval between 1st and 2nd dose (e.g., <5 , ≥5m)Bias in observational studies of HPV vaccine
effectiveness by number of doses
21 Markowitz et al 2022 https://www.sciencedirect.com/science/article/pii/S0264410X22008349?via%3Dihub
•Cohort study of 2.2M females aged 10 –35, residents of Sweden 2006 –2022
•Linked several registries, including vaccination and cervical screening
•Exposure (time -varying): number of doses of 4vHPV
•Outcome: CIN2+
•Used Poisson models to estimate incidence rate ratios (IRR) vs. unvaccinated
-Adjusted for age, calendar year, county of residence, maternal history of high -grade
cervical lesions, mother’s country of birth, parental education, and household income
-1 year buffer
•Median years of follow -up (IQR):
-Unvaccinated: 8.4 (2.3 –15.3); Vaccinated: 12.4 (8.7 –17.0)Wu-Sweden 2025: methods summary
22
Wu-Sweden 2025: CIN2+ by age at vaccination
23 Wu et al https://www.thelancet.com/journals/lanepe/article/PIIS2666 -7762(24)00347 -8/fulltext
Outstanding questions for reduced
number of HPV vaccine doses
▪Longer term efficacy and immunogenicity
▪Protection at sites other than the cervix
▪Efficacy and immunogenicity in males
▪Efficacy and immunogenicity in immunocompromised persons
▪Efficacy and immunogenicity in older age groupsOutstanding questions for reduced  number of  HPV vaccine doses
25
▪Longer term efficacy and immunogenicity
➢Longest efficacy data: IARC -India (15 years)
➢Longest immunogenicity data: Costa Rica Vaccine Trial (16 years)
▪Protection at sites other than the cervix
➢No data on protection at sites other than the cervix
▪Efficacy and immunogenicity in males
➢13/16 studies include only females
➢No efficacy data in males
➢Some evidence of lower antibody titers in adolescent males versus females after 1 dose
▪Efficacy and immunogenicity in immunocompromised persons
➢Limited data available; not planning to make changes to recommendation
▪Efficacy and immunogenicity in older age groups
➢Limited data available; need to decide appropriate upper age for our PICOs
26Outstanding questions for reduced number of HPV vaccine doses
For more information, contact CDC
1-800-CDC-INFO (232 -4636)
TTY:  1 -888-232-6348    www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Thank you!

Summary: Reduced number of doses for HPV vaccination series:  Work Group progress and literature update Carla L. DeSisto, PhD, MPH Co-Lead, HPV Vaccines Work GroupNational Center for Immunization and Respiratory Diseases Advisory Committee on Immunization Practices April 15, 2025 •PICO and outcomes •Introduction to systematic review •Updated data from studies of interest •Observational studies of HPV vaccine effectiveness •Outstanding questions for reduced  number of HPV vaccine dosesOutline 2 PICOs…


03 Barnabas HPV 508

A randomized trial of single -dose HPV vaccination efficacy
among young women: Month 54 durability results
Ruanne V. Barnabas, MBChB, DPhil
Chief, Division of Infectious Diseases, Massachusetts General Hospital
Department of Medicine, Harvard Medical School
HPV vaccination for all and catch -up vaccination to young adulthood
accelerate the timeline to cervical cancer elimination.
Simms, K. T., Steinberg, J., …, & Canfell , K. (2019). Impact of scaled up human papillomavirus vaccination: A modelling study. The Lancet OncologyPredicted number of cases of cervical cancer globally
We conducted a rigorous randomized trial (the KEN SHE Study) and found that the single
dose HPV vaccination is highly efficacious, with 98% vaccine efficacy for HPV 16/18.
Primary Endpoint Period
Six monthly follow -up visits: clinician collected cervical swabs
Endpoint : Incident, persistent vaccine type -specific infection among participants HPV naïve
at vaccination
Retention  was 96% for four or more swab
Duration of follow -up: 36 months
Barnabas, R., Brown, E., and colleagues. KEN SHE Study 36 months VE results. Nature Medicine, Dec. 2023
Young women aged 15-20
N=2,275 participants
Enrolled
n=757 participants
Immediate
meningococcal vaccine
Controln=760 participants
Immediate bivalent
vaccine
2vHPVn=758 participants
Immediate nonavalent
vaccine
9vHPVRandomization
Participants were followed over 36 months.
Physician
collected
cervical swabs
for HPV DNAFollow -up
6 monthly
VE
18 monthsPrimary analysis
Exclude
prevalent
infectionEnrollment and
month 3
Physician collected
cervical swabs for
HPV DNA
Participants
vaccinatedFollow -up
6 monthly
VE
36 monthsFinal analysis
Participants with prevalent HPV infections at enrollment were excluded from
the per protocol/ mITT  analysis, because the vaccine is prophylactic only.
mITT  HPV 16/18 cohort
•29% (n=661/2,275) prevalent infections → excluded
mITT  HPV 16/18/31/33/45/52/58 cohort
•52% (n=792/1,515) prevalent infection → excluded
9v VE= 99%  for HPV 16/18 (95% CI: 91 – 100%)
2v VE= 98%  for HPV 16/18 (95% CI: 90 – 99%)
VE=96%  for HPV 16/18/31/33/45/52/58
(95% CI: 89 – 98%)
Barnabas, R., Brown, E., and colleagues. KEN SHE Study 36 months VE results. Nature Medicine, Dec. 2023Month 36 VE resultsAfter three years, single -dose HPV vaccine efficacy remained high and durable
(VE= 98%  for HPV 16/18 and VE= 96%  for HPV 16/18/31/33/45/52/58).
n=2
n=1n=72
n=84
n=5
We hypothesized that single -dose vaccination would be effective and durable
over 54 -months based on sustained antibody levels over 16 years.

Joshi, S…Basu, P . Vaccine. 2023 Jan 4;41(1):236 -245.
Porras, C … Kreimer , A. CVT, IPVC, 2023
Participants in the KEN SHE Study were crossed over at month 30/36 while
maintaining the study blind.
Enrollment
Young women aged 15-20 years
Eligibility: 1-5 lifetime partners, HIV RDT
negative, No previous HPV vaccine or
contraindications, Resident
Immediate
meningococcal vaccineImmediate bivalent HPV
vaccineImmediate nonavalent
HPVvaccineRandomized
Delayed nonavalent HPV
vaccineDelayed meningococcal
vaccineDelayed meningococcal
vaccineCrossover vaccination
Primary Endpoint Period
Crossover Period
All Single -dose HPV
Vaccinated Period
Crossover
period
(vaccination at
m 30 or m 36)All single -dose
HPV vaccinated
period
Durability
resultsFinal Endpoint
period
Final RCT VE
results
AIMS
1. To evaluate effectiveness of single -dose HPV vaccination for age 18 -23, we compared the cumulative
incidence of persistent HPV using Kaplan -Meier (cumulative incidence) curves and incident rate
estimates for the immediate and delayed vaccine groups (graphic illustration)
2. To assess durability, vaccine efficacy was evaluated as a function of time since vaccination using a Cox
regression model  (accounting for time and time variable covariates)
•Endpoint : Incident persistent vaccine type -specific HPV infection measured at two time points 6
months apart
•Both analyses used the mITT  cohorts
We extended the KEN SHE Study in a blinded cross -over trial design to assess
vaccine efficacy and durability at month 54.

There were no differences in baseline characteristics between study groups.
Participants were age 18 -23 years at cross -over vaccination.
Characteristics Nonavalent HPV
(n=758)Bivalent HPV
(n=760)Control
(n=757)
Age group 15 -17 years (%) 60% 56% 56%
Median age (years) 17 17 17
Secondary school (%) 73% 73% 73%
Current steady partner (%) 72% 71% 72%
Chlamydia trachomatis
positive (%)12% 13% 14%
Prevalence of baseline characteristics for the ITT cohort
Retention was 90% for three or more swabs and the median time between endpoint
swab collection was 6.00 months.
Retention 90%
for 3 post -crossover swabs
Median follow -up 53 months2,275 Participants
enrolled
22,124 ( 95% )
Received crossover
vaccine
No diff by study grpRetention 91%
for 5 or more pre -
crossover swabs
151 (6.6%)
exited
The incidence of persistent non -vaccine HPV types was stable across the time
periods and between the study groups, indicating continued HPV exposure.
(26/35/39/40/42/43/44/51/53/54/56/59/61/66/68/69/70/73/82 in HPV 16/18 mITT  cohort)
Incidence of persistent
non-vaccine type HPV
per 100 woman -years
(95% CI)Study Group
Delayed HPV
vaccinationImmediate HPV
vaccinationOverall
Primary Endpoint
Period19.5
(15.4 -24.3)20.7
(17.6 -24.2)20.3
(17.8 -23.0)
All Single -dose HPV
Vaccinated Period22.0
(12.0 -36.9)22.5
(14.7 -33.0)22.3
(15.9 -30.3)
Follow -up time amongst women non -vaccine HPV -type DNA negative at month 0 and month 3 (women are excluded if positive at month 0  or
month 3 for any of HPV 26/35/39/40/42/43/44/51/53/54/56/59/61/66/68/69/70/73/82)

Durability and Vaccine Efficacy (VE) Results
Cumulative Incidence of Persistent HPV 16/18 by Original Vaccine Group and Study
Period (HPV 16/18 mITT Cohort)
Pre-crossover n = 4
Post -crossover n = 4
~14 months
Randomized
vaccineBlinded
crossover vaccineCumulative Incidence of Persistent HPV 16/18 by Original Vaccine Group and Study
Period (HPV 16/18 mITT  Cohort)
Pre-crossover n = 4
Post -crossover n = 4Pre-crossover n = 89
Post -crossover n = 7
Participants vaccinated at age 18 -23 years, had similar low rates of incident
persistent HPV 16/18 infection compared to vaccination at age 15 -20 years.

VE to prevent HPV 16/18
as a function of time
since HPV Vaccination
(HPV 16/18 mITT  Cohort)HPV 16/18 vaccine
efficacy, VE=99.2%
(95% CI 96.1 -99.9%) is
sustained over time
without evidence for
waning immunity.

Cumulative Incidence of Persistent HPV 16/18/31/33/45/52/58 by Original Vaccine
Group and Study Period (HPV 16/18/31/33/45/52/58 mITT  Cohort)
Pre-crossover n = 5
Post -crossover n = 5
Cumulative Incidence of Persistent HPV 16/18/31/33/45/52/58 by Original Vaccine
Group and Study Period (HPV 16/18/31/33/45/52/58 mITT  Cohort)
~14 monthsBlinded
crossover vaccine
Randomized
vaccine
Pre-crossover n = 5
Post -crossover n = 5Pre-crossover n = 89
Post -crossover n = 9
Participants vaccinated at age 18 -23 years, had similar rates of incident
persistent HPV 16/18/31/33/45/52/58 infection compared to vaccination at
age 15 -20 years.

Vaccine Efficacy to prevent HPV
16/18/31/33/45/52/58 as a function of
time since HPV vaccination (HPV
16/18/31/33/45/52/58 mITT  cohort)HPV
16/18/31/33/45/52/
58 vaccine efficacy,
VE=98.9% (95% CI
94.9 -99.8%) is
sustained over time
without evidence for
waning immunity.

Discussion
•Adolescent girls and young women were effectively protected from
HPV infection over the first 54 months post -vaccination
•Rigorous design, high fidelity to the protocol, high retention, clear
ascertainment of outcomes → strong evidence for single -dose HPV
vaccine efficacy for age up to 23 years
•Single -dose VE 16/18 and 16/18/31/33/45/52/58 – lower bound of the
CI is >94% - in keeping with licensure trials for three doses without
evidence of waning
•Adds to the growing body of evidence supporting the efficacy of single -
dose HPV vaccine efficacy
•Next step: Extension to evaluate clinical endpoints
Patient perspectives
Shared Clinical Decision Making Increase Access to Prevention

KEN SHE Study collaborators
Dr. Maricianah Onono Dr. Elizabeth BukusiDr. Betty Njoroge Dr. Nelly MugoKenya Medical Research Institute (KEMRI)
Fred Hutchinson Cancer Center
University of Washington
Dr. Denise GallowayDr. Elizabeth Brown
Dr. Rachel Winer
Grace Umutesi
Christine HathawayMassachusetts General
Hospital
Kate Heller
Jesse Heitner
Meighan Krows
Odun  Talabi
Thank you
ClinicalTrials.gov :
NCT03675256•Study Participants
•Bill and Melinda Gates Foundation (Peter Dull, Reena Gulati, Abdul Rawuf  Yousufzay , Sara Vernam );Division of Infectious Diseases, Department of Medicine,
Massachusetts General Hospital (Ruanne  Barnabas, Kate Heller, Diane Kanjilal ,Meighan Krows , Odunayo  Talabi ),Fred Hutchinson Cancer Center (Elizabeth Brown,
Denise Galloway, Jody Carter, Marci Wright, Priya R. Prabhu, Robin Smith, Deborah Donnell, Kidst  Zewdie); KEMRI Kisumu (Elizabeth A. Bukusi , Maricianah  Onono ,
Samya  S. Rashid, Annette A. Opondo, Catherine W. Mwakio ,  Christine A. Olweny , Cynthia Akinyi , David E. Muhoma , Debora A. Odhiambo, Donnavane  A. Ondego ,
Florence A. Ondiek , George O. Omondi, Gilbert C. Mutai, Hellen A. Olweyo , Imelda N. Imali , Imeldah  N. Wakhungu , Janet A. Okeyo , Irene Okumu, Joan A. Ongere , Job A.
Ouma , Kevin O. Onyango, Linet A. Okode , Lizzie N. Kabete, Lyna  A. Memo, Maqline  A. Achola , Meldah  O. Adipo , Mildred A. Owenga , Millicent A. Oronje , Moses O. Siaji,
Nobert B. Walusala , Nollyne  A. Okuku , Penina N. Amboka , Rebecca A. Otieno, Reina Lenturkana , Robai  Mituyi , Simon M. Muthusi ,  Veronica O. Atogo , Dennis Kegode ,
Daisy Chepkoros , Ivy M. Mutuiri , Benard M. Muga, Caren A. Wemali , Enericah  K. Kanampiu , Geoffrey Kebaso , Mildred Imbayi , Teresia O. Akinyi , Rebecca A. Otieno,
Esther A. Odeny , Elijah Mbuya, Stephen O. Abiero , Roseline Sikolia , David N. Marwa, Peter O. Mboya, Elizabeth L. Musi, Beryl A. Osoga , Vincent R. Ochuka , Vincent O.
Odera, Lydiah  A. Okumu, Pius O. Atonga , Nollyne  A. Okuku , Vincent K. Salano , Adero  J. Cate, Nicholas Walukana , Timothy Kwena , Celestine Lihavi , Maureen A. Ochieng,
Robai  M. Mituyi , Perez A. Odhiambo, Oyamo  O. Christopher, Katherin L. Amukonyi , Patricia Matti, Bill Nyongesa , Belder  A. Odedo , Jane A. Odaro , Mathias M. Wakwabi ,
Collins Ochola , Collins I. Mulonga , Nita C. Akech, Synthia Oguna , Grace A. Obinge , Fredrick Ochieng); KEMRI Nairobi (Betty Njoroge, Alice Njoki, Edna Nyandiga ,  Esther
K. Charles, Esther Neema, Faith Ambiyo , John Okumu, Hellen W. Kimani, Paul Mutunga, Syovata  Kimanthi , Umi W. Mugo, Vincent Juma, Umi Mugo, Celina Muthii , Ian
Ng’ang’a , Vallery Obure , Vincent Omondi, Ephraim Njoroge, Florence Thuo );KEMRI Thika (Nelly Mugo, Agata Thumi , Anne Gaitho , Caren Koli, Catherine Kiptinness ,
Charlene Biwott, David Chege, Dorcas Kiboi , Edwin Mugo, Emily Anyango , Erick Koome , Faith Munyaka , Francis Khaemba , Fridah  Nkatha , Gladys Namboka , Grace
Ndung’u , Irene Kamau, Irene Njeru, Innes Wambui, Jacinta Nyokabi , Jane Gacheru ,  Jemimah Nyakio , John Njoroge, Josephine Njeri, Linda Orwa ,  Linet Makena, Lynda
Oluoch , Margaret Mwangi, Mary Kibatha , Mathew Irungu, Matilda Saina, Nina Ouko, Peter Mwenda, Peter Nzuve , Rispa  Nduuru , Rose Odera, Sammy Ng’ang’a , Sarah
Mbaire , Sarah Njoroge, Scholastica Wanjiku, Solomon Maina, Stanley Mwangi,  Stephen Gakuo , Veronica Muchoki , Victoria Wambui, Victor Munene,  Vincent Juma,
Virginia Wangechi , Zachary Gathu , Jelioth  Muthoni, Sabina Ndichu , Faith Rolex); University of Washington, Mombasa (R. Scott McClelland, Emmanuel Kabare , Fatma H.
Mwidadi , Juma Shafi, Khamis Mwinyikai , Rukiya  Hassan, Salwa Mustafa); University of Washington, Seattle (Connie Celum , Elena A. Rechkina , Jared M. Baeten, Rachel
Johnson, Rachel L. Winer, Stephen L. Cherne , Susan Morrison, Torin Schaafsma );DF/Net Research, Inc., Seattle (Angela Williams, Amra Hercinovic , Gavin Robertson,
Krissa  Gunderson, Lisa Ondrejcek ,). The study is dedicated to Kowselia  Ramaswami ( Malitha ) Ramiah , Sarah Kanyi  Mugo, Reginalda  Auma  Onono , Edwina Muga,
Mary Nduta , and all our mothers.

Thank you

Summary: A randomized trial of single -dose HPV vaccination efficacy  among young women: Month 54 durability results Ruanne V. Barnabas, MBChB, DPhil Chief, Division of Infectious Diseases, Massachusetts General Hospital Department of Medicine, Harvard Medical School HPV vaccination for all and catch -up vaccination to young adulthood  accelerate the timeline to cervical cancer elimination. Simms, K. T., Steinberg, J., …, & Canfell , K. (2019). Impact of scaled up human papillomavirus vaccination: A…