Updated August 2025

ACIP/CDC 2025–2026

Immunization Schedule Updates and Contraindications: Rapid Clinical Brief

ACIP addenda (Aug 2025) highlight annual influenza recommendations, MenB shared decision-making for ages 16–23, updated RSV infant prophylaxis with clesrovimab when not protected by maternal vaccination, and clarified schedule-by-indication tables for children and adults. Contraindication guidance remains grounded in CDC General Best Practices with vaccine-specific nuances (e.g., live vaccines in pregnancy/immunocompromise; anaphylaxis to components).

Clinical question

What are the most recent ACIP/CDC updates to U.S. immunization schedules and the key vaccine contraindications that clinicians must apply at the point of care for children, adolescents, and adults?

ACIPCDCImmunization ScheduleContraindicationsInfluenzaRSVCOVID-19MenBAdult VaccinationPediatrics

Key points

Addendum Mechanism for Mid-cycle Changes

ACIP now posts time-sensitive updates in addenda to child/adult schedules; clinicians should check addenda for changes between annual cycles ^[11], ^[12], ^[13].

Influenza 2025–2026 Season

Routine annual influenza vaccination for all persons ≥6 months without contraindications; ACIP specifies use of single-dose, thimerosal-free formulations for children ≤18, pregnant persons, and all adults ^[1].

RSV Prevention in Infants

Infants <8 months born during or entering first RSV season who are not protected by maternal vaccination should receive one dose of clesrovimab monoclonal antibody ^[1].

Schedule by Indication Clarified

Updated tables detail vaccines for specific medical conditions and indications for children/adolescents and adults, including categories for routine, risk-based, shared decision-making, and additional dosing needs ^[3], ^[4], ^[9].

Contraindications: Core Tenets

Severe allergic reaction to a vaccine component or prior dose is a universal contraindication; live vaccines are contraindicated in pregnancy and severe immunodeficiency; apply product-specific nuances (e.g., recent blood products for MMR) ^[7], ^[10].

Evidence highlights

Annual vaccine for ≥6 months without contraindications; single-dose, thimerosal-free for kids ≤18, pregnancy, all adults ^[1]

Flu 2025–2026

Clesrovimab 1 dose for <8 months entering first season if not protected by maternal vaccine ^[1]

RSV Infant

Ages 16–23: vaccinate when shared decision-making favors it ^[1]

MenB SCDM

What Changed

Current ACIP Updates Most Likely to Affect Clinic Decisions

Prioritize these schedule and product updates when counseling, ordering, and screening.

Annual Influenza 2025–2026

Vaccinate all persons ≥6 months who lack contraindications. Use only single-dose, thimerosal-free formulations for children ≤18, pregnant persons, and all adults. Emphasize vaccination before peak circulation, with prompt catch-up for late presenters ^[1].

RSV Infant Prophylaxis

Administer one dose of clesrovimab to infants <8 months born during or entering their first RSV season if not protected by maternal RSV vaccination. Integrate with maternal vaccination history review at birth/early infancy ^[1].

MenB Shared Clinical Decision-Making

For healthy persons aged 16–23, offer MenB when shared decision-making favors vaccination (e.g., higher exposure risk, personal values). Document SCDM rationale and chosen product/series ^[1].

Schedule-by-Indication Tables

Use updated tables to match vaccines to conditions (e.g., asplenia, immunocompromise, pregnancy, diabetes, chronic liver/kidney disease). Apply categories: routine, risk-based, SCDM, and additional doses as indicated ^[3], ^[4], ^[9].

COVID-19 and Other Mid-cycle Changes

Consult the addendum and vaccine-specific ACIP updates for COVID-19, influenza, pneumococcal, RSV, mpox, polio, and combination meningococcal products, as recommendations may shift between annual refreshes ^[5], ^[6], ^[11], ^[12], ^[13].

Screen Before You Vaccinate

Contraindications and Precautions: High-Yield Checklist

Apply universal screening at each visit to maximize safety and avoid missed opportunities.

Universal Contraindications

Severe allergic reaction (e.g., anaphylaxis) after a prior dose or to a vaccine component: contraindication to that vaccine ^[7], ^[10].

Known severe immunodeficiency: contraindication for live vaccines (e.g., MMR, varicella) ^[10].

Pregnancy: contraindication for live vaccines (e.g., MMR, varicella, live attenuated influenza) ^[10].

Common Precautions

Moderate or severe acute illness with or without fever (deferral may be warranted) ^[10].

Recent receipt of antibody-containing blood products (timing affects live vaccines, e.g., MMR; interval depends on product) ^[10].

History of thrombocytopenia or thrombocytopenic purpura (MMR precaution) ^[10].

Tuberculin skin test/IGRA timing considerations around MMR to avoid false-negative results ^[10].

Live Vaccines: Special Situations

Avoid in pregnancy and severe immunodeficiency; consider postpartum catch-up for MMR/varicella ^[10].

Household contacts of immunocompromised persons generally can receive most live vaccines; follow product-specific guidance ^[7].

Spacing between live parenteral/intranasal vaccines if not co-administered, per best-practice intervals ^[7].

Product-Specific Notes

Influenza: prefer single-dose, thimerosal-free products for children ≤18, pregnancy, and all adults; live attenuated influenza remains contraindicated in pregnancy and some high-risk conditions ^[1].

COVID-19: true contraindications are rare; alternative platform may be acceptable if contraindication is product-specific (e.g., component allergy) ^[14].

MMR: pregnancy and severe immunodeficiency are contraindications; heed blood product intervals and thrombocytopenia history ^[10].

Operational Pearls

Check ACIP addendum at each immunization session for mid-year updates ^[11], ^[12], ^[13].

Use schedule-by-indication tables during EHR order entry to reduce errors and missed doses ^[3], ^[4], ^[9].

Document shared clinical decision-making for MenB and adult vaccines designated as SCDM ^[1], ^[4].

References

Source material

Primary literature that informs this article.