Background: SARS-CoV-2 continued to circulate and cause pediatric morbidity in the United States during the 2024-2025 respiratory virus season. Significant pediatric hospitalizations occurred, including among previously healthy children. Antigenic drift and waning immunity from previous vaccines prompted the development and recommendation of updated 2024–2025 COVID-19 vaccines targeting JN.1/KP.2 lineage strains.Objective: This study analyzed the official recommendations, population uptake patterns, and the effectiveness and safety context surrounding the 2024–2025 COVID-19 vaccines among the U.S. pediatric population (aged 6 months to 17 years) from September 2024 through mid-April 2025.Method: A synthesis of publicly available data, primarily from the U.S. Centers for Disease Control and Prevention (CDC) and associated publications, was conducted to characterize the pediatric vaccination landscape during the specified period.Results: In June 2024, the CDC's Advisory Committee on Immunization Practices (ACIP) recommended universal 2024–2025 COVID-19 vaccination for all persons aged ≥6 months. Updated mRNA vaccines (Moderna, Pfizer-BioNTech) targeting KP.2 and a protein subunit vaccine (Novavax) targeting JN.1 were authorized or approved. Age-specific dosing schedules varied significantly. Children aged 6 months–4 years required a complex multi-dose initial series if unvaccinated, contingent on the manufacturer. Children aged 5–11 years and adolescents aged 12–17 years were recommended a simpler single dose of an age-appropriate vaccine, regardless of prior vaccination history. Distinct recommendations, including additional doses, were issued for moderately or severely immunocompromised children. Despite universal recommendations, uptake among U.S. children was markedly low, reaching only approximately 13.0% by mid-April 2025. This rate significantly lagged behind adult uptake (23.2%) and older adult uptake (44.7%). Reported parental intent to vaccinate remaining unvaccinated children was also low (6.5% as of April 5, 2025). Considerable geographic variation in pediatric coverage was observed across reporting jurisdictions.Interim vaccine effectiveness (VE) data (September 2024–January 2025) primarily focused on adults, showing moderate protection against COVID-19–associated emergency department/urgent care visits (VE 33%) and hospitalization (VE 40%–46%). However, pediatric-specific VE estimates for the 2024–2025 vaccine could not be reliably calculated during this period due to insufficient statistical power, likely stemming from low uptake. Prior evidence suggested mRNA vaccination was associated with reduced odds of Post-COVID Conditions (PCC) in children. No new safety concerns were identified with the 2024-2025 vaccines; the safety profile remained consistent with previous formulations, including ongoing monitoring for rare events like myocarditis. (graph)Conclusion: A substantial gap existed between the universal recommendation for pediatric 2024–2025 COVID-19 vaccination and the low uptake achieved in the U.S. This disparity highlights challenges related to perceived risk, vaccine fatigue, schedule complexity, and safety concerns. The absence of contemporary pediatric-specific VE data presented communication difficulties. Understanding and addressing these barriers remains critical for optimizing future pediatric COVID-19 vaccination strategies.
