The National Comprehensive Cancer Network (NCCN) has updated its recommendations on COVID-19 vaccination and pre-exposure prophylaxis.1 

Among the updates are new recommendations for the recently authorized bivalent COVID-19 vaccines and advice for vaccinating immunocompromised children. The recommendations come from an NCCN advisory committee.

The recommendations state that immunosuppressed patients who have previously received a 3-dose primary vaccination series and booster doses according to prior recommendations are now eligible to receive 1 booster dose of a bivalent vaccine. This applies to patients 12 years of age or older for the Pfizer vaccine or at least 18 years of age for the Moderna vaccine. 

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The NCCN advisory committee said it supports the recent authorization of these bivalent vaccines but cautioned that we are still awaiting data on the effectiveness of these boosters in immunocompromised patients.

The advisory committee does not recommend routine use of the Novavax vaccine in cancer patients, due to limited data on efficacy. However, the committee said, Novavax can be considered for patients who are unwilling or unable to be vaccinated with mRNA vaccines.

The committee also said the Moderna vaccine is the preferred mRNA vaccine for pediatric immunosuppressed patients aged 6 months to 17 years.

“Protecting kids from harm is one of the most important things we can do,” committee co-leader Tina Q. Tan, MD, of Northwestern Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, said in a statement.2 

“That’s why we recommend vaccination against COVID-19 for anyone over 6 months of age, especially infants, children, and adolescents who are immunocompromised. It is especially important for eligible household members and caregivers to make sure they are vaccinated as well, since immunocompromised children under age 12 or weighing less than 40 kg are unable to receive monoclonal antibodies for protection.”

The full text of the updated NCCN recommendations is available for download from the NCCN COVID-19 Resources webpage. The guidance includes details about mix-and-match dosing, revaccination after cellular therapies, and more. 


1. Recommendations of the National Comprehensive Cancer Network (NCCN) Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis, version 7.0. National Comprehensive Cancer Network. Updated September 22, 2022. Accessed September 26, 2022. 

2. NCCN updates recommendations for COVID-19 vaccination with information on bivalent vaccines, children with cancer, and other developments. NCCN News Release. Published September 22, 2022. Accessed September 26, 2022.