COVID-19 FAQS: Juvenile Arthritis

By Linda Rath | Feb. 16, 2026

Question: What are the new vaccination guidelines for children with juvenile arthritis (JA)?

Answer: Thinking about COVID-19 vaccination has changed since the height of the pandemic. Instead of a complicated series of vaccines and boosters, the Centers for Disease Control and Prevention (CDC) now says the COVID-19 vaccine will be updated once a year. Like the flu shot, the updated versions will rely on scientists’ best guesses because they are developed before new variants start circulating in the fall. 

The updated 2025-2026 vaccine has been changed from earlier versions to better target the JN.1 lineage, which is part of the Omicron family. The vaccine is not considered a “booster” because it helps the immune system build resistance to newer strains.

The COVID vaccine offers the most protection in the first four weeks after you get it. Protection drops sharply after that, offering just 16% protection after five months. Protection against hospitalization and death lasts longer – about 34% at five months.

Another big change: Instead of recommending vaccines for almost everyone ages 6 months to 64, the CDC now says healthy people should first discuss the need for the vaccine with a health care provider.

The recommendations are different for children who are moderately to severely immunocompromised, including those with JA who take drugs that suppress the immune system. They are also different for kids who were never vaccinated or didn’t finish a full course of earlier vaccines. Here are the recommendations for those children by age and vaccination status:

Ages 6 months to four years

Moderna’s Spikevax is the only vaccine approved for this age group.

For unvaccinated kids:

• Four doses of the updated Moderna vaccine. The initial three doses should be spaced at least four weeks apart, with the fourth dose six months after the third. 

For kids who started but didn’t finish their COVID shots before the 2025-2026 vaccines: 

• If they received one dose of the Moderna vaccine, three doses of the 2025-2026 vaccine, allowing at least four weeks between doses one and two and 6 months before dose three.
• If they received two doses of Moderna, two doses of the 2025-2026 vaccine, with at least 6 months between dose one and dose two.
• If they received one dose of the Pfizer-BioNTech vaccine, three doses of the 2025-2026 Moderna vaccine, allowing at least four weeks between doses one and two and six months before the third dose. 
• If they received two doses of the Pfizer-BioNTech vaccine, two doses of the 2025-2026 Moderna vaccine, with six months between the first and second dose.

Ages 5 to 11 years

Both Moderna’s Spikevax vaccine and the Pfizer-BioNTech vaccine are approved for this age group.

For unvaccinated kids:

• An initial three-dose series of the Moderna or Pfizer-BioNTech vaccine followed by a fourth dose six months later.

For kids who started but didn’t complete their shots before the 2025-2026 vaccines:

• If they received one dose of the Moderna or Pfizer-BioNTech vaccine, three doses of the 2025-2026 vaccine. The first two doses should be the same manufacturer (either Moderna or Pfizer-BioNTech).
• If they received two doses of the Moderna or Pfizer-BioNTech vaccine, two doses of the 2025-2026 vaccine, with the first dose by the same manufacturer.

Ages 12 years and up

Moderna’s mNEXSPIKE and Spikevax vaccines, Pfizer’s Comirnaty and Novavax (non-mRNA vaccine) are approved for this age group. Moderna vaccines can often be used interchangeably.

For unvaccinated kids:

• Three initial doses of the updated Moderna vaccine, spaced at least four weeks apart, followed by a fourth dose from any manufacturer six months later.  
• Or two initial doses of Novavax, followed six months later by a third dose from any manufacturer.
• Or four doses of Pfizer-BioNTech, spaced three weeks apart, with the fourth dose from any manufacturer six months later.

For kids who started but didn’t complete the series before the 2025-2026 vaccines:

• If they received one dose of the Moderna vaccine, two doses of either Moderna vaccine, at least four weeks apart, followed 6 months later by a vaccine from any manufacturer.
• If they received two doses of the Moderna vaccine, one dose of the Moderna vaccine, followed 6 months later by a vaccine from any manufacturer. 
• If they received one dose of the Pfizer-BioNTech vaccine, two doses of the Pfizer-BioNTech vaccine, followed 6 months later by a vaccine from any manufacturer.
• If they received two doses of the Pfizer-BioNTech vaccine, one dose of the Pfizer-BioNTech vaccine, followed 6 months later by a vaccine from any manufacturer.
• If they received one dose of Novavax, a second dose of the Novavax vaccine, followed 6 months later by a vaccine from any manufacturer. 

Immunocompromised people often don’t have a strong response to vaccines, so JA patients have the option of getting an extra shot.

If the COVID vaccine doesn’t work for your child, you and your pediatrician may want to consider an investigational drug called pemivibart (Pemgarda). It’s sometimes used in people ages 12 and up to help prevent coronavirus infection. It is not FDA-approved because there is little data about its safety and effectiveness, but it was granted emergency use authorization (EUA) during the pandemic. 

Pemgarda is given once by infusion and can cause a potentially life-threatening allergic reaction. It’s also not effective against 90% of COVID variants, so you and your child’s pediatrician should carefully weigh the pros and cons of the drug.

Your child’s doctor may also recommend changing the timing of certain medications. Adult studies have shown that taking a one- or two-week break from methotrexate, for example, can make the vaccine more effective without significantly increasing the risk of flares. You and your child’s doctor should work together to decide the best course.

Note: The CDC’s guidance requiring shared clinical decision making for the COVID vaccine shouldn’t prevent you or your child from getting it. You don’t have to prove that you have a weakened immune system or take immune-suppressing medications. You also shouldn’t have to pay for the vaccine if you are on Medicare, Medicaid or private or marketplace insurance, at least through the end of 2026.

The shots are also free through the Vaccines for Children program, which pays for about half of childhood vaccines each year in the U.S.

Question: Will the updated COVID-19 vaccine keep my child from getting sick?

Answer: The updated vaccine won’t prevent all cases of COVID-19 and really isn’t intended to. Its aim is to help protect against severe infection, hospitalization and death, especially during the winter months, when infections spike. The vaccine’s effectiveness diminishes over time, so the CDC recommends getting the vaccine in late October, which should offer the best protection from November through January or February, similar to the flu shot. It’s unclear whether the vaccine offers protection against long COVID. According to a  study using data from more than 5 million health records from the Department of Veterans Affairs (VA), long COVID numbers declined throughout the pandemic as the virus mutated. The decline was considerably steeper in vaccinated people, but other factors also played a role. It’s not known if these findings apply to children. 

Question: Is the vaccine safe and effective for children?

Answer: Most studies, including one that looked specifically at JA patients, found that the vaccine doesn’t make treatment less effective or make disease symptoms worse for most kids. One very small study found the vaccine triggered flares in three of eight children. On the other hand, it is well known that many different viral infections can lead to inflammatory arthritis and the development of autoantibodies. 

The COVID-19 vaccine can cause side effects, including: 

• Inflammation of the heart muscle (myocarditis). This rare side effect mainly affects teenage boys. Symptoms include chest pain, shortness of breath and a fast heartbeat. According to Yale researchers, vaccine-related myocarditis seems to occur when the immune system responds to the vaccine too aggressively, creating inflammation. Why vaccine-related inflammation affects the heart and not other organs isn’t clear. This type of myocarditis is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and prednisone to bring down the inflammation, and most patients recover fairly quickly. There’s no evidence that children who have JA are more prone to vaccine-related heart problems. Although myocarditis is more likely to result from COVID-19 infection than from the vaccine, the CDC is investigating how many vaccine-related cases occur and the long-term effects.   
• Local and systemic side effects. These include pain and swelling at the injection site and flu-like symptoms such as muscle aches, chills, fever and nausea. Similar symptoms were common with earlier vaccines, and experts don’t expect more or different side effects with the updated version. 

Question: Are children with JA more likely to get COVID-19 or have severe disease?

Answer: It’s unclear. Studies suggest that adults with rheumatic diseases are at higher risk of poor outcomes from COVID-19, but there’s less data on children.

Some studies of COVID-19 infection in immunocompromised children — most done in the early days of the pandemic — reported that kids with autoimmune and inflammatory diseases didn’t fare worse than their healthy peers. Those studies found that co-existing health conditions, including obesity and medications like corticosteroids and rituximab (Rituxan), were mainly responsible for severe infections and poor outcomes in JA patients.

A 2022 study of 607 JA patients using data from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) and other pediatric registries didn’t find an increased risk of severe outcomes or hospitalizations, either.

But a 2025 systematic review and meta-analysis of 18 cohort studies involving 1,500 children found the opposite. Although a diagnosis of juvenile arthritis wasn’t associated with a greater chance of hospitalization and worse outcomes, having systemic JA was. Researchers attributed much of the increased risk to arthritis medications, especially corticosteroids and rituximab, although tumor necrosis factor (TNF) blockers seemed to reduce the risk. 

This meta-analysis isn’t the last word, however, since it has several limitations. The data on medications is limited and of low quality, and the researchers fail to account for known risk factors for severe outcomes, including obesity, diabetes and other co-existing illnesses. They also don’t discuss how different study designs can lead to different conclusions.

One thing seems certain, though. Obesity and other chronic diseases can increase the risk for poor COVID outcomes in kids, especially those who have JA.

Question: If my child gets COVID-19, how would it be treated?

Answer: There is no published clinical trial data on COVID-19 treatment for children, but several trials are in the final stages. The largest and most important is an international study looking at the safety and effectiveness of the antiviral drug Paxlovid in children under age 17. The Food and Drug Administration (FDA) has granted emergency use authorization to Paxlovid for non-hospitalized children ages 12 to 17 who are at high risk of severe illness. It is not approved for children under 12. To be effective, your child must start the drug within five days after they first have symptoms. Paxlovid can cause life-threatening interactions with many other drugs, so be sure your child’s doctor knows all the medications your child takes.

Other drugs are under study in clinical trials, including the antiviral remdesivir, which is given by IV infusion. The FDA approved its use in infants and children during the pandemic, based in part on studies that found it safe and effective for adults. Trials in children are ongoing.

Hear firsthand accounts of how juvenile arthritis affects lives. Warning: inspiration ahead!