Important update: Healthcare facilities
CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more
To maximize protection from the Delta variant and prevent possibly spreading it to others, get vaccinated as soon as you can and wear a mask indoors in public if you are in an area of substantial or high transmission.
UPDATE
Given new evidence on the B.1.617.2 (Delta) variant, CDC has updated the guidance for fully vaccinated people. CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place.
UPDATE
The White House announced that vaccines will be required for international travelers coming into the United States, with an effective date of November 8, 2021. For purposes of entry into the United States, vaccines accepted will include FDA approved or authorized and WHO Emergency Use Listing vaccines. More information is available here.
UPDATE
Travel requirements to enter the United States are changing, starting November 8, 2021. More information is available here.

COVID-19 Vaccines for Moderately to Severely Immunocompromised People

COVID-19 Vaccines for Moderately to Severely Immunocompromised People

What You Need to Know

  • People who are immunocompromised are especially vulnerable to COVID-19.
  • Immunocompromised people ages 5 years and older should receive a COVID-19 vaccine primary series as soon as possible.
  • Moderately to severely immunocompromised people ages 18 years and older who completed their Moderna vaccine primary series should plan to get an additional primary dose 28 days after receiving their second shot.
  • Moderately to severely immunocompromised people ages 12 years and older who completed their Pfizer-BioNTech vaccine primary series should plan to get an additional primary dose 28 days after receiving their second shot.
  • Moderately to severely immunocompromised people ages 18 years and older who received an mRNA COVID-19 vaccine primary series (Pfizer BioNTech or Moderna) and an additional primary dose are eligible to receive a booster shot.
  • Moderately to severely immunocompromised people ages 18 years and older who received Johnson & Johnson’s Janssen (J&J/Janssen) COVID-19 vaccine should not receive an additional primary dose. However, they should get a booster shot (you may choose the type of COVID-19 vaccine for your booster shot) at least 2 months after their single-dose J&J/Janssen primary shot.

Who Needs a COVID-19 Vaccine Primary Series?

Everyone ages 5 years and older should receive a COVID-19 vaccine primary series as soon as possible.

Who Needs an Additional Primary Dose of COVID-19 Vaccine?

Receiving an additional primary dose only applies to moderately to severely immunocompromised people who have received an mRNA COVD-19 vaccine primary series (Pfizer BioNTech or Moderna). Currently, moderately to severely immunocompromised people ages 18 years and older who completed their Moderna vaccine primary series should plan to get an additional primary dose 28 days after receiving their second shot. For people ages 12 years and older who completed their Pfizer-BioNTech vaccine primary series, they should also plan to get an additional primary dose 28 days after receiving their second shot. This includes people who have:

  • Been receiving active cancer treatment for tumors or cancers of the blood
  • Received an organ transplant and are taking medicine to suppress the immune system
  • Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response

People should talk to their healthcare provider about their medical condition, and whether getting an additional primary dose is appropriate for them.

Who Needs a Booster Shot?

Everyone ages 18 years and older who is fully vaccinated against COVID-19 is eligible for a booster shot.

Learn more about who is eligible for a COVID-19 booster shot.

Find a COVID-19 Vaccine

Find a COVID-19 vaccine: Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233 to find locations near you.

  • Check your local pharmacy’s website to see if vaccination walk-ins or appointments are available.
  • Contact your state or local health department for more information

Vaccination Card and an Additional Primary Dose

At your first vaccination appointment, you should have received a vaccination card that tells you which COVID-19 vaccine you received, the date you received it, and where you received it. Bring this to your additional primary dose vaccination appointment. Information about what to do if you cannot find your vaccination card is available.

After Getting Your Additional Primary Dose

You may experience side effects after getting a COVID-19 vaccine. These are normal signs that your body is building protection. Get helpful tips on how to reduce any pain or discomfort.

Use v-safe on your smartphone to tell CDC about any side effects after getting the COVID-19 vaccine. If you enter your additional dose in your v-safe account, the system will send you daily health check-ins. Please note that v-safe is not automatically notified when you receive another dose of vaccine, so you must enter the information yourself.

Frequently Asked Questions

How long after getting my mRNA COVID-19 vaccine primary series can I get an additional primary dose?

CDC recommends the additional primary dose of an mRNA COVID-19 vaccine be administered at least 28 days after a second dose of Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine for immunocompromised people ages 12 years and older.

Can you mix and match the vaccines for your additional primary dose?

No, the vaccine used for the additional primary dose should be same as the vaccine used for the primary vaccine series. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered.

What should immunocompromised people who received Johnson & Johnson’s Janssen (J&J/Janssen) vaccine do?

The FDA’s recent emergency use authorization amendment only applies to mRNA COVID-19 vaccines, as does CDC’s recommendation.

Emerging data have demonstrated that immunocompromised people who have low or no protection following two doses of mRNA COVID-19 vaccines may have an improved response after an additional dose of the same vaccine. There is not enough data at this time to determine whether immunocompromised people who received J&J/Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.

What are the benefits of an additional primary dose for people who are immunocompromised who received an mRNA COVID-19 primary vaccine series?

An additional primary dose may prevent serious and possibly life-threatening COVID-19 in people who may not have responded to their two-dose mRNA COVID-19 vaccine primary series. The mRNA COVID-19 vaccines (Pfizer-BioNTech or Moderna) have been shown to prevent COVID-19 following the two-dose series. Limited information suggests that immunocompromised people who have low or no protection after two doses of mRNA vaccines may have an improved immune (antibody) response after an additional primary dose of the same vaccine.

What are the risks of vaccinating individuals with an additional primary dose?

There is limited information about the risks of receiving an additional primary dose of mRNA COVID-19 vaccine. The safety, efficacy, and benefit of the additional primary dose in immunocompromised people continues to be evaluated. So far, reactions reported after the additional primary dose of mRNA COVID-19 vaccine are similar to that of the two-dose primary series: fatigue and pain at the injection site were the most commonly reported side effects, and overall, most symptoms were mild to moderate.

As with the two-dose primary series, serious side effects are rare, but may occur.

What is the difference between an additional  primary dose and a booster shot?

An additional primary dose is administered to people with moderately to severely compromised immune systems. The additional primary dose of an mRNA COVID-19 vaccine is intended to improve immunocompromised people’s response to their vaccine primary series. A booster shot is administered when a person has completed their vaccine primary series to enhance or restore protection against COVID-19 which may have decreased over time.

If I am immunocompromised, do I need an additional primary dose, a booster shot or both?

Additional Primary Dose

If you received a Pfizer-BioNTech (ages 12 and older) or Moderna (ages 18 and older) mRNA COVID-19 vaccine primary series and have a moderately to severely compromised immune system, you should receive an additional primary dose of the same mRNA COVID-19 vaccine at least 28 days after the second dose.

Currently, CDC does not recommend an additional primary dose if you received a single-dose J&J/Janssen COVID-19 vaccine.

Booster Shots

Immunocompromised people 18 years and older who received a J&J/Janssen COVID-19 vaccine primary dose should also receive a single COVID-19 vaccine booster shot at least 2 months after their primary dose.

Moderately to severely immunocompromised people ages 18 years and older who received an mRNA COVID-19 vaccine primary series, and an additional primary mRNA vaccine may get a booster shot 6 months after completing their vaccine primary series.

If you get a booster shot you have the option to either get the same COVID-19 vaccine product as your primary series, or you can get a different COVID-19 vaccine. You may have a preference for the vaccine type that you originally received, and you may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots (Pfizer-BioNTech, Moderna, or J&J/Janssen). You may consider the benefits and risks of each product and discuss with your healthcare provider which COVID-19 vaccine product is the most appropriate booster for you.