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.

COVID-19 Vaccines for Moderately to Severely Immunocompromised People

COVID-19 Vaccines for Moderately to Severely Immunocompromised People

NOTICE: CDC continues to recommend the use of the newly FDA-approved Pfizer-BioNTech (COMIRNATY) COVID-19 Vaccine for people 16 years and older, as one of the recommended vaccines to protect against COVID-19. CDC continues to recommend the vaccine under an emergency use authorization (EUA) for adolescents 12 through 15 years old, as well as an additional mRNA dose for moderately to severely immunocompromised people.  

What You Need to Know

  • People with moderately to severely compromised immune systems are especially vulnerable to COVID-19, and may not build the same level of immunity to 2-dose vaccine series compared to people who are not immunocompromised.
  • This additional dose intended to improve immunocompromised people’s response to their initial vaccine series.
  • Although CDC does not recommend additional doses or booster shots for any other population at this time, HHS has announced a plan to begin offering COVID-19 vaccine booster shots this fall.
  • CDC recommends that people with moderately to severely compromised immune systems receive an additional dose of mRNA COVID-19 vaccine at least 28 days after a second dose of Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine.

Data on Decreased Immune Response Among Immunocompromised People

People who are moderately to severely immunocompromised make up about 3% of the adult population and are especially vulnerable to COVID-19 because they are more at risk of serious, prolonged illness.

Studies indicate some immunocompromised people don’t always build the same level of immunity after vaccination the way non-immunocompromised people do, and may benefit from an additional dose to ensure adequate protection against COVID-19. In small studies pdf icon[2 MB, 36 Pages], fully vaccinated immunocompromised people have accounted for a large proportion of hospitalized “breakthrough cases,” and that suggests immunocompromised people are more likely to transmit the virus to household contacts.

Who Needs an Additional COVID-19 Vaccine?

Currently, CDC is recommending that moderately to severely immunocompromised people receive an additional dose. 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 dose is appropriate for them.

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

Vaccine Card and Any Additional Dose

At your first vaccination appointment, you should have received a vaccination card that tells you what COVID-19 vaccine you received, the date you received it, and where you received it. Bring this vaccination card to your additional dose vaccination appointment.

  • If you did not receive a COVID-19 vaccination card at your first appointment, contact the vaccination provider site where you got your first shot or your state health department to find out how you can get a card.
    • If you have lost your vaccination card or don’t have a copy, contact your vaccination provider directly to access your vaccination record.
    • If you cannot contact your vaccination provider directly, contact your state health department’s immunization information system (IIS). You can find state IIS information on the CDC website. Vaccination providers are required to report COVID-19 vaccinations to their IIS and related systems.
    • If you enrolled in v-safe or VaxText after your first vaccine dose, you can access your vaccination information using those tools.
    • If you have made every effort to locate your vaccination information, are unable to get a copy or replacement of your vaccination card, and still need an additional dose, talk to a vaccination provider.
  • Bring your vaccination card with you to your additional dose appointment so your provider can fill in the information about your additional dose.
  • Keep your vaccination card in case you need it for future use. Consider taking a picture of your vaccination card after your second shot appointment as a backup copy.

CDC does not maintain vaccination records or determine how vaccination records are used, and CDC does not provide the CDC-labeled white COVID-19 vaccination record card to people. These cards are distributed to vaccination providers by state health departments.

Please contact your state health department if you have additional questions about vaccination records. Your local or state health department can also provide more information about the laws or regulations in your area.

Frequently Asked Questions

How long after getting my initial COVID-19 vaccines can I get an additional dose?

CDC recommends the additional dose of an mRNA COVID-19 vaccine be administered at least four weeks after a second dose of Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine.

Can you mix and match the vaccines?

For people who received either Pfizer-BioNTech or Moderna’s COVID-19 vaccine series, a third dose of the same mRNA vaccine should be used. A person should not receive more than three mRNA vaccine doses. 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 the J&J/Janssen vaccine do?

The FDA’s recent EUA 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 the Johnson & Johnson’s Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.

What are the benefits of people receiving an additional vaccine dose?

An additional dose may prevent serious and possibly life-threatening COVID-19 in people who may not have responded to their initial vaccine series. In ongoing clinical trials, 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 response after an additional dose of the same vaccine.

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

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

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