How to Talk with Patients Who Are Immunocompromised

Discussing an Additional Dose of an mRNA COVID-19 Vaccine

Doctor talking with immunocomprimsed patient about an additional dose of the COVID-19 vaccine

As a healthcare provider, your answers to patient questions matter. Your strong recommendation can help patients who are immunocompromised make an informed decision and feel confident about getting an additional dose of an mRNA COVID-19 vaccine.

Effective August 13, 2021, CDC recommends that people who are moderately to severely immunocompromised receive an additional dose of an mRNA COVID-19 Vaccine (Pfizer-BioNTech or Moderna) at least 28 days after the completion of the initial mRNA COVID-19 vaccine series.

Available data show that these people don’t always build adequate levels of protection after an initial 2-dose primary mRNA COVID-19 vaccine series. The data also show that they may benefit from receiving an additional dose of an mRNA vaccine to develop as much protection as possible against COVID-19.

Who is Moderately to Severely Immunocompromised?

Currently, CDC is recommending that moderately to severely immunocompromised people receive an additional dose. This includes people who have:

  • Active treatment for solid tumor and hematologic malignancies
  • Receipt of solid-organ transplant and taking immunosuppressive therapy
  • Receipt of CAR-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.

If Your Patient Has Questions…

If your patient has questions about receiving an additional dose of an mRNA COVID-19 vaccine:

Discuss the patient’s specific situation.

  • Factor in their medical conditions and level of immune suppression; level of COVID-19 community transmission and personal risk of infection; and current or planned immunosuppressive therapies affecting the patient’s medical condition and potential response to vaccine.

Explain the difference.

  • An additional mRNA dose following an initial vaccine series is given to people who may not have had a strong enough immune response after receiving the initial vaccine series. A booster dose is a supplemental dose given to groups whose immune response has weakened over time. No booster doses are recommended at this time. This may change as more information becomes available.

Use the same vaccine product, when feasible.

  • People who need an additional dose and received either a Pfizer-BioNTech or Moderna vaccine series should receive a third dose of the same vaccine used.

Explain what Janssen vaccine recipients should know.

  • What we don’t know at this time is whether people who are immunocompromised who received the Janssen vaccine (Johnson & Johnson) have an improved immune response following an additional dose of the same vaccine.

How to Strongly Encourage Your Patients to Get an Additional Dose

When making a strong recommendation, focus on personal risk and safety of the vaccines:

Explain the risk and benefit.

  • People who are immunocompromised are more likely to transmit the virus that causes COVID-19 to household contacts. Also, small studies suggest that fully vaccinated immunocompromised people accounted for a large proportion (40–44%) of hospitalized breakthrough cases. Lastly, the Delta variant is surging, and the number of people with COVID-19 is increasing in the United States. Share you want the patient to develop as much protection as possible against COVID-19.

Consider and discuss.

  • The patient’s medical condition, risk of infection, and any planned immunosuppressive therapies.

Reaffirm.

  • So far, reactions reported after the third mRNA dose were similar to what people experienced after receiving 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. CDC and FDA will continue to monitor the safety of all COVID-19 vaccines.

If your patients have questions, please guide them to: COVID-19 Vaccines for Moderately to Severely Immunocompromised People

Page last reviewed: August 23, 2021