Updated August 19, 2021.
The FDA and CDC are now recommending a third dose of mRNA COVID-19 vaccines (Pfizer or Moderna) for moderately to severely immunocompromised individuals, as the highly contagious delta variant continues to spread. As public health officials prepare to offer third doses to the general public starting this fall, we’re committed to keeping members informed each step of the way. Here’s everything we know so far:
Who is considered “moderately to severely immunocompromised” and why do they need a third vaccine?
People with moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments include but are not limited to:
- Active treatment for cancer
- Organ, CAR-T-cell, or stem cell transplant
- Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection
- Active treatment with medications that can suppress the immune system (i.e. high-dose steroids, alkylating agents, antimetabolites, transplant-related drugs, chemotherapy, tumor-necrosis (TNF) blockers, and other biologic agents)
According to the FDA and CDC, these immunocompromised individuals have a reduced ability to fight infections, which makes them more vulnerable to infections, severe or prolonged disease, and hospitalizations, as well as more likely to transmit COVID-19 to household contacts. Studies have shown that those who are immunocompromised may not be adequately protected against COVID-19 with the standard two-dose series and are experiencing breakthrough infections at higher rates. Early data, for instance, has found that 40 to 44% of hospitalized breakthrough cases in the U.S. and Israel have been among immunocompromised individuals. Receiving a third dose of the mRNA vaccines may help boost immunity protection against COVID-19 among this high-risk population, as well as help reduce the spread of the virus.
I am immunocompromised. How long after my second dose can I receive the third?
For those who are moderately to severely immunocompromised who have received two doses of an mRNA vaccine (i.e. Pfizer or Moderna), the FDA and CDC recommend a third dose of the same vaccine 28 days or more after the second. If the same vaccine is not available, an alternate mRNA vaccine may be administered, though more research is needed to understand whether receiving a third dose of a different brand is safe and effective.
I got the Johnson & Johnson vaccine. Do I need an additional shot?
If you received a J&J vaccine, no additional vaccination — a second J&J dose or an additional mRNA vaccine — is being recommended at this time. Early data has found the J&J vaccine to be highly effective against all COVID-19 variants and nearly 100% effective at preventing hospitalization and death. While we’re aware of a few cities that are allowing J&J recipients to receive an mRNA vaccine, it is not specifically recommended by public health officials at this time. Clinical trials are underway to determine the safety, effectiveness, and need for additional vaccination after receiving J&J.
What about those who aren’t immunocompromised?
The FDA and CDC are not recommending booster shots for fully vaccinated individuals who aren’t immunocompromised at this time. However, the White House is prepared to offer booster mRNA vaccines to eligible adults aged 18 years and older 8 months or more after their second dose. This recommendation is still pending FDA and CDC approval, but likely will go into effect mid to late September. The goal of this vaccine campaign is to take proactive steps to enhance protection of the COVID-19 vaccine before immunity wanes. What is reassuring is that studies have proven that people who have been fully vaccinated with two doses of an mRNA vaccine or one dose of the J&J vaccine are still protected from severe illness and death, including from emerging strains like the delta variant, despite waning immunity.
How can I get a shot if I’m immunocompromised?
We are working with local health departments to offer additional vaccines to our members as soon as possible. In the meantime, we invite you to visit your local Department of Health’s website to find a third dose COVID-19 vaccine site in your area. Please keep checking these sites as new appointments are added regularly.
It is important that those who are immunocompromised continue to wear a mask and maintain social distancing precautions to help prevent COVID-19 infection. If you are exposed to or test positive for COVID-19, we recommend scheduling a visit with a provider for close monitoring and to discuss your treatment options which may include monoclonal antibody therapy.
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Atlanta, Boston, Chicago, Los Angeles, New York, Orange County,Phoenix, Portland, San Diego, the San Francisco Bay Area, Seattle, and Washington, DC.
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