Updated COVID-19 vaccine recommendations

Among other updates, the Centers for Disease Control and Prevention (CDC) issued interim recommendations for a shortened interval to the booster vaccination, or fourth dose, of the Moderna or Pfizer vaccines for people who are immunocompromised.

The recommendations for Moderna and Pfizer COVID-19 vaccines have been updated to include a booster vaccination, or fourth dose, for moderately-to-severely immunocompromised people at a minimum of three months after completing a messenger RNA vaccination series. This interval has been shortened from the previously recommended five months.

Another key change is a new recommendation for those who initially received the Johnson & Johnson (J&J) vaccine. An additional dose is recommended at least 28 days after the first dose, and now a booster vaccination, or third dose, is recommended at least two months after the second or additional dose. The Moderna or Pfizer vaccine must be used for additional and booster doses ― not the J&J vaccine.

People no longer need to delay vaccination for 90 days after receiving monoclonal antibodies or convalescent plasma, according to the new recommendations.

The terms "immunosuppressed" or "immunocompromised" refer to those who have medical conditions that compromise the immune system, such as advanced or untreated HIV, or patients who require treatment with medications that suppress the immune systems, such as chemotherapy. Immunosuppression lowers the effectiveness of COVID-19 vaccines. View the Centers for Disease Control and Prevention's list of conditions.

Patients eligible for additional COVID-19 vaccine doses at Mayo Clinic locations have been identified and will be contacted through Patient Online Services or by mail, and invited to schedule an appointment.

Learn more in this Q&A.

Who can get a COVID-19 booster vaccination or a fourth dose?

A booster vaccination, or fourth dose, of the Pfizer COVID-19 vaccine is recommended for people 12 and older who are moderately to severely immunocompromised. For Moderna, the recommendation is for people 18 and older. People might be immunocompromised if they have advanced or untreated HIV or have had a solid organ transplant, or are undergoing chemotherapy to treat cancer.

Is the booster vaccination one or two shots?

A COVID-19 booster vaccination is a single shot.

If I qualify, do I have to wait a certain amount of time after completing my COVID-19 vaccination to receive a booster vaccination?

The CDC recommends at least three months following the three-dose regimen of the Moderna or Pfizer vaccines if you are immunocompromised and waiting at least five months after the initial two-dose primary series for others. For those who received the J&J vaccine, a booster may be administered when it has been at least two months from the last dose of a COVID-19 vaccine.

Why is Mayo Clinic administering a booster vaccination, or fourth dose, of a COVID-19 vaccine after the World Health Organization asked for a pause on booster vaccinations?

Mayo Clinic supports the Advisory Committee on Immunization Practices and the CDC's recommendation to administer COVID-19 booster vaccines for moderately to severely immunocompromised patients.

Does the booster vaccination, or fourth dose, of a COVID-19 vaccine need to be from the same company as my original COVID-19 vaccination?

It is preferred that the booster vaccination be the same brand as that used for the primary series. However, you can substitute Moderna if Pfizer is not available or vice versa.

If I am immunocompromised and received the J&J COVID-19 vaccine, Can I get an additional dose of the Moderna or Pfizer COVID-19 vaccines?

Yes, for those who received the J&J COVID-19 vaccine, an additional dose is recommended at least 28 days after the first dose, and a booster vaccination, or third, dose, is recommended at least two months after the second or additional dose. Additional and booster doses must be either the Moderna or Pfizer vaccine and not the J&J vaccine.

I am immunocompromised and haven't yet been vaccinated for COVID-19, what should I do?

If you haven't been vaccinated for COVID-19 yet, you're encouraged to begin a vaccination series as soon as possible.

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date.