Additional Dose of COVID-19 mRNA Vaccines Now Recommended for Immunocompromised People Ages 12 and Older
An additional dose of COVID-19 mRNA vaccine is now recommended for individuals 12 and older with certain medical conditions or who are receiving certain medical treatments that compromise their immune system's functionality. Please review the Centers for Disease Control and Prevention's (CDC) clinical consideration carefully prior to vaccinating. The CDC has not published a Morbidity and Mortality Weekly Report (MMWR) on this topic at this time.
Additional doses are not yet recommended for non-immunocompromised people, or for those who received the Johnson & Johnson COVID-19 vaccine.
ACIP Meeting Review
CDC's expert advisory committee voted on August 13, 2021, to recommend an additional dose of mRNA COVID-19 vaccines (specifically those by Pfizer and Moderna) for individuals with certain medical conditions or who are receiving certain medical treatments that compromise their immune system’s functionality. The vote came just hours after the FDA expanded its emergency use authorization for the vaccines to allow for an additional dose for certain immunocompromised people at least 28 days after finishing the initial 2-dose series.
The recommendation does not currently include additional doses of the Johnson & Johnson (Janssen) vaccine or additional doses for non-immunocompromised people.
Immunocompromised Classifications
Those who qualify for the additional dose include people 12 years of age and older with medical conditions, including:
- 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 two years of transplantation or taking immunosuppression therapy)
- Moderate or severe primary immunodeficiency (DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection
- Active treatment with high-dose corticosteroids (≥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
Individuals with weakened immune systems may not develop adequate immunity following vaccination. These individuals are also more likely to develop serious illness with COVID-19 and may spread the virus to others in their home. Adding an additional dose to the series for immunocompromised people could help better protect those most vulnerable to COVID-19.
Vaccination
The additional mRNA COVID-19 vaccine dose should be the same vaccine product as the initial 2-dose mRNA COVID-19 primary vaccine series (Pfizer-BioNTech or Moderna). If the mRNA COVID-19 vaccine product given for the first two doses is not available, the other mRNA COVID-19 vaccine product may be administered. A person should not receive more than three mRNA COVID-19 vaccine doses.
The additional dose of an mRNA COVID-19 vaccine should be administered at least 28 days after completion of the initial 2-dose mRNA COVID-19 vaccine series, based on expert opinion.
Whenever possible, mRNA COVID-19 vaccination doses (including the primary series and an additional dose) should be completed at least two weeks before initiation or resumption of immunosuppressive therapies, but timing of COVID-19 vaccination should take into consideration current or planned immunosuppressive therapies and optimization of both the patient’s medical condition and response to vaccine.
Vaccination Screenings
CDC does not recommend additonal doses or booster shots for any other population at this time. For screening purposes, vaccinators may accept patient attestations as qualification for an additional dose. The Wisconsin Department of Health Services (DHS) will not supply an attestation form to vaccinators and does not recommend the use of written attestation forms.
Additional Precautions
In addition to an additional dose of mRNA COVID-19 vaccines, immunocompromised people should continue to take precautions such as wearing masks, avoiding crowds, and maintaining physical distance from people they do not live with. Likewise, everyone around immunocompromised people should get vaccinated against COVID-19 to protect their loved ones.
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