Clear Up Confusion About Additional COVID-19 Vaccine Doses

Posted August 30, 2021: Article in Progress. We’re releasing this article ahead of our October 2021 issue to quickly provide information to our readers. The information contained in this version is based on the best evidence available to us as of the date of posting. The final version may include revised recommendations.

Patients will ask you about additional COVID-19 vaccine doses.

Emphasize that 2 doses of mRNA COVID-19 vaccines remain about 90% effective in reducing severe disease, hospitalization, and death.

And almost all severe COVID-19 cases are in UNvaccinated patients.

But explain that overall protection against mild to moderate disease is declining...likely due to waning immunity and the Delta variant.

Identify patients who need an additional mRNA COVID-19 vaccine dose.

Immunocompromised patients. Give a third dose of an mRNA COVID-19 vaccine to people who are moderately or severely least 28 days after the second dose.

It’s an “additional dose”...not a “booster”...since these patients likely have a lower immune response than immunocompetent patients.

Define “immunocompromised” as you do for other vaccines.

For example, look for patients treated for cancer...with HIV and CD4 count under 200 cells/mm3...or on high-level immunosuppressants (Humira, tacrolimus, prednisone at least 20 mg/day for 14 days, etc).

Get specifics in our Vaccinating Immunocompromised Patients chart.

Give the same mRNA COVID-19 vaccine for the third dose. If it’s not available, don’t turn a patient away...give the mRNA vaccine you have.

Keep in mind, you can give this third dose under emergency use authorization...even though FDA has now approved the 2-dose series of the Pfizer-BioNTech COVID-19 vaccine (Comirnaty) for ages 16 and up.

General population. Start planning now for “booster” doses...for patients who likely have had an adequate immune response initially.

Expect to give boosters about 6 months after the second dose. But stay tuned for timing to be finalized as more data emerge.

For anyone getting a third dose, educate that side effects seem similar to after the second dose...and data are limited. Continue to encourage patients to report side effects using “v-safe.”

If needed, give other vaccines (flu, etc) at the same visit. Co-administration isn’t expected to increase side effects...or impact immune response.

Anticipate that a second dose of the Johnson & Johnson/Janssen COVID-19 vaccine will also likely be needed.

Use our FAQ, Communicating About COVID-19 Vaccination, to debunk myths and address other questions...including pregnancy and breastfeeding.