August 12, 2021

The U.S. FDA has modified the emergency use authorization (EUA) for both the Pfizer/ BioNTech and Moderna COVID-19 vaccines to allow a third dose. This booster shot is intended for immunocompromised individuals who have had a solid organ transplant or been diagnosed with a condition considered to cause an equivalent level of compromised immune system.

Individuals with a moderately to severely immunocompromised condition account for only 3% of the United States population but are likely to have an increased risk of COVID-19. Even after receiving a full two-dose course of COVID-19 vaccination with either Moderna’s or Pfizer/BioNTech’s vaccines, they may not have developed the same level of COVID-19 immunity as individuals whose immune systems are not compromised. If an immunocompromised individual receives a booster shot, it should be administered at least 28 days after completion of the first two-dose regimen. Reactions to the third dose are similar to the first two-shot series.

Patients should discuss the need for a booster shot with their healthcare provider. According to the U.S. Centers for Disease Control and Prevention (CDC), the booster shot is recommended for individuals who have:

  • Been receiving active cancer treatment for tumors or cancers of the blood;
  • Received an organ transplant and are taking medicine to suppress the immune system;
  • Received a stem cell transplant within the last two years or are taking medicine to suppress the immune system;
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome or Wiskott-Aldrich syndrome);
  • Advanced or untreated HIV infection; or
  • A risk of suppressed immune response due to active treatment with high-dose corticosteroids or other drugs that may suppress the immune

The third dose should ideally be from the same manufacturer as the initial two doses. However, either vaccine from Pfizer/BioNTech or Moderna can be administered if necessary. At this time, there is not enough data on the COVID-19 vaccine from Johnson & Johnson’s subsidiary, Janssen, to support its use as a booster shot.

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