Bill Oxford Getty Images/iStockphoto
Even if they are vaccinated against COVID-19, people with immune systems classified as “moderately to severely compromised” may not have built up the same level of immunity to the coronavirus as other vaccinated people. These individuals should get a third dose of either the Moderna or Pfizer-BioNTech vaccine to ensure they have adequate protection, according to the latest recommendations from the Centers for Disease Control and Prevention.
Earlier this month, the U.S. Food and Drug Administration authorized immunocompromised people to get additional doses of the Moderna and Pfizer-BioNTech vaccines. (And earlier this week, the FDA approved the Pfizer vaccine.) The Johnson & Johnson COVID vaccine, administered in one dose, does not yet have government approval for a follow-up dose.
It's important to note that there are two different types of doses being discussed here: a third, additional dose and a booster. Third doses are being offered to immunocompromised people: those with moderately to severely compromised immune systems include patients undergoing treatment for cancer and HIV or have conditions in which immunosuppressive medications and treatments are prescribed. But this week, United States officials announced that they are preparing to offer booster shots as early as the week of September 20 for healthy, immunized people who have been vaccinated for at least eight months. "...A booster shot will be needed to maximize vaccine-induced protection and prolong its durability," public health and medical experts from the U.S. Department of Health and Human Service said in a joint press release.
“For almost all eligible immunosuppressed patients, it is advisable to obtain the third dose, as those on immunosuppression [therapy] tend to have reduced immunity following the initial series of SARS-CoV-2 vaccination,” says Dr. Albert Kim, a Washington University rheumatologist at Barnes-Jewish Hospital. “I urge all patients to discuss with their provider about ensuring that any risk of adverse events is discussed and mitigated if possible. In addition, organizations such as the American College of Rheumatology have advised to hold certain medications if possible after receipt of the third dose.”
A third dose for those who are immunocompromised can be administered at least four weeks after a second dose of the Pfizer-BioNTech or the Moderna vaccine, according to the CDC, which says common reactions to the third dose are pain at the injection site and fatigue as they did for the first two shots. Eligible persons are being asked to take the same brand of vaccine.
On August 17, the Missouri Department of Health and Senior Services said the state was following CDC guidelines and that third doses were available at venues providing first and second doses of the COVID vaccine. Amid outbreaks of the Delta variant and rising COVID-19 cases, the state also announced stepped-up efforts to encourage vaccine-hesitant residents to be vaccinated against COVID.
“With the Delta variant infecting many Americans throughout the country, with few places not seeing community spread, vaccinations are urgently needed," says Enbal Shacham, a professor in the College for Public Health and Social Justice at Saint Louis University. "The COVID-19 vaccinations are proving to be effective at reducing the severity and length of the infection when individuals do have breakthrough infections. Masking, vaccinations, and social distancing are the only way that we can prevent the continued spread of COVID-19.”
