Mayo Clinic implements fourth dose of COVID-19 vaccines for immunocompromised people

By Mayo Clinic staff

Mayo Clinic started administering COVID-19 vaccine boosters at the shortened interval to eligible patients on Tuesday, Feb. 15.

Centers for Disease Control and Prevention recommendations for Pfizer and Moderna COVID-19 vaccines have been updated to include a booster, or fourth dose, for moderately to severely immunocompromised people a minimum of three months after completing an mRNA vaccination series.

This interval was shortened from the previously recommended five months in updated recommendations released on Friday, Feb. 11.

Another key change is a new recommendation for those who initially received the Johnson & Johnson vaccine. An additional dose is recommended at least 28 days after the first dose and now a booster, or third, dose is recommended at least two months after the second or additional dose. Additional and booster doses must be mRNA vaccines and not the Johnson & Johnson vaccine. 

Immunosuppressed or immunocompromised refers 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.

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

Questions and answers

Who can get a booster dose, or fourth dose, of COVID-19 vaccine?

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

Is the booster dose one or two shots?

The booster dose of COVID-19 vaccine is a single dose.

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

The CDC recommends waiting at least three months following the 3 dose primary mRNA vaccine series in the immunocompromised, and waiting 5 months after the 2 dose primary series in others.

For those who received the Johnson and Johnson vaccine, a booster may be administered when it has been at least two months from the last dose of COVID-19 vaccine.

Why is Mayo Clinic administering a booster, or fourth, doses of COVID-19 vaccine if the World Health Organization asked for a pause on boosters?

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

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

It is preferred that booster be the same brand as that used for the primary series. However, another mRNA vaccine may be substituted if the original is not available. In other words, you can receive Moderna in place of Pfizer if it is not available, or vice versa.

Is there a difference between the booster, or fourth, dose of COVID-19 vaccine and the original vaccine?

Technically, a booster is given for waning immunity some period of time following completion of the original vaccine series. The current recommendation for an additional dose of the Pfizer or Moderna COVID-19 vaccine is an extension of the primary vaccination series for all patients with moderate to severe immunocompromise, since they may not mount an adequate immune response to a two-dose vaccine series. The additional dose is a third dose of either Pfizer or the Moderna COVID-19 vaccine.

I am immunocompromised and received the Johnson & Johnson COVID-19 vaccine. Can I get an additional dose of an mRNA COVID-19 vaccine?

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

I am immunocompromised and haven't received a COVID-19 vaccine. 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.

A version of this article was originally published on the Mayo Clinic News Network.