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All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub for the most recent information on the COVID-19 pandemic. These individuals are generally at a higher risk of developing severe and persistent illnesses compared with others. They may also lack adequate protection or immunity against coronavirus infection. This makes them susceptible to infection even after receiving a two-dose primary mRNA COVID-19 vaccine. This is already evident from the significant number of immunocompromised individuals hospitalized for “vaccine breakthrough infections” and fully vaccinated people who still get SARS-CoV-2 infections. An infection with the virus SARS-CoV-2 is what causes COVID-19 in people. The Centers for Disease Control and Prevention (CDC) recommends people who are moderately and severely immunocompromised receive three primary doses of Pfizer or Moderna and two boosters. If a person initially had a Janssen vaccine, they should receive another Janssen shot and two boosters. These extra vaccines and boosters can help protect against serious illness and the need for hospitalization due to COVID-19. What to know Share on Pinterestmiodrag ignjatovic/Getty ImagesAll vaccines that currently have approval and authorization in the United States — Moderna, Johnson and Johnson’s Janssen, and Pfizer-BioNTech, aid in preventing hospitalization, severe disease, and death from COVID-19. However, emerging data suggest that these vaccines are less effective in preventing COVID-19 illness and hospitalization in immunocompromised individuals. These people comprise about 2.7% of the adult U.S. population, according to 2013 data. Generally, immunocompromised people seem to be at a higher risk of developing severe forms of COVID-19. A 2021 study found that these individuals are at risk for prolonged infection. Another 2020 study also noted prolonged viral shedding, or the release of viral particles. Additionally, a 2020 study found that immunocompromised individuals and people with diabetes are more likely to pass on SARS-CoV-2 to others in their households. A 2021 Israel study found that 40% of hospitalized breakthrough cases consisted of immunocompromised patients. Immunocompromised individuals also comprised 44% of hospitalized breakthrough cases in a similar U.S. study. Immunocompromised people The CDC recommends moderate to severely immunocompromised people receive a third dose of Pfizer or Moderna, or two shots of the Janssen vaccine, and then an additional two boosters. These may include those with or who have had:active or recent treatment for solid tumors or blood cancersreceived a solid-organ or a recent hematopoietic stem cell transplant, a treatment for some cancers and other diseasessevere primary immunodeficiency, as observable in conditions such as DiGeorge syndromeuntreated or advanced HIV infectionstreatment with medications that suppress the immune system, such as chemotherapy drugs and high dose corticosteroids Individuals with chronic conditions associated with varying immunocompetence, such as chronic kidney disease may also need a third primary vaccine dose. And those with other medical conditions and treatments involving varying immunosuppression may also need a third dose. A person’s healthcare team can assess the degree of immunocompetence and decide whether and when they should receive their third primary dose. Benefits An additional primary dose may prevent serious and life threatening COVID-19 in immunocompromised people who have not developed enough protection from their first two-dose vaccine series. Studies found that individuals with no detectable antibody response after their first two doses of vaccines, such as solid-organ transplant recipients and chronic dialysis patients, developed a 33–50% antibody response after a third dose. It is important to note that experts cannot directly associate antibody levels with preventing infection. However, research is currently underway to understand this link further. Risks There is currently limited information on the risks of taking additional doses of the COVID-19 vaccine. Studies about their efficacy, safety, and benefits are currently underway. According to available data, reactions to the third primary dose are similar to the two-dose series, including pain in the injection site and fatigue. Most people report mild to moderate symptoms. Guidelines All individuals with an appointment for an additional COVID-19 vaccine dose should bring their vaccination cards. These contain relevant information, including the type of vaccine they initially received and when and where they received their initial two doses. Currently, the CDC does not advise immunocompromised people to mix and match vaccines, as research on this remains ongoing. For example, an immunocompromised person who received either the Moderna or Pfizer-BioNTech COVID-19 vaccine series should safely receive a third shot of the same mRNA vaccine. However, if the type of mRNA product is unknown or unavailable, a person may receive any of the two product types for their additional dose. Currently, the Food and Drug Administration’s (FDA) emergency use authorization amendment endorses additional mRNA doses for Pfizer-BioNTech, Moderna, and Johnson and Johnson’s Janssen COVID-19 vaccines. The CDC recommends slightly different primary vaccine timelines for immunocompromised persons of different age groups depending on the vaccine they receive:VaccineAge groupTotal dosesSecond doseThird dosePfizer5–12+321 days after the first doseat least 28 days after the second doseModerna18+328 days after the first doseat least 28 days after the second doseJanssen18+2Pfizer or Moderna at least 28 days after the first dosenot recommended The CDC recommends everyone ages 5 and over receives at least one booster. Currently, the organization recommends adults who are 50 years of age or older and immunocompromised people who are 12 years or older receive two boosters. Booster recommendations The CDC recommends moderately and severely immunocompromised people follow its booster recommendations:VaccineAgeFirst boosterSecond boosterPfizer5-11 at least 3 months after their third dosenot recommendedPfizer12+at least 3 months after their third at least 4 months after their first boosterModerna 18+at least 3 months after their third doseat least 4 months after their first boosterJanssen18+at least 2 months after their second primary doseat least 4 months after their first booster Adults who received an initial shot of Janssen should have a Pfizer or Moderna second shot at least 28 days later. They can then receive a Pfizer or Moderna booster shot at least 2 months after their second vaccine. Research updates Several studies and trials are underway to assess the effectiveness and safety of vaccine boosters in immunocompromised individuals. A recent nationwide survey found that local and systemic reactions due to the third dose in immunocompromised individuals were the same as in previous vaccines. Additionally, most individuals reported better responses from the third dose than the second. Trials are also evaluating the effectiveness of mixed-dose vaccine schedules and boosters. A preprint of a 2021 study in Germany found people tolerated a mixed-dose booster vaccination of ChAdOx/BNT well. They also had similar side effects to those observable in same-dose boosters. People also had improved immunity responses in both same-dose and mixed-dose boosters. A similar 2021 preprint found that heterologous, or mixed, vector-mRNA boosted immune response. This means receiving a ChAdOx1-nCoV-19 vector-vaccine for the initial two-dose series and then an mRNA-vaccine booster yielded favorable protection with manageable side effects. Another 2021 study preprint looking at heterologous schedules, or using a different vaccine product for the second dose than the first dose, found that these produced higher antibody levels than the licensed vaccine schedule. The National Institutes of Health (NIH) also states that research shows a person with a mixed vaccine primary and booster shot has antibody levels similar to those who receive the same vaccine for all of their shots. Additionally, levels of CD4 and CD8 T cells, which are types of immune cells that may help against SARS-CoV-2, rose no matter which vaccine a person received, unless they had a Janssen shot as their first vaccine. However, people who had a Janssen shot already had higher levels of CD8 T cells. Summary Emerging data suggest current COVID-19 vaccines are less effective in preventing illness and hospitalization in immunocompromised people. Therefore, those who are immunocompromised are at a higher risk of developing severe forms of COVID-19. This population may wish to ensure that close contacts are up-to-date on their vaccinations. They should also continue to take preventive measures such as regular handwashing, mask-wearing, and maintaining social distancing. The CDC recommends immunocompromised persons have three primary vaccine doses. Those who are 12 years of age and older should have two additional boosters of an mRNA COVID vaccine. People should receive their first booster at least 3 months after their last primary dose and then a second booster at least 4 months later. Immunocompromised children aged 5–11 years should receive one mRNA COVID vaccine booster at least 3 months after their last primary dose. Any immunocompromised people interested in COVID-19 booster shots but are unsure of which to receive and when can contact their doctor for further guidance. Last medically reviewed on May 26, 2022HIV and AIDSImmune System / VaccinesCOVID-19 19 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.At-a-glance COVID-19 vaccination schedules [Fact sheet]. (2022).https://www.cdc.gov/vaccines/covid-19/downloads/COVID-19-vacc-schedule-at-a-glance-508.pdfAvanzato, V. A., et al. (2020). Case study: Prolonged infectious SARS-CoV-2 shedding from an asymptomatic immunocompromised individual with cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640888/Brosh-Nissimov, T., et al. (2021). BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261136/CDC statement on ACIP booster recommendations. (2021). https://www.cdc.gov/media/releases/2021/p0924-booster-recommendations-.htmlCoronavirus (COVID-19) Update: FDA takes additional actions on the use of a booster dose for COVID-19 vaccines. (2021).https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-takes-additional-actions-use-booster-dose-covid-19-vaccinesCOVID-19 vaccine boosters. (2022).https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.htmlCOVID-19 vaccines for moderately to severely immunocompromised people. (2022).https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.htmlDavid, S. S. B., et al. (2021). Reactogenicity of a third BNT162b2 mRNA COVID-19 vaccine among immunocompromised individuals and seniors - A nationwide survey.https://www.sciencedirect.com/science/article/pii/S1521661621001972Haidar, G., et al. (2021). Improving the outcomes of immunocompromised patients with coronavirus disease 2019.https://academic.oup.com/cid/article/73/6/e1397/6265293Harpaz, R., et al. (2016). Prevalence of immunosuppression among US adults, 2013.https://jamanetwork.com/journals/jama/fullarticle/2572798Hillus, D., et al. (2021). Safety, reactogenicity, and immunogenicity of homologous and heterologous prime-boost immunisation with ChAdOx1-nCoV19 and BNT162b2: A prospective cohort study.https://www.medrxiv.org/content/10.1101/2021.05.19.21257334v2Lewis, N. M., et al. (2020). Household transmission of severe acute respiratory syndrome coronavirus-2 in the United States. https://academic.oup.com/cid/article/73/7/1805/5893024Liu, X., et al. (2021). Safety and immunogenicity report from the com-COV study – a single-blind randomised non-inferiority trial comparing heterologous and homologous prime-boost schedules with an adenoviral vectored and mRNA COVID-19 vaccine.https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3874014Longlune, N., et al. (2021). High immunogenicity of a messenger RNA-based vaccine against SARS-CoV-2 in chronic dialysis patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195197/pdf/gfab193.pdfMixing and matching COVID-19 vaccine booster doses. (2022).https://covid19.nih.gov/news-and-stories/mixing-matching-covid-19-vaccine-booster-dosesSchmidt, T., et al (2021). Immunogenicity and reactogenicity of a heterologous COVID-19 prime-boost vaccination compared with homologous vaccine regimens [Abstract].https://www.medrxiv.org/content/10.1101/2021.06.13.21258859v1Tenforde, M. W., et al. (2021). Effectiveness of SARS-COV-2 mRNA vaccines for preventing COVID-19 hospitalizations in the United States. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282104/Three doses of an mRNA COVID-19 vaccine in solid-organ transplant recipients. (2021).https://www.nejm.org/doi/pdf/10.1056/NEJMc2108861?articleTools=trueUse of COVID-19 vaccines in the United States (2021).https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-immunocopromisedFEEDBACK:Medically reviewed by Michaela Murphy, PA-C — By Rachel Ann Tee-Melegrito on May 26, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageHow do COVID-19 vaccines compare with other existing vaccines? 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