Do I need a 4th dose of the COVID-19 vaccine?

Wondering about vaccines, precautions or anything else that
immunocompromised people need to know? Talk to your doctor.

2nd boosters? 4th doses? Here’s what you need to know.

There’s a lot of confusion about 2nd boosters, 4th doses, and yes, we’ve even heard misinformation around 5th doses of the COVID-19 vaccines. We get it, recommendations change and sometimes the vocabulary being used isn’t familiar. As science evolves and medical experts learn more, guidelines can and will change to help you make the best decisions for yourself and your family.

Let’s go over a few terms you’ve probably heard:

  • Primary series: the initial dose (or doses) you need to be “fully vaccinated.”
  • Booster dose: a supplemental vaccine dose given to people when their immune response to a primary vaccine series is likely to have waned over time.
  • Fully vaccinated: means it has been 2 weeks or longer since you had your final dose of a primary series of the COVID-19 vaccine.
  • Up-to-date: means you’ve had all recommended COVID-19 vaccines, including any booster dose(s) when eligible.

How many doses of the COVID-19 vaccine do I need?

For most people, the primary series for the Pfizer and Moderna mRNA vaccines is 2 doses or 1 dose of the Johnson & Johnson (J&J) COVID-19 vaccine. We’ll explain what we mean by most people in a minute.

After a certain amount of time, and depending on which vaccine you had for your primary series, you’ll be eligible for a booster dose. Keep in mind, there’s no “2nd boosters” – it’s more likely you fall into a group of people who need an additional primary dose series (and then a booster dose).

In February, the CDC updated its guidance for how many COVID-19 vaccines people who are moderately or severely immunocompromised need. People who have certain health conditions or take certain medicines that weaken their immune system don’t have as robust of an immune response to the vaccines as other people and need additional protection from COVID-19. They are also more likely to suffer from severe illness or be hospitalized if they get COVID-19.

Who is moderately or severely immunocompromised?

Many conditions and treatments can cause a person to be immunocompromised, or have a weakened immune system. You are moderately or severely immunocompromised if you have:

  • Been receiving active cancer treatment for tumors or cancers of the blood.
  • Received an organ transplant and are taking medicine to suppress your immune system.
  • Received a stem cell transplant within the last 2 years or are taking medicine to suppress your immune system.
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome).
  • Advanced or untreated HIV infection.
  • Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response.

Talk to your healthcare provider about which COVID-19 vaccination will be best for you to get given your medical condition.

(Source: CDC)

Updated guidance for people who are moderately or severely immunocompromised:

  • If you are moderately or severely immunocompromised, you  should get 3 mRNA doses for your primary series of the COVID vaccine, then get a booster dose when eligible, making a total of 4 doses.
  • Once you’ve completed your primary series of an mRNA vaccine (Pfizer or Moderna), get your booster dose 3 months (instead of 5 months) after the last primary dose.  
  • If you got the single-shot Johnson & Johnson vaccine, you need 1 additional dose of an mRNA vaccine to complete your primary series and then a booster dose (preferably an mRNA booster) 2 months after your last primary dose for a total of 3 vaccine doses.  

Remember, if you or a loved one is immunocompromised it’s important to use all of the tools we have to protect yourself from this virus – get vaccinated and boosted, consider wearing a mask in public, get tested quickly if you feel sick, and seek treatment right away if you test positive for COVID-19. 

How an immunocompromised person gets a 4th dose