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Vaccine Guidance for Immunocompromised Patients

An additional dose of the COVID-19 vaccines are recommended for certain immunocompromised individuals. This is as a result of medical studies suggesting a reduced antibody response after the usual two-dose vaccine primary series.

Immunocompromised individuals should also receive a booster dose. For those who received the mRNA vaccines, that would result in a 4th dose. 

The Centers for Disease Control (CDC) now recommends an additional dose for patients:

  • Receiving treatment for a blood cancer (for example, leukemia, lymphoma, myeloma, myelodysplastic syndrome)
  • Receiving treatment for a solid tumor with chemotherapy, hormonal therapy, immunotherapy, surgery and/or radiation therapy (currently or within one year of initial mRNA COVID-19 vaccine series)
  • Received a stem cell transplant within the last two years or requiring immune-suppressing medication
  • Received a solid organ transplant (such as a kidney or liver transplant) and are taking immune-suppressing medication
  • Moderate or severe primary immunodeficiency (such as DiGeorge or Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV disease

If you are taking (or were taking at the time of your initial mRNA COVID-19 vaccine series) high-dose corticosteroids (equal to at least 20 mg of prednisone daily) or other medications that suppress the immune system, you are also eligible for a third dose of the COVID-19 vaccine. The list of eligible medications include:

  • 6-mercaptopurine (Purinethol, Purixin)
  • Abatacept (Orencia)
  • Adalimumab (Humira)
  • Alemtuzumab (Lemtrada, Campath)
  • Anakinra (Kineret)
  • Azathioprine (Imuran, Azasan)
  • Baricitinib (Olumiant)
  • Belatacept (Nulojix)
  • Benlimumab (Benlysta)
  • Certolizumab (Cimzia)
  • Cladribine (Mavenclad)
  • Cyclosporine (Gengraf, Neoral, Sandimmune)
  • Etanercept (Enbrel, Erelzi)
  • Fingolimod (Gilenya)
  • Golimumab (Simponi)
  • Infliximab (Remicade, Inflectra, Renflexis, Avsola)
  • Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
  • Mycophenolate motefil (Cellcept, Myfortic)
  • Obinutuzumab (Gazyva)
  • Ocrelizumab (Ocrevus)
  • Ofatumumab (Kesimpta)
  • Ozanimod (Zeposa)
  • Rituximab (Rituxan, Truxima, Ruxience, Riabni)
  • Siponimod (Mayzent)
  • Sirolimus (Rapamune)
  • Tacrolimus (Prograf, Envarsus XR)
  • Tofacitinib (Xeljanz, Xeljanz XR)
  • Upadacitinib (Rinvoq)

If you have one of the above conditions, you are eligible to receive a third dose if:

  1. You received two doses of the Pfizer vaccine, at least 28 days have passed since your last dose, and you are at least 5 years old;
    OR
  2. You received two doses of the Moderna vaccine, at least 28 days have passed since your last dose, and you are at least 18 years old.

**Please note: An additional primary dose is not recommended for those who received the Johnson & Johnson vaccine. However, they should receive a booster dose.

The third dose of the Pfizer of Moderna vaccine should be the same type of vaccine that you initially received. For example, if you received two doses of the Moderna vaccine, you should schedule your third dose at a site that is offering the Moderna vaccine on the day of your appointment.

Those who are immunocompromised should also receive a booster at least three months after their primary vaccine series, which includes the third dose. Unlike with the third dose, it is possible to "mix and match" your booster dose. For example, if you received the Moderna vaccine for your first three doses, it is OK to receive a Pfizer vaccine as your booster.

You will be asked to identify and confirm that you have one or more of the qualifying conditions at the time of scheduling. If you have questions about whether you are immunocompromised, please speak to your treating clinician.

See the vaccine distribution schedule.

Learn more about how to schedule an appointment online.