Updated COVID-19 Vaccination Guidance

KEY MESSAGES

• Older adults are now able to receive a second COVID-19 booster dose.

o If you’re 50 years and older and received an initial COVID-19 booster dose (regardless of which vaccine was used) at least 4 months ago, you now have the option to receive a second booster dose using either Pfizer-BioNTech or Moderna (mRNA COVID-19 vaccines.)

o People in this age group may be at increased risk for severe illness from COVID-19 and may benefit from a second booster dose, especially if they have underlying conditions that increase their risk for severe COVID-19.

o In the setting of this unprecedented pandemic—and low but ongoing community transmission—older adults who want to increase their protection now can choose to receive another booster dose based on their individual circumstances.

o Individuals who have questions can talk to their healthcare provider.

• People who are moderately or severely immunocompromised are now able to get a second COVID-19 booster dose.

o If you’re 12 years and older, moderately or severely immunocompromised, and previously received any booster dose at least 4 months ago, you now have the option to receive a second booster dose using an mRNA COVID-19 vaccine.

o People who are moderately or severely immunocompromised make up about 3% of U.S. adults (nearly 8 million people) and include recipients of organ or stem cell transplants, people with advanced or untreated HIV infection, people currently undergoing treatment for cancer, people who are taking certain medications that weaken the immune system, and others. A complete list of conditions can be found on CDC’s website.

o These individuals are at increased risk for severe illness from COVID-19 and may benefit from a second booster dose.

• Anyone who received Johnson & Johnson’s Janssen COVID-19 vaccine for the primary dose and booster dose is now able to get a second COVID-19 booster dose using an mRNA Vaccine.

o If you’re 18 years and older, and previously received the J&J/Janssen COVID-19 vaccine for both your primary dose and your booster dose, you are now able to receive an mRNA COVID-19 booster dose at least 4 months after your J&J/Janssen booster dose.

o mRNA COVID-19 vaccines provide the most effective and safe protection against severe disease caused by COVID-19.

Additional Messages

• The Centers for Disease Control and Prevention (CDC) updated its COVID-19 vaccination guidance to give some individuals the option to receive a second booster dose using an mRNA COVID-19 vaccine.

• These individuals include:

o People ages 50 years and older who received an initial COVID-19 booster dose (regardless of which vaccine was used) at least 4 months ago;

o People ages 12 years and older who are moderately or severely immunocompromised who received an initial COVID-19 booster dose (regardless of which vaccine was used) at least 4 months ago; and

o People ages 18 years and older who received both a primary dose and a booster dose of J&J/Janssen COVID-19 at least 4 months ago.

• COVID-19 vaccines continue to offer high levels of protection against severe disease, hospitalization, and death—especially for individuals who are boosted.

• Since the risk of severe COVID-19 increases with age, adding second booster dose eligibility for older adults helps to ensure those at highest risk are protected from severe disease. In addition, the update helps make strides toward addressing health equity, as racial and ethnic minority groups are more represented among ages 50 to 64, compared to older age groups.

• COVID-19 vaccines are safe, effective, and the most important tool we have to protect everyone from severe outcomes.

• The known risks of COVID-19 illness and its related, possibly severe complications—such as long-term health problems, hospitalization, and even death—continue to far outweigh the potential risks of having a rare adverse reaction to vaccination.

• CDC continues to monitor and evaluate evidence and data as it is available to inform guidance, including whether or when additional doses for other populations may be needed.

Q&A

Q: When can eligible individuals receive a second booster dose of an mRNA COVID-19 vaccine?

A: People ages 50 years and older, as well as people ages 12 years and older who are moderately or severely immunocompromised, have the option to receive a second booster dose using an mRNA COVID-19 vaccine at least 4 months after their first booster dose. And people who received both a primary dose and a booster dose of J&J/Janssen COVID-19 at least 4 months ago are now able to receive a booster dose of an mRNA COVID-19 vaccine.

Q: Why are you making a second booster of an mRNA vaccine available to people who previously received the J&J/Janssen COVID-19 vaccine?
A: For individuals who previously received a J&J/Janssen COVID-19 vaccine, data reveal that mRNA vaccines provide the most effective and safe protection against infection with the virus that causes COVID-19 and severe illness. Of note, a new CDC report shows that adults who received the J&J/Janssen COVID-19 vaccine as both their primary dose and booster dose had lower levels of protection against COVID-19-associated emergency department and urgent care visits during Omicron compared to those who received an mRNA booster dose.

Q: Which type of COVID-19 vaccine can eligible people receive as a second booster dose?

A: They have the option to receive a second booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccines.

Q: What is your guidance for immunocompromised people? Should they be receiving a fifth dose?

A: Under this update, people (ages 12 years and older if they received the Pfizer-BioNTech series, or ages 18 years and older if they received the Moderna series) who are moderately or severely immunocompromised may now receive 5 doses total (a primary series of 3 doses, plus 2 booster doses). People who are moderately or severely immunocompromised—and who received a single J&J/Janssen COVID-19 vaccine primary series—are now able to receive a total of 4 vaccine doses: 1 J&J/Janssen dose, 1 additional mRNA dose, and 2 booster doses.

Q: When will other age groups be eligible for another booster dose?

A: CDC, FDA, and other federal partners continue to monitor and evaluate the data, including whether additional booster doses may be needed for other populations in the future. On April 6, FDA will gather its independent panel of outside experts to discuss considerations for another booster for the broader population. CDC will participate in this public meeting

Q: Can people ages 50 years and older who received a J&J/Janssen primary dose and a J&J/Janssen booster get 2 booster doses of an mRNA vaccine?

A: No. People ages 50 years and older who received a J&J/Janssen primary dose and J&J/Janssen booster dose at least 4 months ago are able to receive 1 mRNA COVID-19 booster.

Q: Does this recommendation change the definition of ‘up to date’?
A: No, the definition of up to date has not changed. A person is up to date when they have received all recommended doses in their primary series of COVID-19 vaccine, and a booster dose when eligible. Receipt of a second booster dose is not necessary to be considered up to date at this time. Q: For those eligible to receive a second booster dose now, will they be able to get another one this fall? A: FDA and CDC will continue to discuss the data and need for a booster dose this fall. We anticipate those who choose to get a second booster now may still need additional doses later this year, if authorized. In the meantime, with cases of COVID-19 rising again in some parts of the world—and the possibility that the U.S. will experience another uptick in COVID-19 cases in the coming months—this update allows these individuals the option to increase their individual protection now. Another booster dose could help restore protection that may wane over time, and provide peace of mind for those who want optimal protection as soon as possible.

Q: Is this a recommendation?

A: CDC has made two types of vaccine recommendations in the past. The first is when the benefits clearly outweigh the risks in the population, and we recommend everyone should follow the recommendation. The second type is used when there is a diversity of benefits and risks on an individual basis, allowing flexibility, and we recommend that everyone (or people in certain groups or by age) may get vaccinated.
CDC’s new guidance for second boosters gives people in specific populations the option to receive a second booster dose using an mRNA COVID-19 vaccine under a ‘may’ recommendation. As a result, people who are at higher risk of severe COVID-19 outcomes—and who want to increase their protection now—may receive another booster dose based on their individual circumstances. Individuals who have questions can talk to their healthcare provider.