Those with moderately to severely compromised immune systems who received an mRNA COVID-19 vaccine (Pfizer or Moderna) should receive an additional, third dose of the vaccine – before the booster shot – according to the U.S. Centers for Disease Control and Prevention (CDC).1
This third dose is part of the primary vaccine series, and should be given 28 days after the second dose. A booster shot should be given three or more months later for those who are immunocompromised.9
For those who received the Johnson & Johnson COVID-19 vaccine, the CDC is recommending an additional primary shot of an mRNA vaccine (Pfizer or Moderna). An mRNA booster shot is also recommended, two or more months later (it’s recommended to get an mRNA booster after a J&J primary vaccine).9
Those who are immunocompromised are eligible for the additional primary dose if they have:
- Been receiving active cancer treatment for tumors or cancers of the blood
- Received an organ transplant and are taking medicine to suppress the immune system
- Received a stem cell transplant within the last two years and are taking medicine to suppress the immune system
- Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, or Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection
- Been taking high-dose corticosteroids (defined below) or other drugs that may suppress your immune response1
High-dose corticosteroids are defined as ≥20 mg prednisone or equivalent per day, while other immunosuppressive medications listed by the CDC include tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.2
What does this mean for those with spondyloarthritis? Some reports indicate a lower immune response to the vaccines in individuals with rheumatic disease, especially those taking certain medications such as corticosteroids and TNF blockers. (This data applies to adults only. There is limited to no data available for children.) Those living with spondyloarthritis should speak to their doctors to find out if they are eligible, and should receive, a third dose of an mRNA vaccine.
If you qualify for a third dose of the vaccine, please call your healthcare provider to find out how to receive your shot. “The decision whether to receive an additional vaccination should be made in conjunction with your rheumatologist, taking into consideration the medications that you are currently taking,” said rheumatologist Pamela Weiss, MD, MSCE, Chair of SAA’s Medical and Scientific Advisory Board.
The additional vaccine dose should be of the same type as the first two doses received (so if you received a Pfizer vaccine, you should receive an additional Pfizer shot; the same goes for Moderna). The third shot should be given at least 28 days after the second dose.1 The extra Pfizer shot is recommended for immunocompromised individuals aged 5 and over, while the extra Moderna shot is recommended for immunocompromised individuals aged 18 and over.
Including the booster shot, immunocompromised individuals who received an mRNA vaccine should receive a total of four shots. Immunocompromised individuals who received a J&J vaccine should receive a total of three shots.
If you are unable to access the same type of mRNA vaccine you received initially, it is okay to get the other mRNA vaccine.1
People who are moderately to severely immunocompromised are at greater risk of serious, prolonged illness from COVID-19 infection, the CDC says. Studies suggest that some immunocompromised people gain less protection from the two-dose mRNA vaccines,3 and may benefit from a third dose.
The FDA’s support for the expanded authorizations came from two studies looking at mRNA vaccine response in solid-organ transplant recipients. In a randomized trial of 120 organ transplant recipients, a third dose of the Moderna vaccine two months after the second shot raised the immune response in 55% of patients, compared to 18% in a placebo group. In a second study of 101 transplant recipients in France, the number of patients demonstrating antibodies against COVID-19 jumped 28% one month after receiving a third Pfizer vaccine.4
Recent research has also found that post-vaccine flares were uncommon in individuals with rheumatic and musculoskeletal diseases. Among 1,377 individuals who were given either the Pfizer or Moderna mRNA vaccine, 11% reported a rheumatic flare that required treatment, but none of the flares were severe, according to a study conducted from December 2020 to April 2021 at Johns Hopkins University in Baltimore.6 The most common diagnosis among the cohort was inflammatory arthritis, and 72% of patients were on a biologic medication. Factors associated with post-vaccine flares included previous COVID-19 diagnosis, having a flare within the six months prior to vaccination, and receiving combination therapy (a biologic plus a disease-modifying antirheumatic drug [DMARD]).6
“While people who are immunocompromised make up about 3% of the U.S. adult population, they are especially vulnerable to COVID-19,” said CDC Director Rochelle Walensky, MD, MPH. “This official CDC recommendation is an important step in ensuring everyone, including those most vulnerable to COVID-19, can get as much protection as possible from vaccination.”5
Please note that the information in this article is accurate as of today, but recommendations may change in the future. We will do our best to keep you updated in a timely manner.
Standard precautions such as wearing masks, social distancing, and washing hands should still be practiced by those who are immunocompromised.
- COVID-19 Vaccines for Moderately to Severely Immunocompromised People | CDC
- CDC Panel Backs Third COVID Shot for the Immunocompromised | MedPage Today
- Science Brief: COVID-19 Vaccines and Vaccination (cdc.gov)
- FDA Authorizes COVID Booster Shots for Certain Populations | MedPage Today
- Media Statement from CDC Director Rochelle P. Walensky, MD, MPH
- Rheumatic Flares Uncommon After COVID Vax | MedPage Today
- CDC Expands Eligibility for COVID-19 Booster Shots | CDC Online Newsroom | CDC
- People with Certain Medical Conditions | CDC
- Interim Clinical Considerations for Use of COVID-19 Vaccines | CDC