• COVID-19 Response Team

Additional COVID-19 Vaccine Dose Recommended for Immunocompromised Individuals

Effective August 13, 2021, the CDC recommends that people who are moderately to severely immunocompromised receive an additional dose of the Pfizer or Moderna COVID-19 Vaccine. Caroline County Health Department is now offering third doses for those that meet the criteria.


Who should get the additional dose?


Only those who are moderately to severely immunocompromised AND who received either Moderna or Pfizer vaccines previously are recommended to receive the additional dose.


Who is Moderately to Severely Immunocompromised?


Individuals with specific medical conditions or receiving medical treatments that cause them to be moderately to severely immunocompromised include those who 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 or are taking medicine to suppress the immune system.

  • Have moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome).

  • Have advanced or untreated HIV infection.

  • Receiving active treatment with high-dose corticosteroids (greater than 20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, or other drugs that may suppress your immune response.


Why is an additional dose being recommended for Moderately to Severely Immunocompromised people?


Immunocompromised people have a reduced ability to fight disease and may not have had a strong enough immune response to the initial series of COVID-19 vaccines to provide adequate protection. Vaccine effectiveness is about 59% to 72% in immunocompromised people, compared to 90% to 94% overall.


At the same time, those with compromised immune systems are at greater risk of severe illness, hospitalization, and death from COVID-19. Data has also shown that those who are moderately to severely immunocompromised are more likely to have breakthrough infections and more likely to spread COVID-19 to household contacts.


An additional dose of vaccine can increase an immunocompromised person’s level of protection against COVID-19.


What if I got Johnson & Johnson?


Right now, there is no recommendation for an additional dose for those with compromised immune systems who received the Johnson & Johnson (Janssen) vaccine. The FDA and CDC are working to better understand the data on whether immunocompromised people who received the J&J COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine. We will share any information on changes to the recommendations on our website and social media.


When should I get the additional dose?


You should get the third dose at least 28 days after your second vaccination.


Can I get a different kind of vaccine than my original shots?


The additional dose should be the same vaccine product as your initial two-dose COVID-19 vaccine series (Pfizer or Moderna). If you are 18 years or older and the vaccine product you got for the first two doses is not available, you can get the other vaccine product that is available.


For example, if you received your first two doses of Pfizer COVID-19 vaccine but you cannot find a vaccine location that has Pfizer vaccine, you can get an additional dose of Moderna COVID-19 vaccine if you are 18 years or older.


However, if you are immunocompromised and are younger than 18 years old, your additional dose has to be a dose of Pfizer COVID-19 vaccine, since that is the only vaccine approved for use in people under the age of 18.


I’m not sure if I meet the criteria. What should I do?


If you aren’t sure if you should get an additional dose based on your specific medical history, you are strongly encouraged to discuss the issue with your primary care provider.


How can I get the additional dose?


You do not need a referral or prescription to get a third dose of Moderna or Pfizer.


You can receive the additional dose at any vaccine provider, including the Health Department, participating pharmacies, or your primary care office. You do not have to get your third shot at the same place you got your previous two vaccinations.


To receive an additional dose vaccine through the Health Department, you can register online for any of our regular vaccine clinics. Be sure to check the vaccine type being offered at the specific clinic you are registering for to make sure it matches your previous vaccines. When you complete the health screening questions of the registration, there will be a place to indicate that you are registering for a third shot.


If you can’t register online, our Call Center team would be happy to help you register over the phone. Call (410) 479-5880.


If possible, bring your white CDC COVID-19 vaccination card or a printed or downloaded summary of your immunization record.


What is the difference between an “additional dose” and a “booster dose?”


An “additional dose” is recommended for people who may not have received adequate protection from their initial vaccine series. Those with weakened immune systems don’t always build the same level of immunity after vaccination the way non-immunocompromised people do. People who are moderately to severely immunocompromised are recommended to get an additional dose to increase their immune response so they have protection against COVID-19.


A “booster dose” is a supplemental vaccine dose given to people when the immune response to a primary vaccine series is likely to have decreased over time. At this time, the need for and potential timing of booster doses has not yet been determined and they are not recommended. The CDC and FDA continue to review evidence and data and we will update the public through our website and social media if recommendations change.


What else do I need to know?


Because those who are moderately or severely immunocompromised may not have as strong protection against COVID-19 without a third dose, it is especially important that members of their household and close, regular contacts be vaccinated against COVID-19 to help provide the immunocompromised person with more protection.


Additionally, prevention measures like wearing a mask and frequent handwashing are vital if you are going to be around an immunocompromised person.


Find more information on the CDC website.

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