ThirdVaccineDoseQandA Questions and Answers: Additional COVID-19 Vaccine Doses for People Whose Immune Systems are Compromised

Questions and Answers: Additional COVID-19 Vaccine Doses for People Whose Immune Systems are Compromised

Updates as of May 11, 2022:

  • To align with the U.S. Food and Drug Administration's newest guidance for who may receive the Johnson & Johnson COVID-19 Vaccine.


Who is eligible for an additional dose of the COVID-19 vaccine?

The U.S. Food and Drug Administration (FDA) has authorized additional doses for those aged 5 and older who are immunocompromised.  Immunocompromised people includes individuals 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 2 years
  •  Been taking medicine to suppress the immune system
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Been in active treatment with high-dose corticosteroids or other drugs that may suppress your immune response

People should talk to their healthcare provider about their medical condition and whether getting an additional dose is appropriate for them.

Why isn't everyone eligible for an additional vaccine dose?

The U.S. Food and Drug Administration (FDA) and federal Centers for Disease Control and Prevention(CDC) continue to review data as it pertains to protecting our communities against severe illness and death. Additional vaccine doses from mRNA vaccines have shown to be helpful for people aged 5 and older who are immunocompromised in a manner similar to those who have undergone solid organ transplantation have a reduced ability to fight infections and other diseases. Those who are immunocompromised are especially vulnerable to infections, including COVID-19. The administration of additional vaccine doses has been shown to increase protection in these populations.

What if I'm not eligible and still want to get an additional dose because I have other pre-existing medical conditions?

You may be eligible for a booster dose if enough time has passed since completing your initial series. Learn more by reading the CDPH Booster Doses Questions and Answers.

What is the difference between additional doses for immunocompromised individuals and booster doses?

Some people have weakened immune systems, otherwise known as people who are immunocompromised, and require additional doses of the vaccine to strengthen their protection against disease.

Most people have strong immune systems, otherwise known as high levels of immunity to disease, but still suffer from immunity decreasing over time. Booster doses are a common and normal part of vaccine series that help strengthen their protection against disease.

Learn more by reading the CDPH Booster Doses Questions and Answers.

How is the state defining 'immunocompromised,' and will Californians be required to verify they are immunocompromised?

California will follow the guidance of the Advisory Committee on Immunization Practices (ACIP) and CDC. ACIP will take the FDA modifications to the vaccine's Emergency Use Authorizations and create channels based on current evidence of effectiveness and safety.

The authorizations cover people aged 5 and up who are solid organ transplant recipients or those who are diagnosed with conditions that are considered to have a moderate or severe level of immunocompromise. Verification of immunocompromised status will not be required. Your medical provider can help clarify if you meet the threshold for immunocompromised or not.

When will additional doses be available for immunocompromised individuals in California?

Additional vaccine doses became available in California on August 16, 2021.

How does someone find and receive an additional vaccine dose?

Additional vaccine doses will be available through all current vaccination channels, including healthcare providers, clinics, and neighborhood pharmacies. Visit myturn.ca.gov to make an appointment or find a walk-in clinic.

When should I receive my additional vaccine dose?

Additional doses can be received after the minimum time has passed following completion of the initial vaccine series (one dose of the Johnson & Johnson vaccine or two doses of the Pfizer or Moderna vaccines). The minimum time required varies based on the primary series.

Which vaccines are covered by an emergency use authorization?

On August 12, 2021, the FDA authorized Pfizer, Moderna, and Johnson & Johnson to be used for additional doses.

On March 29, 2022, the FDA authorized Pfizer and Moderna for additional dose, first booster, and second booster for vulnerable groups.

On May 5, 2022, the FDA aligned with current CDC recommendations to limit who may receive the Johnson & Johnson COVID-19 Vaccine (J&J) to people aged 18 and older who cannot receive other COVID-19 vaccines due to medical reasons, have limited access to the other vaccines, or who elect to receive (J&J) because they would otherwise not receive a COVID-19 vaccine.

What if someone received a Johnson & Johnson vaccine initially? Should they still get a Pfizer or Moderna vaccine?

It is recommended that if a single dose of Johnson & Johnson vaccine was received, people should receive an additional dose and booster of either mRNA vaccine (Pfizer or Moderna), though they may choose Johnson & Johnson, providers recommend mRNA.

Can a person get an additional vaccine dose from a different vaccine brand, or do they need to stay with the brand for their original supplier?

The booster doses may be administered as a mix and match (heterologous) booster dose following completion of a primary vaccination series. Eligibility requirements and dosing intervals remain the same regardless of which booster dose is selected.

Californians can receive the booster dose of their choice, but mRNA COVID-19 vaccines (Pfizer or Moderna) are preferred over the Johnson & Johnson COVID-19 vaccine.

Why would I want to get an additional vaccine dose? (Are additional doses really necessary?)

Most people have strong immune systems, otherwise known as high levels of immunity to disease, but still suffer from immunity decreasing over time. Booster doses are a common and normal part of vaccine series that help strengthen their protection against disease.

People who are immunocompromised in a manner similar to those who have undergone solid organ transplantation have a reduced ability to fight infections and other diseases. They are especially vulnerable to infections, including COVID-19. The FDA determined that the administration of additional vaccine doses may increase protection in this population. These patients should be counseled to maintain physical precautions to help prevent COVID-19. In addition, close contacts of immunocompromised persons should get vaccinated, as appropriate for their health status, to provide increased protection to their loved ones.

Can I get multiple additional doses?

Currently, additional vaccine doses are only authorized for immunocompromised individuals by the FDA and recommended by the CDC.

What is the current CA Public Health Order regarding COVID-19 vaccination?

Find important state guidance on activities related to COVID-19 on CDPH's Find All Guidance page. Sign up to receive alerts for updates to California state public health officer orders and public health mandates related to COVID-19 in 14 languages.

Will digital vaccine records be updated to show that individuals have received the additional dose of vaccines?

Yes, the Digital COVID-19 Vaccine Record has been updated and will show the additional dose. However, your previously saved vaccine record will not automatically update, so a new version will need to be re-downloaded to reflect that you have received an additional and/or booster dose.

We recommend waiting fourteen days for your new dose to show up in the California Immunization Registry.

If I get an additional dose, will it show on my digital vaccine record?

Your digital vaccine record does not automatically update. If you receive an additional dose of the COVID-19 vaccine, you'll have to get a new QR code through the Digital COVID-19 Vaccine Record portal.

We recommend waiting fourteen days for your new dose to show up in the California Immunization Registry.

Will an antibody or other test show whether I need an additional dose?

We do not recommend using antibodies or any other tests to determine protection from the virus at this time. There is significant variability from one antibody test to another, and further studies are needed to ensure correlation between antibody levels and degree of protection from COVID-19 and its variants.

Does receiving an additional vaccine dose eliminate the need for further harm-reduction precautions?

To prevent severe illness and death, a comprehensive approach to harm-reduction is needed. In addition to receiving all eligible doses, it is imperative that we keep all Californians safe by staying SMART: masking up in large crowds or when feeling sick, staying aware of rising cases in your area, and getting tested with known or suspected exposure.

Is there a test to determine who qualifies as an immunocompromised individual?

No, if you think you qualify but are not positive, please check with your medical provider to confirm you are eligible for an additional dose.

As a person with a weak immune system, once I get an additional dose, can I reduce the use of other precautions such as masking, distancing, and avoiding groups and crowds?

No, because even with an extra dose of mRNA vaccine, not everyone with a compromised immune system builds immunity at the same rate. Further studies are needed to ensure correlation between antibody levels and degree of protection from COVID-19 and its variants. Harm-reduction strategies are just as important to continue following.


Provider Questions

How do providers order an additional supply of vaccine doses?

Vaccine providers don't need specific vaccines for additional doses. It is the same dose as used in the original vaccination.

How are additional doses recorded in a series?

All doses administered to an individual are recorded in CAIR in the same way.

How are additional doses recorded in CAIR?

All doses administered to an individual are recorded in CAIR in the same way.


More Information


Originally published August 16, 2021