COVID-19 Vaccines for Moderately or Severely Immunocompromised People


If you are moderately or severely immunocompromised (have a weakened immune system), you are at increased risk of severe COVID-19 illness and death. CDC recommends that you complete your primary series of COVID-19 vaccines if you are 5 years and older, and if you are 12 years or older, get a booster. Because the immune response following COVID-19 vaccination may differ in people who are moderately or severely immunocompromised, specific guidance has been developed.


Children Ages 5-11 Years Who Are Moderately or Severely Immunocompromised

Children ages 5 through 11 years who are moderately or severely immunocompromised should receive a primary series of 3 doses of Pfizer-BioNTech COVID-19 vaccine. A booster is not recommended for this age group at this time.

Primary Series COVID-19 Vaccine

Age Group

Number of Doses to Complete Primary Series and Timing

Booster and Timing

Pfizer-BioNTech

5–11 years

3 doses

2nd dose given 3 weeks (21 days) after 1st dose 3rd dose given at least 4 weeks (28 days) after 2nd dose

Not recommended

Pre-teens, Teens and Adults Who Are Moderately or Severely Immunocompromised

People ages 12 years and older who are moderately or severely immunocompromised should receive a total of 4 doses of COVID-19 vaccine. The 4 doses are made up of a primary series of 3 doses of an mRNA COVID-19 vaccine, plus 1 booster of an mRNA COVID-19 vaccine (4th dose).



Primary Series COVID-19 Vaccine

Age Group

Number of Doses to Complete Primary Series and Timing

Booster and Timing

Pfizer-BioNTech

12+ years

3 doses

2nd dose given 3 weeks (21 days) after 1st dose

3rd dose given at least 4 weeks (28 days) after 2nd dose

1 booster

Given at least 3 months after 3rd dose

Moderna

18+ years

3 doses

2nd dose given 4 weeks (28 days) after 1st dose 3rd dose given at least 4 weeks (28 days) after 2nd dose

1 booster

Given at least 3 months after 3rd dose

*Although mRNA vaccines are preferred for people 18 years and older, J&J/Janssen COVID-19 vaccine may be considered in some situations.


People Who Are Moderately or Severely Immunocompromised and Have Received a J&J/Janssen Vaccine

People ages 18 years and older who are moderately or severely immunocompromised and received the 1 dose Johnson & Johnson’s Janssen COVID-19 vaccine should get a second dose of either Pfizer-BioNTech or Moderna COVID-19 vaccine (mRNA COVID-19 vaccines). They should also receive a booster—for a total of 3 doses.

Primary Series COVID-19 Vaccine

Age Group

Number of Doses to Complete Primary Series and Timing

Booster and Timing

J&J/Janssen

18+ years

2 doses

1st dose J&J/Janssen 2nd dose Pfizer-BioNTech or Moderna (mRNA COVID-19 vaccines) given at least 4 weeks (28 days) after 1st dose

1 booster

Either Pfizer-BioNTech or Moderna (mRNA COVID-19 vaccines) in most situations given at least 2 months after 2nd dose

Who Is Moderately or Severely Immunocompromised?

Many conditions and treatments can cause a person to be immunocompromised, also known as having a weakened immune system. People are considered to be moderately or severely immunocompromised 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 2 years or are taking medicine to suppress the immune system

  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)

  • Advanced or untreated HIV infection

  • Active treatment with high-dose corticosteroids or other drugs that may suppress their immune response

People should talk to their healthcare provider about COVID-19 vaccination given their medical condition.

People Who Were Vaccinated Outside of the United States

People who are moderately or severely immunocompromised and completed a primary COVID-19 vaccine series with a U.S. Food and Drug Administration (FDA) approved or FDA-authorized COVID-19 vaccine (Pfizer-BioNTech, Moderna, or J&J/Janssen) outside of the United States should follow the guidance above.

People who are moderately or severely immunocompromised and were vaccinated outside of the United States and:

  • Received all the recommended doses of a World Health Organization Emergency Use Listing (WHO-EUL) COVID-19 vaccine, not approved or authorized by FDA, or

  • Completed a mix and match series composed of a combination of one FDA-approved or FDA-authorized and one WHO-EUL COVID-19 vaccine, or of two WHO-EUL COVID-19 vaccines

Should receive a third primary dose of Pfizer-BioNTech or Moderna COVID-19 vaccine at least 4 weeks (28 days) after completing the primary vaccine series. Learn more about the COVID-19 Interim Clinical Considerations.


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