People with weakened immune systems are now eligible for an additional dose of Pfizer or Moderna COVID-19 vaccine following a primary mRNA vaccine series to help prevent serious and possibly life-threatening COVID-19. Health officials are not recommending booster vaccine doses for the general public and have not addressed the need for additional doses following the Johnson and Johnson (J&J) vaccine but is continuing to review the need for booster doses in this population. A third dose of Pfizer or Moderna COVID-19 vaccine is not a booster dose but is an additional dose for people in whom the initial response to the vaccine series was insufficient.

The Alabama Department of Public Health (ADPH) follows the guidance of the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC) regarding all vaccines, including COVID-19 vaccine. ADPH has notified Alabama healthcare providers about these recommendations and will implement additional third-dose vaccines as outlined by these experts.

Moderately to severely immunocompromised people make up only about 3 percent of U.S. adults; however, they represent 40 to 44 percent of people hospitalized with COVID-19. Vulnerable people who may benefit from an additional vaccine dose include those with medical conditions or who are receiving treatment associated with moderate to severe immune compromise with at least one of the following conditions:

• Active or recent treatment for cancer - solid tumor and blood malignancies

• Receipt of solid organ or recent hematopoietic stem cell transplants

• Severe primary immunodeficiency

• Advanced or untreated HIV infection

• Active treatment with high-dose corticosteroids, alkylating agents, antimetabolites, tumor-necrosis blockers, and other biologic agents that may suppress immune response

• Persons with chronic medical conditions such as asplenia and chronic renal disease which may be associated with varying degrees of immune deficiency

Persons seeking additional vaccine doses are advised to consult their healthcare provider who can provide them with a prescription for a 3rd mRNA dose of Pfizer or Moderna or alternatively can present to a COVID-19 vaccination site and self-attest that they fall in this eligible population. The additional dose of mRNA COVID-19 vaccine should be administered at least 28 days after completion of the primary mRNA COVID-19 vaccine series.

The additional dose should be the same vaccine product as the initial COVID-19 vaccine series (Pfizer-BioNTech or Moderna). There is not enough data at this time to determine whether immunocompromised people who received J&J’s Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.

Immunocompromised people, including those who receive an additional mRNA dose, should continue to follow prevention measures including the following:

· Wear a well-fitting mask

· Stay 6 feet apart from others outside their household

· Avoid crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider

In addition, close contacts of immunocompromised people are strongly encouraged to be vaccinated against COVID-19. ADPH continues to recommend all persons 12 years of age and above be vaccinated against COVID-19 as the best line of defense against this severe and deadly virus. Visit https://www.alabamapublichealth.gov/covid19/index.htmlfor more information.

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