Mufid Majnun on Unsplash.

None of the information provided is medical advice, and individuals should consult their providers with medical questions.

Who is eligible for the third COVID-19 vaccine?

At this time, immunocompromised patients who have received the Pfizer or Moderna two-dose regimen are eligible for a third dose.

What qualifies as immunocompromised?

The CDC recommendation includes individuals who are moderately to severely immunocompromised. Under this definition, the CDC 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 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 your immune response”

The NC Department of Health and Human Services issued guidance to providers about administering the third dose.

“Factors to consider in assessing the general level of immune competence of patients include disease severity, duration, clinical stability, complications, comorbidities, and any potentially immune-suppressing treatment,” the guidance said.

Why would immunocompromised people need a third dose?

Immunocompromised individuals may not develop vaccine response, or immune protection, at the same level as healthy people from the first two-dose regimen.

Data presented at the CDC committee meeting showed patients with hematologic cancers had less response than other cancers. Organ transplant recipients also had low response.

CDC ACIP presentation. August 13, 2021.

Some small studies showed “fully vaccinated immunocompromised people have accounted for a large proportion of hospitalized breakthrough cases (40-44%). Immunocompromised people who are infected with SARS CoV-2 are also more likely to transmit the virus to household contacts,” according to a statement by the FDA.

Will I have to prove my status? Do I need a prescription or letter from my medical provider?

Immunocompromised patients are asked to self-attest to their status, or declare that they are immunocompromised. No prescription or letter is needed.

When can I get a third dose?

The CDC advises individuals wait at least 28 days after their second dose to receive a third dose.

Do I get the same shot I received for the first two doses?

“For people who received either Pfizer-BioNTech or Moderna’s COVID-19 vaccine series, a third dose of the same mRNA vaccine should be used,” according to the CDC. “If the mRNA COVID-19 vaccine product given for the first two doses is not available, the other mRNA COVID-19 vaccine product may be administered.”

What if I received the Johnson & Johnson vaccine first?

Currently, the CDC does not recommend an additional dose for Johnson & Johnson recipients.

“There is not enough data at this time to determine whether immunocompromised people who received the Johnson & Johnson’s Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine,” according to the CDC.

Should I get an antibody test before I get a third dose?

Testing is not recommended by the CDC. Different tests may show varying results, and it is not yet clear whether the results correlate with protection from COVID-19, according to Dr. Kathleen Dooling of the CDC. 

Where can I get my third shot?

Patients are encouraged to contact their health provider about eligibility and appointment scheduling. Vaccine doses are available through CVS and Walgreens. UNC Health is offering doses to qualified individuals with online scheduling. Other major hospitals in the state are expected to issue additional guidance on availability shortly.

Once I get a third shot, can I stop taking other precautions?

No. The CDC recommends continued hand-washing, masking and social distancing for immunocompromised individuals, regardless of vaccine status.

My child is immunocompromised but is too young to qualify under the current EUA for COVID-19 vaccines. Does this guidance make age-related exceptions?

The current third dose recommendation is only for those individuals who were eligible under the earlier approval. Patients 12 and older who received the Pfizer vaccine two-dose regimen may receive a third dose. Those under 12 are not yet eligible for vaccination.

I am about to begin an immunosuppressing drug. How does this affect the timeline for vaccination?

“Whenever possible, mRNA COVID-19 vaccination doses (including the primary series and an additional dose) should be completed at least two weeks before initiation or resumption of immunosuppressive therapies, but timing of COVID-19 vaccination should take into consideration current or planned immunosuppressive therapies and optimization of both the patient’s medical condition and response to vaccine,” according to the CDC guidelines.

I’m not immunocompromised but I have a chronic condition. Should I get a third dose?

The FDA and CDC do not recommend additional doses for non-immunocompromised patients at this time.

“For example, it would not include long-term care facility residents or persons with diabetes, persons with heart disease,” Dr. Amanda Cohn, senior adviser for vaccines at the CDC’s National Center for Immunization and Respiratory Diseases said. “Those types of chronic medical conditions are not the intent here.”

How many people in North Carolina have received a third dose?

According to the NC Department of Health and Human Services, almost 19,000 people have received a third dose.

NC Providers9,074
Federal Pharmacy Programs9,862
NCDHHS data as of Aug. 26, 2021.

I have other questions about the vaccines. Where can I find answers?

Find more answers at the FAQ on vaccination including logistics, locations and safety data.

Editor’s note: This article was initially posted on Aug. 16, 2021 but has been updated several times, most recently on Aug. 28, 2021.

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Laura Lee is the former news editor at Carolina Public Press.

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