HEALTH ADVISORY: Additional mRNA COVID-19 vaccine dose after an initial 2-dose COVID-19 mRNA vaccine series for immunocompromised people.


  • The U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) for the available mRNA vaccines to include the option of administering an additional dose of an mRNA vaccine to immunocompromised individuals.
  • The Advisory Committee on Immunization Practices (ACIP) made an interim recommendation for an additional dose of Pfizer and Moderna COVID-19 vaccine for people with defined moderate to severe immunosuppression, at least 28 days after the completion of an initial 2-dose primary mRNA COVID-19 vaccine series. There is no maximum time period for when a third dose can be given after the second dose.
  • At this time, an additional dose of COVID-19 vaccine is not recommended for any other group.
  • Currently, there are insufficient data to support the use of an additional mRNA COVID-19 vaccine dose after a single-dose Janssen COVID-19 vaccination series in immunocompromised people.
  • The age groups authorized for an additional dose remain the same as those for the primary mRNA COVID-19 dose series (Pfizer: aged ≥12 years or Moderna: aged ≥18 years).
  • Serologic testing to assess immune response to vaccination is not recommended.
  • The reactogenicity profile of the additional dose was similar to prior doses of mRNA COVID-19 vaccines.
  • Although certain chronic medical conditions, such as diabetes and cardiovascular disease, may be associated with varying degrees of immune deficit, these conditions are not considered moderately to severely immunosuppressive and thus a third dose of vaccine is not recommended at this time.
  • Immunocompromised individuals should be informed about the potential for a reduced immune response to vaccination, even after a third dose, and the need to continue other COVID-19 prevention measures.
  • Regardless of vaccination status, providers should discuss monoclonal antibody treatment options with their immunocompromised patients and encourage them to seek care right away if they have COVID-19 symptoms or an exposure to someone confirmed with COVID-19.

Click here to access the full health advisory by NYSDOH. Click here to access NYSDOH’s Guidance for the New York State COVID-19 Vaccination Program. Click here to access DOHMH Vaccine Information for Providers.

Published on 08/18/2021