Need to Know: Second COVID-19 Booster Dose

Currently, there are three populations eligible to receive a second booster dose of COVID-19 vaccine. These populations include people who may be at an increased risk of severe illness, hospitalization and death due to COVID-19 infection. According to the FDA, current evidence suggests some waning of protection over time against serious outcomes from COVID-19 in older and immunocompromised individuals. People need to consider their age and health status when choosing whether or not to receive an additional booster dose. North Dakotans are encouraged to have a conversation with their doctor or a trusted health care provider to make sure they are making the best decision for themselves.

1. All adults ages 50 years and older

All adults ages 50 and older are eligible to receive a second booster dose of an mRNA (Pfizer or Moderna)  COVID-19 vaccine at least four months after their first booster dose of any approved or authorized COVID-19 vaccine.

2. All individuals 12 years and older who are immunocompromised

All individuals age 12 or older who are moderately or severely immunocompromised are eligible for a second booster dose of an mRNA (Pfizer or Moderna) COVID-19 vaccine at least four months after their first booster dose. Currently, adolescents aged 12-17 years old are only authorized to receive the Pfizer COVID-19 vaccine for all doses including their primary series, additional dose and booster doses. If you are moderately or severely immunocompromised and have not received your additional dose, you must do so before requesting a booster dose. Please refer to your health care provider if you have questions regarding if your medical condition qualifies you as a patient who is moderately or severely immunocompromised.

3. All adults 18-49 years old who have received two doses of Johnson & Johnson’s COVID-19               vaccine

All adults 18-49 years old who received the Johnson & Johnson COVID-19 vaccine for both their primary dose and first booster dose at least four months ago are now eligible to receive a second booster dose of an mRNA (Pfizer or Moderna) COVID-19 vaccine. This guidance does NOT include adults who received the Johnson & Johnson COVID-19 vaccine for their primary series but then received a first booster dose of an mRNA (Pfizer or Moderna) COVID-19 vaccine.

There are a number of reasons why you may want to consider receiving a second booster dose if you are eligible. Your decision will depend on your personal level of risk associated with COVID-19 infection, including whether or not you are at an increased risk of severe illness, hospitalization and death, as well as your age and when you received your last dose of COVID-19 vaccine.

A second booster may lower your risk of dying due to COVID-19.

Data from Israel indicates an additional (second) booster dose is safe and lifesaving. Mortality due to the omicron variant in this data set was significantly lower—a 78% reduction—in those ages 60 and older in Israel who received a second booster dose.

Your risk of severe COVID-19 illness increases with age.

The older you are, the greater the benefit a second booster dose may bring you, because protection provided by vaccine booster shots wane over time. Throughout the pandemic, older adults have been more likely to become severely ill from COVID-19. Older adults with COVID-19 are at increased risk of requiring hospitalization, intensive care admission or a ventilator to help them breathe. Additionally, older adults have a 25x-340x greater risk of dying, depending on their age, from COVID-19 compared to individuals aged 18-29 years old. Older adults and individuals living in long term care facilities (such as assisted living and skilled nursing homes) are encouraged to speak with their health care provider regarding receiving a second booster dose.

Vaccine effectiveness after your first booster may begin to wane over time.

The vaccine effectiveness of the COVID-19 vaccine has been shown to decrease over time. Therefore, public health officials and health care workers strongly recommend the importance of staying up to date with your immunizations and getting booster doses when you are eligible. During the peak of the omicron wave, adults were 94% less likely to end up on a ventilator or die from COVID-19 after receiving three shots (or after their first booster dose) when compared to those who had only received two shots. However, this observed level of protection may begin to decrease over time.

A recent CDC analysis shows evidence of waning immunity against COVID-19 emergency room visits and hospitalizations visits during the omicron-predominant period. Two months after a third dose (or first booster dose), people were 91% protected against hospitalization. Four months after that dose, protection dropped down to about 78%. Fortunately, a study conducted in Israel found recipients of both Pfizer or Moderna COVID-19 vaccines had a ∼9-10-fold increase in IgG and neutralizing titers within two weeks of second booster dose vaccination, restoring titers to those measured after the third vaccine dose. Thus, an additional booster dose can provide additional protection.

Data suggests a second booster dose of an mRNA COVID-19 vaccine improves protection against severe COVID-19 and is not associated with any new safety concerns. The FDA has determined the known and potential benefits of a second COVID-19 vaccine booster dose with either of these vaccines outweigh their known and potential risks in these populations.

North Dakotans are encouraged to have a conversation with a trusted health care provider regarding whether or not to receive a second booster dose. Depending on your age, health status, when you had your prior infection and which COVID-19 variant you likely had your health care provider may determine it is best to delay a second booster dose.

The CDC recommends people be vaccinated even if previously testing positive for COVID-19. Individuals may choose to delay vaccination for 90 days after an infection. Emerging evidence suggests the best protection against COVID-19 illness is hybrid immunity, having both vaccination and prior infection. It is best to be vaccinated prior to be infected to reduce severe outcomes from COVID-19.