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COVID-19 Vaccine Third Dose vs. Booster Shots

It takes at least 2 weeks to develop full immune protection after getting your final dose of COVID-19 vaccine.

You are considered fully vaccinated if it has been at least:

  • 2 weeks since your second dose of the Pfizer-BioNTech or Moderna vaccine
  • 2 weeks after 1 dose of the Johnson & Johnson vaccine

Because protection after vaccination may decrease over time, you may also need a COVID-19 booster shot.

The CDC recommends you stay up to date with your COVID-19 vaccines to better protect yourself and others. Everyone 6 months of age and older can now be vaccinated.

Up-to-date means you have received all doses in the primary series and one booster when eligible. It is recommended that everyone 5 and older get one booster. Second COVID-19 boosters are recommended for people in certain groups.

CDC vaccine recommendations

The CDC recommends that anyone who can receive one of the two mRNA vaccines (Pfizer-BioNTech or Moderna) do so. However, the Johnson & Johnson vaccine is available for those over 18 who cannot take an mRNA vaccine due to issues such as a severe allergy. 

This recommendation is based on:

  • Evidence and effectiveness
  • Safety
  • Adverse events

The Advisory Committee on Immunization Practices for the prevention of COVID-19 recommends receiving any vaccine—including the Johnson & Johnson vaccine—over not being vaccinated. 

If you are immunocompromised (have a weak immune system), your doctor may recommend an additional dose of COVID-19 vaccine as part of your initial vaccination series.

The third dose of a COVID-19 vaccine helps those with weak immune systems who may not have built up enough immunity from the first two doses of Pfizer-BioNTech or Moderna.

The booster shot  helps combat a decrease in immune response over time.

People who are immunocompromised may need an additional vaccine does to help protect against COVID-19.

COVID-19 vaccine third dose

Studies have shown that people with weakened immune systems may have a reduced immune response to the vaccine. This results in less protection against severe COVID-19.

People who may need an additional dose of COVID-19 vaccine include patients who:

  • Are currently on active treatment for cancer
  • Have had CAR T-cell therapy or stem cell (bone marrow) transplant within the last 2 years
  • Have an immune system disorder including advanced or untreated HIV infection
  • Have had an organ transplant and are taking medicines that suppress the immune system to prevent rejection of the organ
  • Are taking medicines that severely suppress the immune system such as high-dose corticosteroids, chemotherapy, or other biologic drugs

The third dose can help boost your immune system’s response to the vaccine. You should get your third dose at least 28 days after your last dose. It should be the same vaccine you received previously. 

Currently third doses are authorized for: 

  • People ages 5 and older who were vaccinated with Pfizer-BioNTech and have weakened immune systems
  • People aged 18 and older for those who were vaccinated with Moderna and have weakened immune systems

If you have questions about whether you’re eligible for a third dose, talk with your doctor.

COVID-19 booster shots

Studies have shown that immunity may decrease over time.

The Food and Drug Administration (FDA) authorized boosters for all adults. And the Centers for Disease Control and Prevention (CDC) has updated guidance on who can have boosters.

  • People over age 18 who received a Pfizer-BioNTech vaccine should receive a booster dose at least 5 months after completing their second dose. People who are 12 to 17 may receive a booster at least 5 months after completing their second dose. Children ages 5 to 11 may now also receive a booster dose at least 5 months after completing their second dose.
  • People over age 18 who received a Moderna vaccine should receive a booster dose at least 5 months after completing their second dose.
  • Those 18 and older who received a single dose of Johnson & Johnson should receive a single Johnson & Johnson booster dose at least 2 months after completing their first dose.
  • The FDA has authorized a COVID-19 bivalent booster for people 12 and older. The bivalent booster targets the original strain of COVID-19 as well as omicron subvariants BA.4 and BA.5. 
    • The Pfizer-BioNTech bivalent booster is authorized for people 12 and older. 
    • The Moderna bivalent booster is authorized for people 18 and older. 
    • The bivalent booster can be given two months after the most recent dose. It replaces the original booster.
    • When anyone 12 or older is due for a COVID-19 booster, they should get the bivalent shot.

People in certain groups are eligible for a second COVID-19 booster. Talk to your health care provider about it.

In general, a COVID-19 vaccine booster dose should be the same vaccine brand as what you originally received. However, you may choose to get a different COVID-19 vaccine as a booster shot. Mix and match dosing for booster shots is allowed under current recommendations. Talk to your health care provider if you have questions.

Key Points

  • COVID-19 vaccines are available for everyone 6 months of age and older.
  • Everyone ages 5 and older are also eligible for COVID-19 boosters 5 months after their final dose.
  • Third doses of the COVID-19 are recommended for some people.
  • Your child’s care team can help you make the best decision for your family.
How antibodies work after receiving extra doses and booster shots.

Reviewed: October 2022