Published:
April 13, 2022
On March 29, 2022, the FDA and CDC expanded access to a fourth dose (or second booster shot) of the COVID-19 vaccines. Many people have questions about this second booster—and the vaccine in general. We compiled some frequently asked questions to help you sort it all out.
What if I haven’t received my first booster shot yet?
All of the published information and science tells us that being fully vaccinated and boosted provides significant protection from infection and the most serious complications of COVID-19, including hospitalization, severe illness and death. If you are eligible for your first booster dose and have not yet received it, we strongly recommend you get that now.
What if I received my third shot (first booster), and I have a compromised immune system? Should I get a fourth shot?
For patients with moderately or severely compromised or weakened immune systems, the fourth shot is important to stay protected. If you have a weakened immune system, we strongly recommend you get a fourth dose as soon as three months after you received your third dose.
What if I’m over 50, and I don’t have a moderately or severely compromised immune system?
Based on available information from the FDA and international studies, a fourth dose (second booster) in older people, especially those with underlying medical conditions, provides a few months of higher antibody levels. You are eligible to get a fourth shot of the Pfizer-BioNTech or Moderna vaccines if you are age 50 and older, and at least four months have passed from your first booster.
If you are 50 and older, we recommend you speak to your medical team to determine when a fourth dose may be right for you.
I am over the age of 50. Should I get a fourth dose now if I had a COVID-19 infection during the Omicron surge in January and February 2022 despite being vaccinated?
Your recent Omicron infection is a natural boost to your immunity, so it is reasonable to wait a few months before getting your fourth dose. You can talk about your individual risk and benefit and discuss the best timing of your fourth dose with your medical team.
Who is moderately or severely immunocompromised?
As a general guideline, the CDC has identified people as moderately or severely immunocompromised if they:
- Are 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 two years or are taking medicine to suppress the immune system
- Have moderate or severe primary immunodeficiency (i.e., DiGeorge syndrome, Wiskott-Aldrich syndrome and others)
- Have advanced or untreated HIV infection
- Are in active treatment with high-dose corticosteroids or other drugs that may suppress the immune response including B cell targeted CD20- and CD19-directed therapies, such as rituximab, obinutuzumab, tafasitamab and blinatumomab
The degree of immune system compromise is not always clear. We recommend you talk with your medical team to determine whether your condition is moderately or severely immunocompromising, and whether you should get a fourth dose.
Schedule your COVID-19 vaccination and booster shots at LGHealth.org/Vaccine. For additional information on COVID-19 vaccinations, please visit the CDC’s website.
Michael R. Ripchinski, MD, MBA, CPE, FAAFP
Chief Physician Executive,
Penn Medicine Lancaster General Health