Q: Who Needs an Additional COVID-19 Vaccine?
A: Currently, the Centers for Disease Control and Prevention (CDC) is recommending that moderately to severely immunocompromised people receive an additional dose. This includes people who:
Talk to your health care provider about your medical condition and whether getting an additional dose is appropriate for you.
Q: I am an immunocompromised patient of National Jewish Health. When will I receive a third dose? Will I be contacted by National Jewish Health?
A: National Jewish Health is prepared to give a third dose of the Pfizer-BioNTech vaccine immediately. We are actively researching which of our patients meet the immunocompromised criteria so that we can notify you to come in and receive your next dose of the vaccine.
Q: Can I mix and match vaccine types/doses between the first two and the third?
A: No. While there have been some studies suggesting this is acceptable, mixing vaccine types (Moderna and Pfizer, etc.) and doses is not recommended at this time, except in extenuating circumstances. In addition, a person should not receive more than three mRNA COVID-19 doses of any type.
Q: What do I do if I am immunocompromised and received Johnson & Johnson as my initial vaccine?
A: 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. Watch for additional guidance from the CDC or talk to your doctor if you have immediate questions.
Q: Why do I need a third dose? What are the benefits?
A: The research trials around the vaccine suggest there may be decreased effectiveness over time. The third dose is designed to re-prime your immune system to provide better immunity. The third dose may still not provide full immunity to COVID-19 in people who are immunocompromised, and you should continue to maintain physical precautions to help prevent COVID-19. In addition, your close contacts should be vaccinated as appropriate.
Q: What are the risks of receiving a third dose of COVID-19 vaccine?
A: The information on risks of the third dose is currently limited and continues to be evaluated. Reported reactions so far are similar to that of the initial two doses – fatigue and pain at the site of injection were the most commonly reported, with most symptoms being mild to moderate.
Q: What are the risks of not receiving a third dose of COVID-19 vaccine?
A: Emerging data have demonstrated that immunocompromised people who have low or no protection following two doses of mRNA COVID-19 vaccines may have an improved response after an additional dose of the same vaccine. Not receiving the third does may increase your risk of serious infection.
Q: How long do I need to wait after my second dose for my third?
A: If you are immunocompromised, you may receive a third dose COVID-19 vaccine at least one month after the second dose. These guidelines are the same for both the Pfizer and Moderna COVID-19 vaccines. There is currently no guidance on getting an additional dose of the Johnson & Johnson COVID-19 vaccine.
Q: Is the vaccine amount in the third dose the same as the first two?
A: Yes, the amount of the third dose is the same as the first two. Remember, mixing vaccine doses (Moderna and Pfizer, etc.) is not recommended at this time, except in extenuating circumstances.
Q: When will non-immunocompromised people need a third dose?
A: Non-immunocompromised people may need a third dose of vaccine, but at this time, there is no authorization or guidance on timing for those individuals. Additional information will likely be released by the CDC and the U.S. Food and Drug Administration (FDA) over the next several weeks.
Q: Where can I get additional information?
A: Additional information can be found on the CDC website.
Q: Can I mix and match the three different vaccines?
A:To date, there are no studies about the efficacy and safety of mixed-product series. The three COVID-19 vaccines are not interchangeable. However, if an individual is unable to complete the series with one of the mRNA vaccines, the Janssen COVID-19 vaccine may be administered at least 28 days from the first dose of the mRNA vaccine. In addition, in exceptional situations in which vaccine type of the first dose is undetermined or unavailable, an individual could receive any available mRNA vaccine with a minimum of 28 days between doses.
Q: Can the COVID-19 vaccine give you the disease?
A: No! The vaccine cannot give you COVID-19. The mRNA vaccines and recently approved adenovirus vaccine from Johnson & Johnson contain only a tiny part of the virus's genetic material, instructions to make just one protein called "s" or "spike." None of the vaccines contain the pieces needed to make more virus. You can have side effects from the vaccine, including low grade fevers, chills, and body aches, but those are effects of your immune system responding to the vaccine and developing immunity.
Q: How do these first COVID-19 vaccines work?
A: Vaccines expose us to pieces of either a bacteria or a virus, which causes our bodies to recognize a potential threat and to mount an immune response. The goal with a vaccine is to help the body prepare for an actual infection, so it is ready to rapidly and effectively eliminate the SARS-CoV-2 virus when exposed to it.
There are different types of vaccines. The Pfizer, Moderna and Johnson & Johnson vaccines all carry genetic material, which the cells use to make copies of the viral spike protein. The Pfizer and Moderna messenger RNA (mRNA) vaccines deliver genetic material inside minuscule oily bubbles. The Johnson & Johnson vaccine carries the coronavirus genetic material within a harmless cold virus, which has been altered so that it cannot copy itself inside a cell and therefore cannot make you sick. Once your cells use that genetic material to make the coronavirus spike proteins, they will be displayed on the surface of those cells. Immune cells will encounter these proteins, recognize them as foreign invaders, and generate an immune response specific to the spike protein. Then if you are exposed to the real virus, your body activates that specific immune response so that antibodies can disable the virus and protect you from getting sick.
Q: How soon will someone be protected after taking the vaccine?
A: With the two mRNA vaccines, it is estimated that immunity develops around two to three weeks after completing the second shot in the series. The exact timing of immunity can vary because each vaccine works a little differently and every individual responds a little differently. Both the Pfizer and Moderna vaccines are two-shot vaccines, and it is important that an individual have both shots in order to confer the degree of immunity demonstrated by the trials.
The Johnson & Johnson adenovirus vaccine requires only one shot. Most people develop some immunity within two weeks of getting the shot, with full immunity about four weeks after the shot.
Q: How many shots will I need to get?
A: The Pfizer and Moderna vaccines require two shots given three to four weeks apart. The Johnson & Johnson shot requires one shot.
Q: Can I get the vaccine if I am not feeling well?
A: If you are in a group that is currently eligible to receive the vaccine and you are not feeling well, it is recommended that you wait until you are feeling better to get the vaccine. If you have symptoms and/or signs of respiratory infection, evaluation and testing from health care resources in your community is recommended.
Q: If you have severe allergies or food allergies, including anaphylaxis, should you get the COVID-19 vaccine?
A: You should talk to your doctor, but for most people the answer is YES, you should get the vaccine. Your doctor may tell you to take medicine before and after the shot to decrease the risk of an allergic reaction. You should also tell people giving you the vaccine that you have allergies, and remain at the vaccine site for at least 15-30 minutes after receiving the shot. Most people with allergies have not had a problem with the vaccine. The CDC considers it a “precaution” to vaccination if you have had an allergic reaction to any injectable medicine or vaccine but not to other medications or environmental allergens. The only true contraindications to the vaccine are having had an allergic reaction to one of the vaccine’s components, or to a first dose of the vaccine itself.
Q: If you have cancer, should you get the COVID-19 vaccine?
A: You should talk to your oncologist. For most people, the answer is YES, you should get the vaccine. Cancer is a risk factor for having more severe COVID-19, and the vaccine can help prevent severe disease.
Q: If you are pregnant or nursing, should you get this vaccine?
A: You should talk to your doctor and decide together. The vaccine was not formally studied in pregnant people, so safety data are not available. However, pregnant women are at increased risk of severe COVID-19, and based on current studies, experts believe mRNA vaccines, like other vaccines that do not contain live virus, are not a risk to pregnant people. While safety in breastfeeding women was not studied, scientists believe the vaccine is unlikely to pose a risk to breastfeeding mothers or infants.
Q: I recently received passive antibody therapy for COVID-19, can I still get vaccinated with a COVID-19 vaccine?
A: Yes, BUT vaccination should be deferred for at least 90 days for individuals who had received monoclonal antibodies or convalescent plasma as part of COVID-19 treatment as a precaution to prevent those therapies from potentially interfering with development of immunity from the vaccine.
Q: What are the side effects of the vaccine?
A: Side effects of the vaccines include flu-like symptoms such as aches, headache and fever. A small number of people with a history of allergies have developed severe allergic reactions after receiving the vaccine. As a result, people receiving vaccines are asked about their history of allergic reactions and are advised to remain at the vaccine site 15 to 30 minutes after receiving the shot to make sure they do not develop allergic reactions. All vaccination sites are equipped with medications to treat allergic reactions. A CDC analysis of 14 million Pfizer and Moderna vaccinations from January to February 2021, found a rate of 4.5 cases of anaphylaxis for every 1 million doses which is similar to other vaccines that have been given for influenza or pneumonia.
Q: Are COVID booster shots anticipated as being necessary in years to come?
A: Booster shots are quite likely because the experience with other coronaviruses that cause the common cold is that after becoming sick (i.e., natural infection) you lose immunity over a matter of months. One study of people who had COVID-19 showed only a small drop in immune responses at six to eight months, though it is still unclear if those responses mean protection from reinfection. The hope is that a COVID-19 vaccine will provoke a stronger and more lasting protective immune response even than many people who have had “natural infection” with COVID-19. In scientific experiments, the response to the mRNA vaccines was still strong at three months, and studies are ongoing to see how long it truly lasts. However, there is a strong possibility that people will need re-vaccination at some point for this “durability” consideration. If the virus mutates into variants for which the vaccine is not as effective, a booster may be needed.
Q: Did disease specialists anticipate “dual pandemics” with COVID-19 and the flu season?
A: Yes, the health care field was concerned about having a typical flu season overlap with COVID-19. Influenza typically leads to around 150,000 hospitalizations in the United States in any given year and our health care system in fall 2020 was already pushing capacity from COVID-19, and other usual medical conditions. So, to have added a typical flu season to our winter COVID-19 wave would have been a tremendous stress to the system, and it’s when the hospital system is stressed that morbidity and mortality from COVID-19 increase, as seen in places such as northern Italy and New York City early on.
Q: Does the COVID-19 vaccine take the place of the Pneumococcal vaccine or the flu vaccine?
A: No, the COVID-19 vaccine specifically protects against infection by SARS-CoV-2. It does not take the place of the pneumonia vaccine or the flu vaccine, which are caused by other organisms. Please consult with your health care provider regarding which vaccines are recommended for you.
Q: Will COVID-19 become a seasonal illness such as influenza?
A: COVID-19 is already seasonal in that there have been larger spikes of cases in the winter months, as is seen for many respiratory viruses. However, unlike influenza which drops to very low prevalence in the summertime, cases of COVID-19 remained at a significant level even in warmer months. This ongoing “reservoir” of virus in the population allows for the pandemic to persist. A larger amount of circulating virus in the population also allows for more opportunities for mutation over time and the creation of variants of SARS-CoV-2 (the virus that causes COVID-19). Depending on the mutations they carry, these variants can be more transmissible, or elicit a less effective immune response in people who have already had COVID-19 or been vaccinated. As the virus continues to mutate you may continue to see spikes here and there in different places at different times, which may or may not be seasonal. The premature relaxing of mitigation measures (social distancing, masking) could also lead to similar spikes. The immunity you get from either “natural infection” (getting sick with COVID-19) or vaccination may fade over time. Repeated vaccination may be necessary, without which we could see regular spikes accentuated by the seasons.
Q: Have wearing masks, social distancing and handwashing helped decrease cases of influenza this season?
A: Yes. When social distancing measures were put into place in the spring, at the start of the COVID-19 pandemic, the influenza season abruptly ended. Like SARS-CoV-2 and other respiratory viruses, influenza is spread primarily from respiratory particles breathed or coughed out by one person that travel short distances through the air to be inhaled by another person. The other measure that has helped prevent flu this season was limiting international travel which typically allows influenza strains to circulate around the world.
Q: Can we stop masking and social distancing after receiving the vaccine?
A: Until your vaccine if fully effective (about two weeks), in public you should continue to mask, practice social distancing and wash your hands often and well, even if you get a vaccine. Once fully vaccinated you may gather privately with other vaccinated individuals or a single unvaccinated family, assuming there is no one in that family with a medical condition that puts them at risk for severe COVID-19. It is important to remember that since full immunity is not reached until several weeks after completion of a vaccine series, the vaccine does not immediately protect you and therefore masking and social distancing continue to be important in this period. Although COVID-19 vaccines protect against severe infection very well, we are still unsure to what degree they prevent mild or asymptomatic infection. If this is the case, an infected person could still spread the virus, which can put others nearby at risk. If you develop symptoms of COVID-19, get tested, stay home and practice basic safety – mask-up, practice social distancing, wash your hands often and well.
Q: Are the vaccines effective against COVID-19 virus variants?
A: Yes. Remember that even if the vaccines are less effective for certain variants, they are still quite effective in preventing serious illness and death even in these variants. Also, the chances of contracting a variant for which current vaccines are less effective is still small – so it would be foolish to not receive a vaccine right now due to concern over variants.
Q: Will the COVID-19 vaccine still work if the virus mutates?
A: Yes they will work, but the degree depends on the mutation. The current vaccines produce antibodies that bind the spike protein, which the virus uses to enter cells. Mutations that change the spike protein could affect vaccine effectiveness. Recent mutations that have shown up in Britain, South Africa, Brazil and elsewhere, do affect the spike protein. Preliminary studies have shown that the vaccines still work against viruses with those mutations in terms of preventing serious illness and death, although they are somewhat less effective at preventing even mild-moderate disease for the South African or Brazilian variants. Pharmaceutical companies and health officials around the world are monitoring these mutations closely and are developing plans to adjust the vaccines as necessary. See Patient Vaccine Information for additional details.
Q: What are some lessons infectious disease specialists can take from COVID?
A: First, we need to be much better prepared for the threats posed by emerging pathogens, and particularly highly transmissible viruses. Despite the trial run of the H1N1 Swine Flu pandemic in 2009, our focus lapsed and we were woefully underprepared for COVID-19. Secondly, we need to continue to question preliminary assumptions about new diseases. We doubted that COVID-19 could be transmitted by asymptomatic people, we doubted how much it spread through the air and the necessity of widespread mask use, we doubted long-term complications, we assumed that children could not be seriously affected, we believed that the mutation rate was so low that the virus would not change in any meaningful way: all of these assumptions turned out to be incorrect to various degrees. We also learned not to ignore the scientific method in the rush to find new therapies – preliminary studies grounded on weak data were later disproven by more rigorous randomized controlled trials. Finally, we learned that the control of highly infectious diseases requires broad societal support for public health measures.
Q: I had a known exposure in the last 14 days with a COVID-19 case, can I get the vaccine to stop me from developing the disease?
A: No. current evidence suggests that the vaccine cannot be used for post-exposure prophylaxis as protection from the vaccine is not immediate, requires 2 doses, and may take 1 to 2 weeks from second dose to acquired immunity.
If you have had a known exposure to COVID-19 you should not seek vaccination until the quarantine period has ended to avoid potentially exposing healthcare personnel and other during the vaccine visit and to make sure you are not sick with COVID-19 at the time of vaccination.
Q: If I had COVID-19 and recovered do I need to get the vaccine?
A: Yes, the CDC recommends people who have had COVID-19 and recovered should get a vaccine, because experts do not yet know how long immunity lasts after a case of COVID-19 and reinfection is possible.
In Colorado, patients are advised that they can wait for up to 90 days after their infection before getting a vaccine because re-infection is uncommon within the first three months following infection. This also allows more vaccine to be given more quickly to others who have not developed any immunity. Ultimately, if you recently had COVID-19 infection or have other concerns about receiving the vaccine, you should discuss your concerns with your primary care physician about when and how to proceed with vaccination.
Q: Can children get the COVID-19 vaccine?
A: Yes. Children 12 to 15 years old are eligible for the Pfizer vaccine per the emergency use authorization granted by the Federal Drug Administration May 10, 2021. Children under 16 were not included in the early clinical trials for various COVID-19 vaccines. The groups recommended to receive the vaccines could change in the future, as ongoing clinical trials in children are completed. As of now, it is recommended that children under 16 do not receive the Pfizer vaccine and children under 18 do not receive the Moderna or Johnson & Johnson vaccine. Learn more here.
Q: What are the phases for COVID-19 Vaccine Distribution?
A: Given the limited supply of vaccines in the first months of its availability, vaccines will be distributed in a phased process, with people at high risk of infection or severe disease inoculated first along with healthcare professionals and frontline essential workers. The CDC has created a system to guide distribution of the vaccine. Each state has then fine-tuned these to the needs of their state. Review the current CDPHE COVID-19 Vaccine Eligibility Guidelines.
Beginning April 2, guidelines move into Phase 2 of the CDPHE vaccine distribution plan, which is the general public. Coloradans now eligible for the COVID-19 vaccine are those age 16 and older for the Pfizer vaccine and 18 and older for the Moderna and Johnson & Johnson vaccines.
See the CDPHE guidelines here.
Q: What is vaccination?
A: Vaccination is a medical process that is critical to the prevention and control of infectious-disease outbreaks. Vaccines are already used to prevent millions of deaths every year from diseases like tetanus, measles and influenza.
A vaccine is a medical preparation of biologic material that is introduced into the body in order to provide the recipient with immunity (an effective host defense) against an infectious disease without actually making you sick. A vaccine essentially tricks the body into thinking it has been infected when it has not so that if you encounter the infection in the future your body will “remember” and mount an effective immune response that usually prevents the disease.
Q: What is the National Jewish Health vaccine roll-out plan?
A: The Colorado Department of Public Health and Environment (CDPHE) is guiding the distribution process and priorities. National Jewish Health is following CDPHE guidance.
Q: Will National Jewish Health offer the COVID-19 vaccine to our patients?
A: Yes. We are notifying patients as they become eligible for vaccines. We are also offering vaccines to eligible community members through an online appointment system on our website.
Q: Will National Jewish Health offer the COVID-19 vaccine to our broader communities?
A: Once there is sufficient supply and following CDPHE guidance on prioritization, National Jewish Health is prepared to partner with CDPHE and serve the needs of our broader community. We will make our facilities and personnel available to vaccinate those individuals and populations as needed in accordance with the Phased roll out. National Jewish Health is fortunate to have the infrastructure and expertise available on its main campus to store and administer a large volume of vaccine.
We anticipate that the model of vaccination is likely to change over time and be adapted to reflect the populations we need to serve.
Learn more about COVID-19 and how it affects specific health conditions in these printable patient education materials.
Download COVID-19 Materials