This information has been reviewed and approved by Rosine Angbanzan, MPH (March 2022)
Q: Who Needs an Additional COVID-19 Vaccine?
A: The CDC recommends booster shots after five months for everyone who has received primary doses of either the Pfizer or Moderna vaccine. For some immunocompromised peopled, the CDC recommends an additional primary shot of either the Pfizer or Moderna vaccine after 28 days. This includes people who:
If you received an mRNA vaccine, the most recent guidelines for booster shots now also include these groups:
If you’re 18 or older and received the J&J vaccine, the most recent guidelines state that you should get a dose of the Pfizer or Moderna vaccine at least two months after your second shot in the primary series.
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 can I receive a third dose?
National Jewish Health is giving booster and third doses of the Pfizer-BioNTech vaccine now.
Q: Can I mix and match vaccine types/doses between the first two and the third?
A: Yes, and there is evidence that mixing vaccines may enhance the immune response. However, it’s not recommended that anyone receive a Johnson and Johnson vaccine for their third dose. The additional third shots should be either Moderna or Pfizer mRNA vaccines. If you initially received the J&J vaccine, you can get any of the mRNA vaccines as a booster.
Q: What do I do if I am immunocompromised and received Johnson & Johnson as my initial vaccine?
A: It is now recommended that all individuals initially vaccinated with J&J should receive an additional dose. Because of the J&J vaccine’s waning efficacy and higher risk of side effects, the mRNA Pfizer and Moderna vaccines are the preferred option for an additional dose. However, in certain circumstances, an additional J&J shot can be considered.
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: 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. Furthermore, after five months (as the efficacy of the vaccine wanes), a booster can help enhance your immunity. Not receiving the third dose may increase your risk of serious infection.
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 of COVID-19 vaccine at least one month after the second dose. If you meet the newer updated criteria, the booster dose should be given at least five months after the second dose. These guidelines are the same for both the Pfizer and Moderna COVID-19 vaccines. Recipients of the Johnson & Johnson COVID-19 vaccine are now recommended to receive a dose of an mRNA vaccine at least two months after their original J&J shot.
Q: Is the vaccine amount in the third dose the same as the first two?
A: For the Pfizer and J&J vaccines, the booster dose is the same as the first two. Booster doses for Moderna were authorized at a lower dose.
Q: Where can I get additional information?
A: Additional information can be found on the CDC website.
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 peak immunity after two weeks of getting the shot. However, a second dose of an mRNA vaccine is recommended as the J&J vaccine was shown to have a short efficacy period and severe side effects.
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. There is growing evidence that the COVID vaccine is safe and effective for pregnant women, with the benefits of receiving the vaccine far outweighing potential risks.
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: The hope is that a COVID-19 vaccine will provoke a stronger and more lasting protective immune response than that produced by “natural infection” with COVID-19. In scientific experiments, the response to the mRNA vaccines was still strong at three months. However, there is evidence that vaccine-induced immunity begins to wane after five months, prompting the need for booster shoots at intervals.
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: Can we stop masking and social distancing after receiving the vaccine?
A: Until your vaccine is fully effective (about two weeks after the second dose), you should continue to mask, practice social distancing and wash your hands often and well. Because the COVID pandemic is still developing in terms of regional effect and community transmission, you should check with your state and local guidelines, along with those provided by the CDC.
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, including Delta and Omicron, 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. Learn more here.
Q: What are the phases for COVID-19 Vaccine Distribution?
A: 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.
The information on our website is medically reviewed and accurate at the time of publication. Due to the changing nature of the COVID-19 pandemic, information may have since changed. CDC.gov and your state’s health department may offer additional guidance.