Vaccine Booster Doses

Content last updated December 9, 2022

Staying up to date with booster doses as soon as you are eligible is your best protection against serious illness and death from COVID-19.

The Center for Disease Control and Prevention (CDC) updated booster dose recommendations are as follows:

  • Children 6 months-5 years who received the original monovalent Moderna COVID-19 vaccine are now eligible to receive an updated bivalent booster two months after completing the primary series. 
  • The Pfizer COVID-19 vaccine for children 6 months-4 years will now include two monovalent Pfizer doses and one bivalent Pfizer dose.
    • Children 6 months-4 years who have not yet begun the 3-dose Pfizer primary series or who have not received the third dose of their primary series will now receive the updated Pfizer series
    • Children 6 months-4 years who have already completed the 3-dose Pfizer primary series will not be eligible for additional doses or boosters at this time
  • Novavax COVID-19 boosters are available for adults if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA booster. 
If you received... Who should get a booster Which booster to get When to get a booster
Pfizer-BioNTech People 5 years and older

Children 5 years old who received Pfizer may only receive an updated Pfizer bivalent booster

People 6 years and older should receive an updated bivalent Pfizer or Moderna booster regardless of their primary series

At least 2 months after completing the primary series or prior booster dose

People 18 years and older can also opt to receive a Novavax booster if they cannot or will not receive an updated mRNA booster Novavax: At least 6 months after completing the primary series
Moderna People 6 months and older

Children 6 months-4 years old should receive an updated bivalent dose that is the same brand as their primary series

People 5 years and older should receive an updated bivalent booster dose of Pfizer or Moderna

At least 2 months after completing the primary series or prior booster dose

People 18 years and older can also opt to receive a Novavax booster if they cannot or will not receive an updated mRNA booster Novavax: At least 6 months after completing the primary series
Novavax People 12 years and older People 12 years and older should receive an updated bivalent booster dose of Pfizer or Moderna

At least 2 months after completing the primary series or prior booster dose

People 18 years and older can also opt to receive a Novavax booster if they cannot or will not receive an updated mRNA booster Novavax: At least 6 months after completing the primary series
Johnson & Johnson* People 18 years and older People 18 years and older should receive an updated bivalent booster dose of Pfizer or Moderna At least 2 months after completing the primary series or prior booster dose
People 18 years and older can also opt to receive a Novavax booster if they cannot or will not receive an updated mRNA booster Novavax: At least 6 months after completing the primary series

* mRNA vaccines are preferred, but the Johnson & Johnson COVID-19 Vaccine is still available if you aren’t able or willing to get another vaccine. 

Doses for Immunocompromised

If you are moderately or severely immunocompromised, guidelines will vary.

If you got… Should I get an additional dose? Can I get a booster?
Pfizer: Two doses administered 21 days apart for ages 5 years and older Yes, people age 5 years and older who are moderately or severely immunocompromised should get an additional dose 28 days after their 2nd shot.

Yes, an updated bivalent mRNA booster is recommended 2 months after the last dose to be up to date for those ages 5 and older.

Children 5 years old who received Pfizer may only receive an updated Pfizer bivalent booster.

People 18 years and older can also opt to receive a Novavax booster 6 months after completing the primary series if they cannot or will not receive an updated mRNA booster.

Pfizer: Three doses administered for children 6 months through 4 years old. The first two doses are to be administered 21 days apart and the third dose 8 weeks after the second dose. No, children 6 months through 4 years old who are moderately or severely immunocompromised should not receive an additional primary dose at this time. No, an updated bivalent dose is not authorized for those 6 months through 4 years old that already completed the Pfizer primary series at this time.
Moderna: Two doses administered 28 days apart for ages 6 months and older Yes, people aged 6 months and older who are moderately or severely immunocompromised should get an additional dose 28 days after their 2nd shot.

Yes, an updated bivalent mRNA booster is recommended 2 months after the last dose to be up to date for those 6 months and older.

Children 6 months-4 years old should receive an updated bivalent dose that is the same brand as their primary series.

People 5 years and older should receive an updated bivalent booster dose of Pfizer or Moderna.

People 18 years and older can also opt to receive a Novavax booster 6 months after completing the primary series if they cannot or will not receive an updated mRNA booster.

Novavax: Two doses, administered 21 days apart for ages 12 and older No, people who are moderately or severely immunocompromised should not receive an additional primary dose at this time.

Yes, an updated bivalent mRNA booster is recommended 2 months after the last dose to be up to date for those 12 years and older.

People 18 years and older can also opt to receive a Novavax booster 6 months after completing the primary series if they cannot or will not receive an updated mRNA booster.

Johnson & Johnson: One dose, authorized for ages 18 and older* Yes, people age 18 years and older who are moderately or severely immunocompromised should get an additional dose with mRNA vaccine 28 days after 1st dose of J&J.

Yes, an updated bivalent mRNA booster is recommended at least 2 months after the last dose for those aged 18 and older to be up to date.

People 18 years and older can also opt to receive a Novavax booster 6 months after completing the primary series if they cannot or will not receive an updated mRNA booster.

* mRNA vaccines are preferred, but the Johnson & Johnson COVID-19 Vaccine is still available if you aren’t able or willing to get another vaccine.

Frequently Asked Questions

Do I have to get the same vaccine brand for my booster dose?

Children 6 months-4 years old should receive an updated bivalent dose that is the same brand as their primary series. Children 5 years old who completed the Pfizer primary series should only receive an updated bivalent Pfizer booster. Children 5 years old who received Moderna may receive an updated Moderna or Pfizer bivalent booster. People 6 years and older can receive an updated Pfizer or Moderna booster dose, regardless of which brand they received for their primary series or previous booster dose. People 18 years and older can also opt to receive a Novavax booster if they have completed primary series vaccination but have not previously received a COVID-19 booster — and if they cannot or will not receive an updated mRNA booster.

Why are booster doses important?

Booster doses will help provide continued protection against severe disease. Booster doses were previously recommended only for populations at high risk for severe COVID-19, but the recommendation expanded to include ages 6 months  and older to help increase protection against COVID-19 illness. This is especially important with the rise of more contagious variants and cases of COVID-19 increasing across the United States.

The COVID-19 vaccines authorized or approved in the United States are still very effective at reducing the risk of severe disease, hospitalization, and death from COVID-19, even against variants. Still, the current vaccines may be associated with a drop in protection over time. Booster doses will increase vaccine-induced protection against COVID-19 and help immunity last longer.

Are you still vaccinating people with the primary series?

Yes. Getting everyone who is eligible vaccinated with a primary series is still a top priority. People who are vaccinated are significantly less likely to get seriously sick (or sick at all) from COVID-19, compared to those who are unvaccinated. National data shows adults who are up to date with COVID-19 vaccines are less likely to be hospitalized compared to those who did not receive a COVID-19 vaccine. Vaccinations can also protect people from suffering from serious complications from COVID-19 illness such as long-haul symptoms.

If we need booster shots, does that mean that the vaccines aren't working?

No. The current COVID-19 vaccines we have in the U.S. are working well to prevent severe illness, hospitalization, and death, even against variants. However, public health experts are seeing reduced protection against mild and moderate COVID-19 illness, especially among high-risk populations.

The updated boosters were created to help boost immunity and provide better protection from the omicron variant. It's important to get all recommended doses available for best protection.

If I don't get a booster dose, am I still fully vaccinated?

You are up to date with your COVID-19 vaccines if you have completed a COVID-19 vaccine primary series and received the most recent booster dose recommended for you by CDC.

Should I get an updated booster even if I already had COVID-19 or received a prior booster?

Yes, it is recommended that you get an updated booster if you are eligible despite previously contracting COVID-19. Getting a COVID-19 vaccine after recovering from COVID-19 infection provides added protection to your immune system. The same is true for people who completed their primary series or received one or two boosters. For maximum effectiveness, individuals who recently had COVID-19 may consider delaying any COVID-19 vaccination, including the updated booster dose, by 3 months from the start of their symptoms or positive test.

How do I show that I'm eligible for a booster dose?

You can self-report that you are eligible for a booster dose. You do not need to show a recommendation from a health care provider.

Please take your vaccination card to your booster dose appointment so the provider can first confirm that you've completed the entire primary vaccine series. If you don't have your card, the provider can look up your record.

What’s the difference between an additional vaccine dose and a booster vaccine dose?
  • An additional dose is for some patients (see table above) who completed a primary vaccine series but did not have a strong enough immune response.
  • A booster dose is for patients when it’s likely that their immunity after the initial vaccine series waned over time.
What does it mean to be immunocompromised?

The U.S. Food and Drug Administration (FDA), Advisory Committee on Immunizations Practices (ACIP), and Western States Scientific Safety Review Workgroup recommend a third dose of vaccine for moderately to severely immunocompromised people who received a two-dose mRNA series or one dose J&J vaccine.

If you have any of the following medical conditions, you are considered moderately to severely immunocompromised and may benefit from an additional dose of COVID-19 vaccine. This includes people who:

  • 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 2 years or are taking medicine to suppress the immune system
  • Have moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Have advanced or untreated HIV infection
  • Are receiving active treatment with high-dose corticosteroids or other drugs that may suppress the immune response.

While the vaccines we have are 90% effective against most virus variants, studies show that moderate to severely immunocompromised individuals do not always build strong immunity. The third dose is not considered a booster, but an additional dose for those who did not develop adequate immunity with the two-dose series.

What are underlying medical conditions?

People of any age with the conditions listed below are more likely to get severely ill from COVID-19. Severe illness means that a person with COVID-19 may:

  • Be hospitalized
  • Need intensive care
  • Require a ventilator to help them breathe
  • Die

COVID-19 vaccines (initial doses and boosters) and other preventive measures for COVID-19 are important, especially if you are older or have multiple or severe health conditions including those on this list. This list does not include all possible conditions that place you at higher risk of severe illness from COVID-19. If you have a condition not included here, talk to your health care provider about how best to manage your condition and protect yourself from COVID-19.

  • Cancer
  • Chronic kidney disease
  • Chronic liver disease
  • Chronic lung diseases
  • Dementia or other neurological conditions
  • Diabetes (type 1 or 2)
  • Down syndrome
  • Heart conditions
  • HIV infection
  • Immunocompromised state (weakened immune system)
  • Mental health conditions
  • Overweight and obesity
  • Pregnancy
  • Sickle cell disease or thalassemia
  • Smoking, current or former
  • Solid organ or blood stem cell transplant
  • Stroke or cerebrovascular disease, which affects blood flow to the brain 
  • Substance use disorders
  • Tuberculosis
Will people who are moderately or severely immunocompromised need a doctor’s note/prescription or other documentation to receive these doses?

No, individuals can self-identify and receive all doses anywhere vaccines are offered. This will help ensure there are not additional barriers to access for this population. If immunocompromised individuals have questions about their specific medical condition, they may discuss whether getting an additional dose is appropriate for them with their health care provider.