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APhA COVID-19 Resources: Know the Facts

COVID-19 vaccine booster doses recommended for certain individuals


CDC continues to expand eligibility for COVID-19 vaccines amid the ongoing surge in infections. APhA has summarized the latest eligibility requirements below and answered frequently asked questions. For detailed information, pharmacists should reference CDC’s interim clinical considerations for use of COVID-19 vaccines.

Pfizer-BioNTech or Moderna mRNA COVID-19 vaccine booster dose


Everyone 12 years of age and older who received a primary series of the Pfizer-BioNTech COVID-19 vaccine is recommended to receive a booster dose at least 5 months after completion of the primary series.

The following individuals should receive a booster dose:

  • People aged ≥12 years

Moderna COVID-19 vaccine booster dose


Everyone 18 years of age and older who received a primary series of the Moderna COVID-19 vaccine is recommended to receive a booster dose is recommended at least 5 months after completion of the primary series.

The following individuals should receive a booster dose:

  • People aged ≥18 years

Janssen (Johnson & Johnson) COVID-19 vaccine booster dose


For individuals aged ≥18 years who received a single dose of the Janssen (Johnson & Johnson) COVID-19 vaccine, a booster dose is recommended at least 2 months (8 weeks) after the initial dose (primary vaccine series).

The following individuals should receive a booster dose:

  • People aged ≥18 years

Heterologous (or “mix-and-match”) booster doses


Individuals aged ≥18 years may choose which vaccine they receive as a booster dose. Some individuals may prefer the vaccine type that they originally received (homologous booster), and others may prefer to get a different booster (heterologous booster). CDC’s recommendations now allow for this type of mix-and-match dosing for booster shots. However, CDC states that in most situations, an mRNA (Pfizer-BioNTech or Moderna) COVID-19 vaccine is preferred over the Janssen COVID-19 vaccine for primary and booster vaccination.

Booster doses


The Pfizer-BioNTech (purple cap or gray cap) COVID-19 vaccine booster dose is 0.3 mL (same as primary series dose and additional dose; product with purple cap or grey cap can be used).The Moderna COVID-19 vaccine booster dose is 0.25 mL (different than primary series dose and additional dose).

The Janssen (Johnson & Johnson) COVID-19 vaccine booster dose is 0.5 mL (same as primary series dose).

Should a moderately or severely immunocompromised individual receive a booster dose?


For moderately or severely immunocompromised individuals (≥5 years of age) who received a primary series of mRNA COVID-19 vaccine, an additional dose 28 days after the second dose in the primary series is recommended before a booster dose is given. Booster doses may only be given to individuals ≥12 years of age.

For moderately to severely immunocompromised individuals aged ≥18 years who received the Janssen (Johnson & Johnson) COVID-19 vaccine, a booster dose can be given 2 months later.

What is the evidence driving the recommendations for booster doses?


Studies show the COVID-19 vaccines protect against severe illness, hospitalization, and death. However, CDC references recent data for the Pfizer-BioNTech, Moderna, and Janssen (Johnson & Johnson) COVID-19 vaccines suggesting protection against mild to moderate disease in certain groups is waning. More information about the safety and efficacy of the COVID-19 vaccines can be found in CDC’s Morbidity and Mortality Weekly Report updates regarding COVID-19.

How should I verify and document a booster dose of a COVID-19 vaccine?


Patients should be encouraged to bring their COVID-19 vaccination cards with them for their vaccination appointment. Pharmacists can document booster doses in the boxes labelled “other,” which appear underneath the second dose listed on the patient’s COVID-19 vaccination card. If they don’t have their card, and it is feasible to access an immunization information system (IIS), the provider should verify previous doses. Pharmacists can re-issue a new vaccination card to individuals who lost their original card, preferably if the pharmacist or pharmacy team verifies within the IIS, prescription profile, or patient medical record that a patient received the primary dose(s) of COVID-19 vaccine.

Can COVID-19 vaccines be given at the same time as a flu vaccine or other vaccine?


Yes. There is no need to space out other vaccines, such as the flu and COVID-19 vaccines, over time. Pharmacists should emphasize to patients that all of their vaccine needs—whether coming for a booster dose or any dose of the COVID-19 vaccine—can be met in one visit to the pharmacy. Providers should administer vaccines in different arms, if possible; space vaccinations by at least one inch if injecting more than one vaccine in an arm; note which vaccine was administered in which location; and discuss potential post-vaccination symptoms effects and their management with the patient. Be diligent in your vaccine preparation and vaccination process to verify the vaccine requested, the vaccine to be administered, and the location the vaccine is being administered into (left or right arm, etc.).

Should patients seek a booster dose earlier than recommended?


No. When a booster dose is given sooner than recommended, the resulting immune response may not be as robust as it could have been if the patient had waited the recommended interval. It is in the patient’s best interest to wait the recommended amount of time before seeking a booster dose. If the booster is given earlier than the recommended interval, the booster does not need to be repeated.

What should patients expect after their booster dose?


Patients may experience post-vaccination symptoms such as fever, head or muscle aches, and fatigue like those experienced with the primary dose(s). Patients should be monitored for 15–30 minutes after vaccination. During that time, remind them to enroll and use V-safe to track how they feel; as a provider, be sure to report any adverse events to the Vaccine Adverse Event Reporting System (VAERS)..

With the introduction of booster doses for COVID-19 vaccines, how is “fully vaccinated” defined?


Currently, patients are considered fully vaccinated 2 weeks after completing their primary series.