Booster Doses: Frequently Asked Questions

What is the updated COVID-19 vaccine?

Covid-19 vaccines are updated periodically to better protect against new strains of the virus. For more information on the most up to date vaccine formulation, visit the CDC website.

Why do I need an updated COVID-19 vaccine dose?

An updated COVID-19 vaccine dose will provide a boost in the fight against COVID-19 so New Yorkers have continued protection against the virus. That's why New York State encourages all eligible New Yorkers to stay up to date with their COVID-19 vaccine series.

Our federal health and medical experts have been analyzing the scientific data closely from New York, the United States, and around the world to understand how long the vaccine's protection will last and how we might maximize this protection. Although COVID-19 vaccines remain highly effective in preventing severe disease and hospitalization, the available data suggest that protection against COVID-19 infection begins to decrease over time. Updated COVID-19 vaccines will help eligible New Yorkers maximize their protection, prolong the vaccine's effectiveness, and continue to safeguard our communities against the virus.

If we need an updated COVID-19 vaccine, does that mean that the vaccines aren't working?

COVID-19 vaccines are working very well to prevent severe illness, hospitalization, and death, even against widely circulating variants. That's why CDC and NYSDOH encourage all eligible New Yorkers to get their updated COVID-19 dose for added protection.

It is normal for a vaccine's protection to wane over time, and an updated COVID-19 dose will help maximize New Yorkers' protection, prolong the vaccine's effectiveness, and keep eligible New Yorkers healthy and safe.

If I already had COVID, should I still get my updated COVID-19 vaccine?

Yes, you should be vaccinated regardless of whether you already had COVID-19 because:

• Research has not yet shown how long you are protected from getting COVID-19 again after you recover from COVID-19.
• Vaccination helps protect you even if you've already had COVID-19.
• You may not have had the strain that is in the vaccine.

However, individuals who have recently recovered from COVID-19 in the last 3 months (90 days) may wish to delay the updated COVID-19 vaccination until 3 months after their positive test result.

What is the guidance for New Yorkers who are moderately or severely immunocompromised?

The guidance for those who are immunocompromised is based on age and prior vaccination status.

Can I get an updated COVID-19 vaccine and flu shot at same time?

Yes. You may receive a COVID-19 vaccine and other vaccines without regard to timing. This includes simultaneous administration of a COVID-19 vaccine and other vaccines (including vaccines such as the measles-mumps-rubella [MMR] vaccine) on the same day, as well as coadministration at any time interval.

Can I get an updated COVID-19 vaccine dose before I am eligible?

No. Individuals should only receive their age-appropriate updated vaccine dose when eligible.

What are the side effects of the updated COVID-19 vaccine?

Just like your previous COVID-19 vaccine doses, you may not notice any changes in how you feel after your vaccine. But it's also possible to feel a little "under the weather." This can happen after anyvaccine.

After the COVID-19 vaccine, you may have:

• A sore arm where you got the shot
• A headache
• Chills
• Fever
• Tiredness
• Nausea and vomiting

These side effects are notdangerous and are just a sign of your immune system doing its job. They are easily treatable with over-the-counter pain medicine and fever reducers and usually only last for a short period of time. Serious or long-lasting side effects are extremely rare. If you still don't feel well after two or three days, contact your healthcare provider.

Are updated COVID-19 vaccine doses safe?

Yes. The doses are safe and effective.

Are there other vaccines in addition to COVID-19 vaccines that require more than two doses?

Yes, this is common. Many vaccines require more than one or two doses for long-lasting protection. For example, the life-saving polio vaccine requires four doses; the hepatitis B vaccine requires two, three, or four doses depending on vaccine or condition.

Other vaccines require occasional "boosts" like the tetanus-diphtheria vaccine, given to individuals every ten years. There are other vaccines that need to be administered even more often. For example, the influenza (flu) vaccine is recommended for individuals each year because new strains emerge every season.

Can people who received Johnson & Johnson's (J&J/Janssen) COVID-19 vaccine get an updated COVID-19 vaccine?

Yes, eligible New Yorkers can receive either the Pfizer or Moderna updated COVID-19 vaccine or in some situations, Novavax monovalent booster dose, after receiving Janssen. Please note that the J&J vaccine is no longer authorized in the US.

Can people who received Johnson & Johnson's (J&J)/Janssen) COVID-19 vaccine for their first booster dose receive a subsequent updated COVID-19 vaccine dose?

New Yorkers who are 18 years of age and older, who received 1 or 2 J&J/Janssen COVID-19 vaccine doses, are recommended to receive an updated mRNA vaccine dose, either Pfizer-BioNTech or Moderna. If you have questions, talk to your primary healthcare provider or vaccine administrator.

Why do immunocompromised individuals need an additional dose of the vaccine?

According to the CDC, people who are moderately to severely immunocompromised make up about 3 percent of the adult population and are especially vulnerable to COVID-19 because they are more at risk of serious, prolonged illness.

Studies indicate some immunocompromised people don't always build the same level of immunity after vaccination the way non-immunocompromised people do and may benefit from additional dose(s) to ensure adequate protection against COVID-19.

If I am immunocompromised, am I eligible for my additional dose of the COVID-19 vaccine?

Moderately to severely immunocompromised people may receive an additional dose of the COVID-19 vaccine when eligible. People with moderately to severely compromised immune systems are especially vulnerable to COVID-19 and may not build the same level of immunity to the vaccine series compared to people who are not immunocompromised. This additional dose is intended to improve immunocompromised people's response to their initial vaccine series. Individuals who are moderately to severely immunocompromised are eligible for an updated COVID-19 vaccine dose. This additional dose may be administered at least 2 months after completing the primary series or after the most recent monovalent or bivalent dose.

What qualifies a New Yorker as moderately or severely immunocompromised?

According to the CDC, having a weakened immune system can make you more likely to get severely ill from COVID-19. Many conditions and treatments can cause a person to be immunocompromised or have a weakened immune system. Primary immunodeficiency is caused by genetic defects that can be inherited. Prolonged use of corticosteroids or other immune weakening medicines or certain diseases can lead to secondary or acquired immunodeficiency.

These conditions and treatments include but are not limited to:

• Active treatment for solid tumor and hematologic malignancies
• Receipt of solid-organ transplant and taking immunosuppressive therapy
• Receipt of CAR-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
• Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
• Advanced or untreated HIV infection
• Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.

Factors to consider in assessing the general level of immune competence in a patient include disease severity, duration, clinical stability, complications, comorbidities, and any potentially immunosuppressing treatment.

People should talk to their healthcare provider about their medical condition, and whether getting an additional dose is appropriate for them.

When should I receive my additional dose of the COVID-19 vaccine?

New Yorkers with moderately to severely compromised immune systems should receive an additional dose based on age and vaccination history. Immunocompromised individuals should talk with their physicians regarding the appropriateness and timing for receiving an additional dose of COVID-19 vaccine. The New York State Department of Health also encourages physicians to proactively reach out to their immunocompromised patients to discuss the benefits of receiving an additional dose.

What immunocompromising conditions currently qualify children 5 – 11-years-old to be eligible for an additional dose of the COVID-19 vaccine?

Children 5-11-years-old with certain immunocompromising conditions who received their initial vaccine series at least 28 days ago are eligible for an additional dose of the COVID-19 vaccine.

Consistent with CDC's guidance, this includes children who are moderately or severely immunocompromised due to a medical condition or receipt of immunosuppressive medications or treatments. Specifically, immunocompromising conditions may include:

• Active treatment for solid tumor and hematologic malignancies
• Receipt of solid-organ transplant and taking immunosuppressive therapy
• Receipt of CAR-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
• Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
• Advanced or untreated HIV infection
• Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.

Because of the risk of COVID-19 infection in this population, immunocompromised people should continue to be counseled regarding the potential for a reduced immune response after vaccination and the importance of additional protective measures, regardless of the decision to receive an additional dose of the COVID-19 vaccine. Prevention measures include wearing a well-fitting mask (or respirator if high risk), staying six feet apart from others they don't live with, and avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider particularly in areas of increased transmission. Close contacts of immunocompromised people should be strongly encouraged to be vaccinated against COVID-19.

Parents or guardians with questions are encouraged to consult with their child's healthcare provider.

Can you mix and match the vaccines for my additional dose? For example, if I received the Pfizer-BioNTech for my initial vaccine series, can I receive Moderna's COVID-19 vaccine for my additional dose?

Interchangeability of vaccines varies by vaccination history, age, and product.

What are the risks of vaccinating individuals with an additional dose?

There is limited information about the risks of receiving an additional dose of vaccine, and the safety, efficacy, and benefit of additional doses of COVID-19 vaccine in immunocompromised people continues to be evaluated. So far, reactions reported after the additional dose were similar to that of the two-dose series: fatigue and pain at injection site were the most commonly reported side effects, and overall, most symptoms were mild to moderate.

However, as with any COVID-19 series, serious side effects are rare.

How should I expect to receive proof of my COVID-19 booster dose and/or my additional dose?

You should expect to receive proof of your booster dose on your original CDC COVID-19 vaccination card. If you lost your original vaccination card, please reach out to your healthcare provider to obtain a copy of your immunization record.