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Should you mix and match COVID-19 boosters?

Should you mix and match COVID-19 boosters?

When the Food and Drug Administration (FDA) authorized a third dose of the Pfizer and Moderna COVID-19 vaccines for certain people with compromised immune systems in mid-August and booster shots for some adults who received the Pfizer vaccine in September, it seemed inevitable that other fully vaccinated adults would soon be next in line. The FDA, along with the Centers for Disease Control and Prevention (CDC), recently announced that time has come, and the rollout for Moderna and Johnson & Johnson boosters can begin.

The two agencies now recommend that people who received either the Pfizer or Moderna COVID-19 vaccine — and are age 65 or older, live in a long-term care facility, or are at increased risk for severe illness — receive a booster shot 6 or more months after receiving their second dose. They also recommend that all people age 18 or older who received the single-dose Johnson & Johnson vaccine receive a booster at least 2 or more months after receiving their original dose.

Additionally, younger people who received the Pfizer or Moderna vaccines and have an underlying medical condition or are at greater risk of exposure because of their profession may also choose to receive a booster.

OK given to mix and match vaccines

The most recent recommendations also allow booster recipients to mix and match the vaccines. Regardless of which vaccine was received initially, those eligible for a booster can receive a dose of any of the three authorized COVID-19 vaccines if desired or necessary due to vaccine availability.

“The ability to mix and match vaccines will be a tremendous convenience, because that means you can boost with whatever you have available,” says Dr. Abisola Olulade, a family medicine doctor with Sharp Rees-Stealy Medical Group. “It is safe to do so, and it seems to be effective.”

For all populations, the dosage of the Pfizer and Johnson & Johnson booster shots will remain the same as the original vaccine doses. However, the Moderna booster will contain half of the vaccine dose received in the first two shots.

“While the messaging around booster shots has been confusing for some members of the public, it’s important to recognize that our public health experts have taken the time to make careful decisions about COVID-19 vaccines,” Dr. Olulade says. “The decision to recommend boosters for everyone 65 and over and those at greater risk for serious illness from COVID is not surprising. In fact, it is simply a preventive measure for these specific populations and should offer reassurance that the vaccines continue to work well for others.”

Why do we need a booster shot?

Booster vaccines are usually advised when the protection provided by some vaccines wears off over time or as different viruses circulate or mutate. Other vaccinations that require boosters or updated shots include the annual flu shot, the pneumonia vaccine, and the tetanus, diphtheria and pertussis (Tdap) vaccine.

While confidence in the COVID-19 vaccines’ ability to protect against severe illness, hospitalization and death remains strong, concern has grown as the delta variant has led to increased COVID-19 infections, primarily in people who are not yet vaccinated. Additionally, a small number of vaccinated people have experienced breakthrough infections.

Such infections after vaccination are of greatest concern for people whose immune systems may not have mounted a robust response after receiving the first single- or double-dose COVID-19 vaccine due to advanced age, chronic illness or treatment for conditions such as cancer. This leaves them at increased risk for severe illness and hospitalization. Data also show that people who live in long-term care facilities may be at increased risk for breakthrough infections.

“Booster vaccines are a common medical necessity, and don’t mean that the original vaccines were not effective,” Dr. Olulade says. “We have seen proof of how very effective the COVID-19 vaccines are by studying the rate of hospitalizations and deaths, which are almost exclusively among people who are unvaccinated.”

Who is eligible for a booster?

People with compromised immune systems who received either the Pfizer or Moderna COVID-19 vaccine have been permitted to receive third doses since August. Individuals who are immunocompromised and originally received the Johnson & Johnson vaccine are now also eligible for an additional dose of any of the three vaccines.

A booster shot is now also recommended for:

  • People age 18 or older who received the single-dose Johnson & Johnson COVID-19 vaccine no less than 2 months ago.
  • People age 65 or older who received their second dose of the Pfizer or Moderna COVID-19 vaccine no less than 6 months ago.
  • People age 50 or older who are at greater risk for severe illness from COVID-19 due to underlying health conditions — such as high blood pressure; diabetes; obesity; cancer; chronic heart, lung or kidney disease; dementia; and disabilities — and received their second dose of the Pfizer or Moderna COVID-19 vaccine no less than 6 months ago.
  • People who live in a long-term care facility and received their second dose of the Pfizer or Moderna COVID-19 vaccine no less than 6 months ago.

In addition, the following groups may also choose to receive a booster shot:

  • People who are at greater risk of coronavirus exposure on the job — such as health care workers, first responders, grocery workers, prison or shelter staff, and teachers — and received their second dose of the Pfizer or Moderna COVID-19 vaccine no less than 6 months ago.
  • People ages 18 to 49 who are at greater risk for severe illness from COVID-19 due to underlying health conditions — such as high blood pressure; diabetes; obesity; cancer; chronic heart, lung or kidney disease; dementia; and disabilities — and received their second dose of the Pfizer or Moderna COVID-19 vaccine no less than 6 months ago.

Individuals ages 12 to 64 who are fully vaccinated and not at risk for severe illness or exposure are not included in the current booster rollout, as the data do not currently support the need for a third shot for this group.

How do I get a COVID-19 vaccine booster?

If you or a loved one is eligible to receive a COVID-19 vaccine booster shot, you can schedule an appointment at a county vaccination site through MyTurn or call 211 for help with scheduling. You can also go to any walk-in San Diego County vaccine location or make an appointment at participating local pharmacies. Sharp HealthCare offers three vaccine sites in Chula Vista, Coronado and Grossmont.

Proof of an underlying medical condition will not be required of those seeking boosters. And it is not necessary to return to the location where you received your previous vaccine doses, though you should bring your vaccination card from the original location with you when receiving your booster shot.

As with the original doses of the vaccines, you may experience mild side effects after receiving a booster. Side effects can include soreness at the injection site, fatigue, body aches, fever and headaches.

Talk with your doctor if you have concerns about receiving a booster or if you had an adverse reaction to earlier doses. If you have been treated for COVID-19 with monoclonal antibody or convalescent plasma in the last 90 days, your doctor can help you determine if a third dose is appropriate.

“While we are pleased to see an opportunity for increased protection for some of those who are already vaccinated, we are still very focused on encouraging everyone who is eligible, but not yet fully vaccinated, to get their first and second doses of a COVID-19 vaccine,” says Dr. Olulade.

She adds, “This is our best option to stop the spread of COVID-19 and protect others within the community, such as older adults, the immunocompromised and children under 12, who are not yet able to be vaccinated.”

Sharp HealthCare joins the CDC in encouraging everyone who is eligible to receive a COVID-19 vaccine. Get COVID-19 vaccine information and access to COVID-19 resources from Sharp.