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Vaccines

COVID vaccine cocktails: A guide to mixing and matching Pfizer, Moderna, J&J booster shots

On Oct. 21, the CDC OK'd booster doses from competing companies.

Lindsey Leake
Treasure Coast Newspapers
  • Immunocompromised people 16+ may get an additional and booster dose
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So, you’re thinking of getting your COVID-19 vaccine booster shot. 

As recently as mid-October, only select populations that had completed their primary, two-dose Pfizer series were eligible for a booster. Now, not only is everyone 16 and older eligible, they’re also free to choose which type of booster they want — regardless of which pharmaceutical company manufactured their first dose(s).

That’s right: If you got the single-dose Johnson & Johnson shot, you can get a Moderna or Pfizer booster two months later. Completed the primary, two-dose Moderna series? In six months, you can opt for the Pfizer or J&J booster. And if you started with Pfizer, you can get a Moderna or J&J booster after six months.

The Centers for Disease Control and Prevention frequently has updated its vaccine guidelines since first recommending boosters for certain groups Sept. 24

Most recently, the agency recommended people opt for one of the two mRNA vaccines, produced by Pfizer and Moderna, over J&J’s viral vector vaccine, citing “the latest evidence on vaccine effectiveness, vaccine safety and rare adverse events, and consideration of the U.S. vaccine supply.” 

However, the Dec. 16 announcement assured that receiving any vaccine is preferable to being unvaccinated, and did not change the CDC’s booster guidelines.

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“They both work very similarly, in that they teach your own immune system how to fight against COVID-19, but they do it in a little bit of a different manner,” Dr. Kruti Yagnik said, referring to the mRNA and viral vector vaccines.

As soon as you’re eligible for a booster, the best option for your health and that of those around you is to get the one that’s first available, said Yagnik, an infectious disease specialist at Cleveland Clinic Indian River Hospital in Vero Beach, Florida.

Vaccine-induced protection wanes over time, which is why “the booster is especially very important when it comes to preventing COVID-19 infection and severe disease,” she said.

Early studies suggest the vaccinated will need a booster shot for the best chance at preventing omicron infection, too. As of Monday, the omicron variant accounts for more than 70% of new cases in the U.S., according to the CDC.

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Who can get a COVID booster shot and when?

Everyone 16 and older in the U.S. is eligible for a free booster shot, but there are restrictions based on age and how long it’s been since your primary dose(s). 

You may not receive a booster shot until you have waited at least:

  • J&J: Two months after your first and only dose
  • Pfizer and Moderna: Six months after your second dose.

If you’re 16 or 17 years old, you’re permitted to receive only a Pfizer booster. If you’re 18 or older, you may select any of the three boosters.

Are COVID boosters different from primary doses?

The J&J booster, which doesn’t contain mRNA, is no different than the primary dose.

The Pfizer booster contains 30 micrograms of mRNA, as does each of the two primary doses. 

The Moderna booster is a half-dose, but that’s “more than enough to boost immunity,” Yagnik said. It contains 50 micrograms of mRNA, while each of the two primary doses contains 100.

Can immunocompromised people get a COVID booster?

People with moderately to severely compromised immune systems — such as those undergoing cancer treatment — have a host of options for increasing protection against COVID-19.

If you fall into this category, the CDC recommends you first get what’s called an “additional dose” — a third dose of the Pfizer or Moderna vaccines at least 28 days after completing your primary series. Six months after that, you also may get any booster, which would be your fourth dose in all.

Children 12-17 with compromised immune systems may receive an additional Pfizer dose; 16- and 17-year-olds also may receive a Pfizer booster.

Immunocompromised people who got the J&J shot aren’t eligible for an additional dose, but still may receive any booster at least two months later.

Consult your health care provider about which option may be most effective for you.

Is it safe to mix and match COVID booster doses?

The CDC authorized mix-and-match boosters in part based on the results of a clinical study sponsored by the National Institute of Allergy and Infectious Diseases.

The Pfizer, Moderna and J&J boosters each demonstrated an enhanced immune response, regardless of which vaccine the participants initially had received. 

Researchers also found that “using the mix-and-match strategy elicited either a similar or a higher response as compared to using the same vaccine,” Yagnik said. “All of them are safe, all of them are efficacious, and it’s your choice on which one you want to go with.”

Can children under 16 get a COVID booster shot?

Children 5-15 may complete the primary, two-dose Pfizer series — a pediatric, 10-microgram dose for those 5-11 and an adult dose for those 12-15 — but are not yet eligible for a booster.

Immunocompromised adolescents 12-15 may receive an additional dose, but not a booster.

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“I do anticipate that they’ll probably recommend boosters for [children] as well,” Yagnik said. “As each day passes, we get more and more information. We should know … in the next couple of months.”

Follow Lindsey Leakeon Twitter @NewsyLindsey

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