• The Centers for Disease Control and Prevention (CDC) recommended Pfizer COVID-19 vaccine booster shots for adults over 65 and other high-risk individuals.
• People who are immunocompromised — including people taking certain disease-modifying therapies for psoriasis — may be eligible to receive a third dose of the vaccines now.

The Centers for Disease Control and Prevention recommended booster shots of the Pfizer COVID-19 vaccine at least six months after a second dose in the following groups:

• People 65 and older
• Residents of long-term care facilities
• People ages 50 to 64 with underlying medical conditions that place them at high risk for severe COVID-19

The CDC recommendations state that people ages 18 to 49 with underlying medical conditions and people ages 18 to 64 who are at risk of COVID-19 exposure due to their work or living arrangements “may receive a booster shot” of the Pfizer vaccine “based on their individual benefits and risks.”

The CDC’s Sept. 24 recommendations align with the Pfizer booster shot authorizations from the U.S. Food and Drug Administration (FDA) released on Sept. 22.

President Joe Biden confirmed in a speech on Sept. 24 that eligible individuals who received their second dose of the Pfizer vaccine in March or earlier can receive a booster dose of the vaccine now, free of charge.

The CDC and FDA did not release recommendations about the Moderna vaccine or the single-dose Johnson & Johnson vaccine. Moderna announced that a booster shot of its COVID-19 vaccine improved protection against the delta variant in a press release on Sept. 1. Johnson & Johnson released a statement on Sept. 21 sharing that data from a phase 3 study demonstrated the benefits of a booster vaccine dose.

Both companies have submitted data on booster shots to the FDA for review.

Boosters vs. Additional Doses for Immunocompromised People

A COVID-19 vaccine booster is administered when someone developed adequate immunity after the initial vaccine doses, but that immunity has decreased over time.

However, an additional dose of the vaccine may be recommended for those who did not develop an adequate immune response after the two-dose vaccination series.

The FDA amended the Pfizer and Moderna vaccines’ emergency use authorizations on Aug. 12 to allow a third vaccine dose for certain immunocompromised individuals. The new recommendations from the FDA and CDC do not change this eligibility. There is not yet guidance from the FDA or CDC on additional doses for immunocompromised people who received the Johnson & Johnson vaccine.

Individuals defined as immunocompromised include people in cancer treatment, people who received a stem cell transplant in the last two years, people who are organ donor recipients and taking immunosuppressive drugs, people taking high-dose steroids or other immunosuppressive drugs, as well as those with certain other health conditions.

The CDC did not release a comprehensive list of every condition or treatment that would make a person immunocompromised. Instead, the agency recommends individuals consult their doctors to determine if a third dose is appropriate for them.

The CDC recommends a third dose of the COVID-19 vaccine for moderately to severely immunocompromised people at least 28 days after their second vaccination with the Pfizer or Moderna vaccine.

Third Doses for People With Psoriasis

Psoriatic disease, including both psoriasis and psoriatic arthritis, doesn’t directly cause a person to become immunocompromised, but some psoriasis treatments might. Psoriasis is a disease in which the immune system becomes overactive. Some psoriasis medications are immunosuppressive — they can block immune system activity.

In a Sept. 1 town hall event hosted by the National Psoriasis Foundation (NPF), experts discussed booster vaccines for people with psoriasis. Dr. Joel M. Gelfand, co-chair of the NPF COVID-19 Task Force, reported that people who take immunosuppressive drugs are eligible to receive a third vaccine dose if they want one. However, he noted that data does not show that people with psoriasis — including those taking these therapies — are at increased risk.

People can receive a third dose of a COVID-19 vaccine if they take:

• Corticosteroids
• Arava (leflunomide)
• Trexall (methotrexate)
• Xeljanz (tofacitinib)
• Otezla (apremilast)
• Biologics that target tumor necrosis factor (TNF), T cells, or interleukins IL-12/23, IL-17, or IL-23

Dr. Gelfand recommended people with psoriatic disease talk to their doctor about whether to get a third dose. “We recommend shared decision-making with your health care team, to decide whether or not a booster is likely to benefit you,” he said. “Based on the current data, we don’t really know if a third booster is absolutely necessary for patients with psoriatic disease taking the therapies we use to manage psoriasis. It’s likely that the first two doses that a person has received are working quite well against [COVID-19].”

The NPF COVID-19 Task Force believes that certain people with psoriasis are more likely to have increased protection when they get a third dose. This includes those who:

• Are at least 50 years old
• Are taking Orencia (abatacept), Gengraf (cyclosporine), leflunomide, methotrexate, tofacitinib, or glucocorticoid medications like prednisone
• Have received their second mRNA vaccine dose more than six months ago
• Have been diagnosed with other health conditions that increase the chances of developing severe COVID-19

If you believe you are immunocompromised, ask your doctor whether you might benefit from an additional dose of an mRNA COVID-19 vaccine.