• The U.S. Centers for Disease Control and Prevention (CDC) approved a second COVID-19 booster shot of the messenger RNA (mRNA) vaccines for people over 50 years old and those who are immunocompromised.
• Health officials advise that people with rheumatoid arthritis (RA) receive a second booster shot if they meet the recommended eligibility criteria.
• With the omicron variant waning and COVID-19 control measures ending, now is an ideal time to get up-to-date on vaccinations before new variants arise.

Health officials at the U.S. Food and Drug Administration (FDA) and the CDC have authorized a second COVID-19 booster shot for all adults over 50 and people with suppressed immune systems. People in these categories are at increased risk for severe disease and hospitalization from COVID-19, so increased protection against infection is important.

Updated public health recommendations come after research has found that receiving an initial booster of the Moderna or Pfizer vaccines is safe and effective in preventing severe disease and hospitalization. These vaccines both use a molecule called mRNA to teach cells how to make a protein that will trigger an immune system response and help prevent COVID-19.

The CDC has also found that the effectiveness of the first booster decreases over time and is therefore recommending a second booster to help maintain protection against COVID-19 infection.

The New Recommendation and Second Booster Eligibility

On March 29, the FDA authorized a second booster of either the Pfizer or Moderna COVID-19 for the following groups:

• Individuals aged 50 or older who received a first booster dose of the Pfizer or Moderna vaccine are eligible to receive a second booster dose of the Pfizer or Moderna vaccine.
• Individuals aged 12 or older with certain immunocompromising conditions who received a first booster dose of either vaccine are eligible for a second booster dose of the Pfizer vaccine.
• Individuals aged 18 or older with certain types of immunocompromising conditions who received a first booster dose of either vaccine are eligible for a second booster dose of the Moderna vaccine.

Some important details about these recommendations include the following:

• This booster vaccine is for people who received their first booster at least four months ago.
• This fourth shot would be of either the Moderna or Pfizer vaccines, not the Johnson & Johnson vaccine.
• Even if you were previously vaccinated with the Johnson & Johnson vaccine, it is now recommended that this booster be a Moderna or Pfizer vaccine only.
• For those who are immunocompromised and received a three-dose primary vaccination followed by an initial booster, this booster would count as their fifth shot.

Are People With RA Eligible for a Second Booster?

The American College of Rheumatology (ACR) updated its recommendations about COVID-19 vaccinations on February 2. The ACR recommends that everyone diagnosed with rheumatic disease (which includes RA, psoriatic arthritis, lupus, and spondyloarthritis) receive booster doses as recommended by the CDC, regardless of whether or not they’ve ever had a COVID-19 infection.

COVID-19 Boosters and RA Medications

The ACR also updated some recommendations about scheduling vaccinations while taking disease-modifying antirheumatic drugs (DMARDs). The ACR recommends people taking certain DMARDs pause their doses for one or two weeks after vaccination, depending on how active their RA is.

Recommendations to pause for a week or two extend to:

• Abatacept (Orencia)
• Janus kinase (JAK) inhibitor drugs, including upadacitinib (Rinvoq) or tofacitinib (Xeljanz)

People taking rituximab (Rituxan) are advised to talk to their doctor about timing.

The ACR also recommends that people with RA avoid using the over-the-counter pain medication acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, and naproxen for 24 hours before receiving a vaccination.

Your RA specialist can advise you on the best timing for your medications to ensure that a vaccine booster is as effective as possible while keeping your RA under control. You can find a location to get a second booster (or any COVID-19 vaccine) at Vaccines.gov.

How Effective Is the Moderna Vaccine in Immunocompromised Individuals?

These recommendations follow promising new results about the effectiveness of the vaccines in immunocompromised people. A recent study from Moffitt Cancer Center included people diagnosed with blood cancers and people with solid tumors in their organs.

Researchers tested levels of antibodies, the proteins the immune system makes to help destroy a target. In this case, the antibodies were to the SARS-CoV-2 virus that causes COVID-19, made in response to the Moderna COVID-19 vaccine.

After the second vaccine dose, about 90 percent of the people in the study developed antibodies against the coronavirus.

The lowest response — around 30 percent — was seen among people with chronic lymphocytic leukemia or B-cell non-Hodgkin lymphoma who were also receiving immunosuppressive therapy. But their response was much higher — nearly 73 percent — when they were not receiving treatment at the time of vaccination.

People receiving certain treatments, including rituximab (Rituxan) less than six months before vaccination, had a lower immune response to the vaccine. People who had autologous (self) stem cell transplants in the past year or allogeneic (donor) stem cell transplants had a stronger response to the vaccine.

How Effective Is the Pfizer Vaccine in Immunocompromised Individuals?

Other research has looked at the response of immunocompromised individuals to the Pfizer vaccine. In one study, antibody testing showed around 72 percent of people who were immunocompromised responded to the Pfizer vaccine. Another study showed immune system response in people with a wide variety of immunocompromising conditions was about 67 percent.

However, people with some health conditions were much more responsive to the Pfizer vaccine than others. For instance:

• People with HIV made antibodies in response to the Pfizer vaccine 98.7 percent of the time (a similar rate as the general population).
• People with multiple myeloma responded nearly 80 percent of the time.
• About 45 percent of people with kidney transplants responded to the vaccine.

A study looking at both mRNA vaccines in immunocompromised people living with HIV or solid organ transplants found the Pfizer vaccine had a similar response rate (about 94 percent) to the Moderna vaccine (around 92 percent).

Why Do These Results Matter?

Although these studies do not directly address third doses or booster shots, additional doses of mRNA vaccines may increase detectable antibodies in a similar way to the first and second doses. Other research tells us antibody levels are likely to decrease over time, so getting booster doses at recommended intervals is necessary — even for vaccinated people who made antibodies after their initial shots.

With the CDC recommending a second COVID-19 booster and the omicron variant declining, now is an excellent time to get vaccinated and give your body a chance to build up immunity before a possible next wave of the pandemic.

Members of myRAteam on COVID-19 Booster Vaccines

Some myRAteam members write that they have already received their second booster shots:

• “I got mine within 12 hours of the announcement.”
• “Had mine this morning!”
• “If it gives us more protection, I’m fine with that. 😊”
• “I had my booster one week ago. Would much rather go through that than get COVID.”

Others describe preferring to wait until they’ve talked with their doctors to make sure getting a second booster will be safe and effective, given their individual conditions and medications.

Find Your Team

Connect with others on myRAteam, the social support network for those living with RA. Over 188,000 members come together to ask questions, give advice, and share their stories with others who understand.

Are you vaccinated against COVID-19? What are your thoughts about getting a second booster? Share your experiences in the comments below, or start a conversation by posting on your activities page.