• People with pulmonary hypertension (PH) may be eligible for additional doses of the Pfizer and Moderna COVID-19 vaccines, depending on personal health factors.
• All adults who received the Johnson & Johnson vaccine are eligible for a booster shot regardless of health status.
• Health agencies have also approved “mix and match” boosters, meaning a person may receive initial doses of one type of COVID-19 vaccine and a booster of another.

The Centers for Disease for Control and Prevention (CDC) released recommendations for Moderna and Johnson & Johnson COVID-19 vaccination boosters on Oct. 21. Based on the new recommendations, adults with pulmonary hypertension who received the Moderna vaccine may be eligible for a booster depending on personal factors. All adults who received the Johnson & Johnson vaccine are eligible regardless of health status or other factors. Additionally, the CDC and U.S. Food and Drug Administration (FDA) have approved mix and match boosters, which allow people to receive initial doses of one type of COVID-19 vaccine and a booster of another.

Booster Shot Eligibility

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

The following groups are now eligible for a booster shot at least six months after their second dose of the Moderna COVID-19 vaccine:

• People over 65
• People over 18 who have underlying medical conditions, including PH
• People over 18 who live in long-term care facilities
• People over 18 who live or work in high-risk settings (such as front-line workers or people who are incarcerated)

The FDA and CDC approved booster shots of the Pfizer vaccine for the same groups in September.

All adults over 18 who received the single-dose Johnson & Johnson COVID-19 vaccine are eligible for a booster shot at least two months after receiving their shot.

The CDC recommendations were released after the FDA amended the emergency use authorizations for the Moderna and Johnson & Johnson COVID-19 vaccines to allow for booster doses.

Mix and Match Doses

The FDA authorized mix and match booster doses for the three COVID-19 vaccines available in the United States. This means that you can receive a booster dose of a different vaccine from your original vaccine. For example, any adult over 18 who received the Johnson & Johnson vaccine can receive a booster dose of the Pfizer, Moderna, or Johnson & Johnson vaccines at least two months after receiving their shot. Those who have received the Pfizer or Moderna COVID-19 vaccines and are eligible for a booster may receive it from any of the three companies six months after their second dose.

Additional Doses for People With Pulmonary Hypertension

People with PH who are considered immunocompromised may be eligible for a third dose of the Pfizer or Moderna vaccines at least 28 days following their second dose. These additional doses may be recommended for those who did not develop an adequate immune response after the two-dose vaccination series. For Pfizer vaccines, the third dose and the booster are identical in the amount of vaccine administered. The Moderna booster is half the amount of vaccine as the first, second, or third doses.

The FDA amended the Pfizer and Moderna vaccines’ emergency use authorizations on Aug. 12 to allow a third vaccine dose for certain immunocompromised individuals.

Individuals defined as immunocompromised include people taking high-dose steroids or other immunosuppressive drugs:

• People in cancer treatment
• People who received a stem cell transplant in the past two years
• People who are organ donor recipients and taking immunosuppressive drugs
• Those with certain other health conditions

Vaccine Guidance for People With Pulmonary Hypertension

While PH is a qualifying diagnosis for a booster, having the condition does not always mean an additional vaccine dose 28 days after the first series is necessary. People with PH may need the additional dose if they are taking immunosuppressive medications or have other health conditions that prevented them from mounting an adequate immune response to the first two doses in the vaccine series.

The Pulmonary Hypertension Association has voiced support for the CDC’s recommendations for vaccination. Additionally, the International Society for Heart and Lung Transplantation said in a statement that it encourages immunization for people with advanced heart or lung disease or those who have had or are awaiting cardiothoracic transplantation.

If you have pulmonary hypertension, talk to your doctor about whether you qualify to receive a Moderna or Pfizer COVID-19 vaccine booster or a third dose of these vaccines, or about any questions related to COVID-19 vaccination.

Even if you are not considered immunocompromised based on your medications or other health factors, you are likely eligible for a Pfizer or Moderna booster six months after the second dose of your COVID-19 vaccine based on your PH diagnosis.

The CDC’s list of underlying medical conditions that would make someone eligible for a Moderna or Pfizer booster six months after their second dose explicitly lists PH as a condition that may qualify someone. The list of underlying medical conditions also includes chronic lung disease, diabetes, obesity, smoking or smoking history, and HIV infection, as well as several other conditions.

Talk to your doctor if you have questions about your eligibility for an additional COVID-19 vaccine dose.