COVID-19 Vaccine Booster FAQ for Transplant Patients

The FDA has authorized a COVID-19 booster vaccines for persons with weakened immune systems, including: transplant recipients, HIV patients, dialysis patients, and autoimmune patients. We RECOMMEND that patients receive the COVID-19 vaccine and booster.

Vaccine Safety and effectiveness

Is the COVID-19 vaccine safe?

We believe the vaccine is safe for nearly everyone. We recommend COVID-19 vaccination for all pre- and post-transplant patients as well as all living donors. Early data shows that there may be decreased efficacy in immunosuppressed individuals. We expect more data about this over the weeks and months to come. Please remain cautious by wearing masks, washing your hands and practicing social distancing.

Will the COVID vaccine hurt my transplanted organ?

As previously noted, the recommendation is to wait at least one month after your transplant surgery to receive either of the available COVID-19 vaccines. You can find more information in the American Society of Transplantation's COVID-19 vaccine FAQ sheet.

What if I've had allergies to vaccines in the past?

If you've ever had an allergic reaction to a vaccine, please talk to your primary care provider about whether the vaccine is right for you. Also, the CDC offers an information page on allergic reactions to COVID and other vaccines.

Has anyone had life-threating reactions to the COVID-19 vaccines?

The CDC notes that there have been reports of severe reactions that required treatment with epinephrine or a trip to the hospital. If you have had a serious reaction to any of the ingredients in the currently available COVID-19 vaccines, the CDC recommends that you do not get one of these vaccines. Read more from the CDC about vaccine reactions.

How effective is the additional vaccine dose in transplant patients?

The response in this population is variable. Studies show that the additional dose increases antibody levels in some patients, yet these studies also show that even after an additional dose, some transplant patients continue to have a lesser response to the vaccine than people who aren’t immunocompromised. For this reason, it’s important that you continue to protect yourself by wearing masks, social distancing, and encouraging your family and household members to get vaccinated.

Transplant Eligibility

Will patients have to be fully vaccinated to receive a transplant?

Not at this time. This might become a requirement at some point, however. It is required in a number of other programs in other states.

I’m on the transplant waiting list. Can I get an additional vaccine dose?

At this time, the FDA is authorizing additional doses for transplant recipients and patients whose immune response is moderately to severely affected by medical conditions or treatments. Please check with your primary care provider or specialist to see whether your condition qualifies you for an additional vaccine dose.

who Should Get the Vaccine and booster

I’m a fully vaccinated transplant recipient. Should I get an additional vaccine dose?

Yes, we are recommending boosters for all fully vaccinated transplant recipients because of the lower response rate to the two-shot vaccines and because of the easy and rapid spread of the Delta variant.

Should members of my family and caregivers get the booster?

We highly encourage all eligible family and household members of transplant recipients to get the standard vaccine regimen. At this time, the only people eligible for the booster dose are transplant recipients and patients whose immune response is affected by medical conditions or treatments for them.

Should living donors be vaccinated for COVID-19?

We recommend the COVID-19 vaccine for all living donors. National Kidney Registry donors should receive the vaccine at least seven days before surgery, so that entire chains aren't jeopardized and there's time to observe for any reaction.

immunosuppression

I am taking medications that suppress my immune system. Do I need to take special precautions with regard to COVID-19?

Based on experience with other viral respiratory infections, it is possible that COVID-19 infection will be more severe in the immunosuppressed population. Immunosuppressed patients should take the following precautions:
- Continue to wear a mask and practice social distancing in public, even after receiving the vaccine.
- Wash your hands often with soap and warm water, scrubbing for at least 20 seconds each time. When soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.
- Practice normal infection prevention techniques, such as regular handwashing, covering your nose and mouth when coughing, and avoiding individuals who are sick.

Should I continue to take my immunosuppressive medications?

Yes. If you develop any signs of illness, such as fever or respiratory symptoms, contact your medical team for guidance on whether to continue these medications as well as whether to seek care. If you have any questions about your regimen, check with your doctor.

As someone with immunosuppression, how do I talk with my employer about workplace accommodations?

HIPAA regulations protect your personal medical information. Only provide medical information that you feel comfortable sharing. A note from your Transplant physician(s) is helpful in validating that you may benefit from protection against COVID-19 in the workplace.

Contracting COVID-19

Can I get COVID-19 even if I have the vaccine?

Transplant recipients are more likely to ‘breakthrough’ the vaccine. This is the major reason we are recommending a booster vaccine for all recipients – it increases the level of protection and decreases the likelihood of a breakthrough case.

How would I get COVID-19 when I’m in the hospital after my transplant?

The most common mechanism is from visitors who are unvaccinated or not fully vaccinated yet (for example, in between vaccine injections 1 and 2). Transmission for hospital staff since vaccination started has been rare in the US.

Will the vaccine help with symptoms if I get COVID-19?

Yes. Unvaccinated patients have an 8-times higher risk of having symptoms than a vaccinated patient.

If I do get COVID-19, what should I know about therapy alternatives, such as monoclonal antibodies?

Currently, the evidence suggests that early administration of monoclonal antibodies for the COVID-19 virus may benefit patients who have an elevated risk of becoming seriously ill, reducing the likelihood of hospitalization and death.
The evidence for using convalescent plasma (donated by people who have recovered from COVID-19 infection) is less convincing. One small study showed benefit, but a more recent study showed no effect on survival. Theoretically, antibody-based therapies may help immunosuppressed transplant patients early in the course of illness from the coronavirus, but further data is needed to determine whether these treatments actually lead to better outcomes.

Timing Your Vaccine and Symptoms

Where can I get the additional dose?

You can get it at your local vaccination site.

How long will a patient have to wait after 2^nd dose of vaccine to be able to be transplanted?

We recommend 14 days. However, in unique or serious cases, this recommendation may be adjusted. Your Transplant team will discuss with you in that situation.

If recently transplanted, how long should they wait before receiving booster dose?

Twenty-eight days (28) or more

When can I get the additional dose?

You should wait at least 28 days after completing your first vaccine series before getting the third dose. Also, you should wait at least one month after your transplant to get the additional dose.

What about the side effects of the vaccine? Will they be worse with the booster?

Vaccine and booster side effects seem to be the same thus far: injection site pain, mild fatigue, low-grade fever, headache – these are the most commonly reported side effects in those who have them. The tend to last about 1-2 days.

Do I need to show proof that I’m a transplant recipient?

No. Medical documentation of transplant status is not required to get the additional dose.

Which brand of vaccine should I get?

The FDA has authorized additional doses of the Pfizer and Moderna vaccines (mRNA vaccines). Transplant recipients are eligible to receive an additional dose from one of these two manufacturers. The recommendation is to get the same brand that you received previously. But if that brand is not available, we recommend taking the brand that’s available to you.

I got the Johnson & Johnson vaccine. Should I get another dose of that?

The FDA has not authorized an additional dose of the J&J vaccine. We are awaiting further information from the CDC about patients who received this brand. Please check this page regularly for updates. You can also check CDC updates.

Do I need a prescription for the additional shot?

How much does the additional dose cost?

The vaccine is provided free to all patients.

Should I take anything before the shot to prevent side effects from the vaccine?

No, do not pre-medicate. In general, taking over-the-counter medications – such as aspirin, acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) – before receiving a vaccine can blunt your immune system's response to the vaccine, reducing its efficacy. However, if you have symptoms that make you uncomfortable after your vaccination, you may take an over-the-counter pain reliever to help you feel better. As always, please only take over-the-counter medications that are recommended by your transplant team.

Should I receive two vaccine doses, and do they have to be the same brand?

The Pfizer and Moderna vaccines both require two doses, while the Johnson & Johnson vaccine requires only one. Ideally, if you receive a vaccine that requires a second dose, the second dose should be the same brand. You must receive both doses to achieve optimal protection.
The Pfizer vaccine doses are given 21 days apart.
The Moderna vaccine doses are given 28 days apart.

Can I choose among Pfizer, Moderna and Johnson & Johnson?

We recommend that you receive whichever vaccine is available to you.

Should I continue to wear a mask after being vaccinated?

Yes. Your body's response to the vaccine takes time, early data shows that immunocompromised individuals may not respond as robustly to the vaccine as other people. You should therefore wear a mask and practice social distancing when outside of your household, even after receiving the vaccine.

I've received my organ transplant. Will the COVID-19 vaccines work for me?

Researchers are examining the immune response of organ transplant recipients to the vaccines, and so far, the evidence suggests it is not as strong as we would wish. Whereas the general population shows rates of seroconversion (producing specific antibodies in response) above 80 percent, one study of 658 vaccinated organ recipients found a seroconversion rate of 54 percent about four weeks after the second dose. Patients who had received certain kinds of medications, such as antimetabolites, were less likely to have an antibody response to their vaccination.
While you will likely have incomplete protection from COVID-19, we recommend that you receive the vaccine. Being fully vaccinated may still lower your risk of getting infected as well as your risk of becoming seriously ill if you do catch the virus. In addition, be sure to encourage your friends and family members to get vaccinated, and continue to exercise preventive measures, such as social distancing and masking, when around unvaccinated people or anyone whose vaccination status is unknown.

Should I get a blood test to measure my response to my COVID-19 vaccination?

The Food and Drug Administration does not recommend routinely checking antibody response after vaccination, particularly as it’s unclear what the results actually mean about how well an individual is protected. Doctors are working to translate relevant study findings into guidance for their patients, so the best place to turn with specific questions is your own providers.