• People with multiple sclerosis (MS) 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 multiple sclerosis 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

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
• 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 Boosters

The FDA authorized mix and match booster doses for the three COVID-19 vaccines available in the United States. This means 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 Multiple Sclerosis

People with multiple sclerosis who are considered immunocompromised may be eligible for a third dose of the Pfizer or Moderna vaccines 28 days following their second dose.

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. An additional dose of the Pfizer or Moderna vaccine 28 days following the second dose 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. 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 last two years
• People who are organ donor recipients and taking immunosuppressive drugs
• Those with certain other health conditions

The National Multiple Sclerosis Society shared recommendations for additional vaccine doses for people with MS on Aug. 19. The guidelines indicate that people with MS are not necessarily considered immunocompromised. However, the guidelines note “Some DMTs [disease-modifying therapies] used to treat MS do alter your immune system and can reduce your responses to a vaccine.”

According to the National Multiple Sclerosis Society’s guidelines, individuals with MS on the following DMTs may benefit from receiving an additional dose of the vaccine:

• Gilenya (fingolimod)
• Kesimpta (ofatumumab)
• Lemtrada (alemtuzumab)
• Mayzent (siponimod)
• Ocrevus (ocrelizumab)
• Ponvory (ponesimod)
• Rituxan (rituximab)
• Zeposia (ozanimod)
• Any biosimilars of these medications — in some cases, the same drug is available under a different brand name

If someone with MS is not considered immunocompromised based on their medications or other health factors, they may be eligible for a Pfizer or Moderna booster six months after the second dose of their COVID-19 vaccine — depending on their age and other health conditions.

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 doesn’t explicitly list MS. The list of underlying medical conditions includes chronic lung disease, diabetes, cancer, heart conditions, obesity, pregnancy, 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.