After a lot of back and forth about who’s eligible for booster shots in the United States right now, health officials finally seem to have settled on a pretty clear and comprehensive list.
You’re eligible if you got either of the two mRNA vaccines (Pfizer or Moderna) and you’re 65 or older, or live in a long-term care setting, or have certain underlying health conditions, or work in a high-risk setting. You can only receive it if it’s been six months since your last dose.
If you got the Johnson & Johnson vaccine, you’re eligible for a booster if you’re 18 or older and it’s been two months since your initial dose.
But what about people who got vaccinated and also have “natural” immunity because they’ve had (and recovered from) COVID-19? According to studies, cases like these may provide the highest degree of protection against severe illness. Should they still get a booster? And when? Here’s what we know now:
First, people who’ve had COVID should definitely still get vaccinated — and get boosted, if they’re eligible.
From the get-go, the Centers for Disease Control and Prevention has been pretty clear: You should get vaccinated even if you’ve already had COVID-19. You should also still get vaccinated if you happen to get COVID in between your two doses of the mRNA vaccines, though you should wait until you no longer have symptoms and you meet the CDC’s criteria for ending quarantine.
That’s because “natural” immunity simply doesn’t last all that long. “We know that antibody levels in people infected [with COVID] start to drop off fairly rapidly, they drop off within a month to two,” said Inessa Gendlina, director of infectious diseases at Montefiore Health System.
She added that antibody levels don’t tell the full picture: T-cells are also activated when building immunity to a disease — and those are much more difficult to measure. This is why it’s recommended that you still get vaccinated if you’ve had COVID and recovered.
Beyond that, you should still get a booster like everyone else. Meaning, if you’re in one of the eligible groups and it has been six months or more since you received one of the mRNA vaccines or two months since you got Johnson & Johnson, you should get another shot, or at least talk to your doctor about whether it’s a good time for you to do so.
If you have a breakthrough infection, you should still get a booster.
First, it’s important to know that there simply isn’t much data on this particular question yet. For one, the CDC is only tracking breakthrough infections that end in hospitalization or death, which are extremely rare. So we don’t even necessarily have a clear picture of mild breakthrough cases.
But the general consensus is that people who are fully vaccinated and have a breakthrough infection should still get boosted if they’re in an eligible category.
“We know their initial immunity maybe didn’t hold up, or didn’t hold up as well, and we know there is a drop-off even after they get an infection, so we would still recommend a booster,” Gendlina said.
The timing, however, is not clear-cut. Gendlina said people are probably protected for about 90 days after an infection, but they’re technically eligible before then. And she said it may be safest to just go ahead and get your booster dose as soon as your symptoms have cleared up and you meet the criteria for ending isolation.
But again, at this point, there is “no data,” added William Schaffner, an infectious disease specialist with Vanderbilt University Medical Center.
“We can’t tell you what the optimal or necessary time is,” he added. “If you ask me, just as a clinician, I would wait a couple of months.”
As has been true throughout the pandemic, experts are still discovering new information about COVID-19 by the day, Schaffner said. So if you have any questions about your particular circumstances or your own booster timeline, talk to your doctor.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.