Vaccination FAQ

The two doses of Pfizer-BioNTech vaccine should be given at least three weeks (21 days) apart and the two doses of Moderna vaccine at least four weeks (28 days) apart. There is no maximum amount of time between the first and second doses for either vaccine, but do not get the second dose earlier than recommended. 

An extended interval is an option for individuals 12 years of age and older based on an individual’s risks and benefits. An 8-week interval may be optimal for some people ages 12 years and older, especially for males ages 12 to 39 years. However, the 21 or 28 day interval between the first and second doses remains the recommended interval for: people who are moderately to severely immunocompromised; adults ages 65 years and older; and others who need rapid protection due to increased concern about community transmission or risk of severe disease. Talk to your healthcare or vaccine provider about the timing of the second shot that is right for you.

If you or your child are scheduled for COVID-19 vaccination but are exposed to someone infected with the SARS-CoV-2 virus, you should self-quarantine for the recommended period and reschedule your vaccination appointment after your quarantine has ended in order to avoid the risk of exposing vaccinators and others to the virus or to COVID-19.

If you get a confirmed COVID-19 infection after the first dose of COVID-19 vaccine, your second COVID-19 vaccine dose should be delayed until after your recovery and after the end of your isolation period to avoid the risk of exposing vaccinators to the virus.

COVID-19 vaccination second doses do not need to be delayed following receipt of monoclonal antibodies or convalescent plasma.

Yes, at least temporarily postponed. 

After you receive a vaccine dose in your arm muscle, the lymph nodes under your upper arm and armpit often swell up as your body begins processing the new vaccine. However, this is an intended and expected effect.

Lymph nodes are sites where many of the antibodies that eventually result in vaccine recipients being protected from COVID-19 are produced. Along with other lymph nodes, the lymph nodes under the arm that received the vaccine are likely to get a lot larger for a time as they begin responding to the vaccine components. .

Since lymph nodes under the arms are also places that cancer cells would spread to in people who develop breast cancer, one of the places that doctors always look for signs of breast cancer when you have a screening mammogram is that same group of lymph nodes under the arms. 

The caution about having a mammogram soon after a COVID-19 vaccination is to avoid having those lymph nodes (that may be enlarged as part of an expected response to the COVID-19 vaccine) be mistaken in the mammogram for a sign of the spread of breast cancer.  

By waiting 4-6 weeks after a COVID-19 injection to have a screening mammogram, you allow the lymph nodes to complete their initial vaccine response and begin going back to their normal size and appearance. By waiting for your mammogram, you reduce the risk of that kind of mistake happening. 

When you eventually have your mammogram, be sure to tell the technician that you recently had a COVID-19 vaccine, including which arm that you had it in.

Please note: If the purpose of your mammogram is to investigate an already existing breast symptom such as a breast lump, then you should have the mammogram first, before your next COVID-19 vaccine dose.

Several studies of people who have already had COVID-19 disease have indicated that people who become up to date with COVID-19 vaccination either before or after having COVID-19 disease are more protected against getting COVID-19 again than those who had COVID-19 disease without being up to date with vaccination. 

VDH and CDC continue to recommend that people who may have natural immunity after having had COVID-19 disease maximize their protection from getting infected again by becoming up to date with COVID-19 vaccination.  

For complete protection, you will need to become up to date with two (2) mRNA COVID-19 vaccine doses and any eligible booster doses.

“Fully vaccinated” still means that (1) a person has received two doses of the original series of either the Pfizer-BioNTech mRNA COVID-19 vaccine OR the Moderna mRNA COVID-19 vaccine OR that the person has received a single dose of the Johnson & Johnson (also known as Janssen) COVID-19 vaccine AND (2) that at least 14 days have passed since the last vaccine dose was received. 

However, being Up to Date goes a step beyond being Fully Vaccinated to include any person who has received ALL of their recommended COVID-19 vaccine doses, including both the primary vaccine series and any booster dose(s) as soon as they are eligible.

Anyone 12 years of age and older who completed a COVID-19 vaccination series with an mRNA vaccine is now recommended to get a booster dose with any FDA-authorized COVID-19 vaccine once five (5) months have passed since their 2nd primary series dose. People who received the single-dose Johnson and Johnson (Janssen) vaccine should get a vaccine booster dose once two (2) months have passed since their initial dose. 

According to a CDC note about the Omicron variant of the SARS-CoV-2 virus, “Data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against [Omicron] infection for two doses of an mRNA vaccine is approximately 35%. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75%.”

To maximize protection against the Omicron variant of COVID-19, even if someone has already met the earlier definition of “fully vaccinated”, for optimal protection, they should still stay up to date on recommended COVID-19 booster vaccinations.

Regardless of community transmission levels, VDH recommends everyone to stay up to date on their COVID-19 vaccines, including boosters, and to increase ventilation in indoor spaces. 

Knowing the COVID-19 Community Level in your area will help you know what additional prevention measures to take.

Mask guidance: 

• People with symptoms, a positive test, or exposure to someone with COVID-19 should wear a mask.
• In areas where the COVID-19 Community Level is 
  • Low: Wear a mask based on your personal preference and your level of risk of developing severe illness.
  • Medium: Wear a mask based on your personal preference, your level of risk, and the risk of the people you live or spend time with. 
  • High: 
    • Everyone, regardless of vaccination status, should wear a mask indoors in public in areas where the COVID-19 Community Levels is high.  
    • People at increased risk should wear a mask or respirator that provides them with greater protection, like an N95 or KN95.
    • People with weakened immune systems or who are at increased risk for severe illness should talk to their healthcare provider about what extra precautions, like masks, they may need. 
• People may choose to mask at any time.

Testing guidance: 

• At all COVID-19 Community Levels, get tested if you have COVID-19 symptoms or after you are exposed to someone with COVID-19.
• People with weakened immune systems or who are at increased risk for severe illness should talk to their healthcare provider about testing recommendations, regardless of the COVID-19 Community Level. 
• At Medium or High Levels: If you have household or social contact with someone at high risk for severe disease, you should consider self-testing to detect infection before contact. 

People with weakened immune systems or otherwise at increased risk for severe illness:

• These individuals should talk to their healthcare provider about what extra precautions they may need, including masking, testing, or early treatment recommendations. 
  • Treatments work best when started early, so rapid access to testing is critical for people at increased risk, in addition to other layers of prevention. 
• At high COVID-19 Community Levels, people should avoid non-essential indoor activities. 

Since no vaccine is100% effective at preventing infection, some vaccine breakthrough cases are expected. (Even if a vaccine is 95% effective, we would still expect 5% of fully vaccinated individuals to be susceptible to infection despite being vaccinated).

Breakthrough cases are expected when vaccine-induced immunity levels decrease over time. Breakthrough cases can also be expected when a new variant (e.g. the Omicron variant or the BA.2 sub-variant of Omicron) displays resistance to the antibody and cellular immunity provided by prior COVID-19 vaccination.

Such breakthrough COVID-19 cases can still result in losing some time away from school or work. In addition, Long COVID can still occur after breakthrough cases (although less often than after COVID-19 in unvaccinated people).   

However, current evidence shows clearly that being up to date with COVID-19 vaccination accomplishes the primary goals of vaccination by making the illness of breakthrough cases less severe for those who are up to date and still get infected (including by the Omicron variant or the BA.2 sub-variant) and that vaccination will also reduce - but not eliminate entirely - the risk of spreading COVID-19 to others.

Study links: 

Decreased SARS-CoV-2 viral load following vaccination

Initial real world evidence for lower viral load of individuals who have been vaccinated by BNT162b2

Comparative transmission of SARS-CoV-2 Omicron (B.1.1.529) and Delta (B.1.617.2) variants and the impact of vaccination: national cohort study, England

From a January 2022 CDC MMWR - adults who were unvaccinated had five (5) times the risk of infection with the Omicron variant compared with adults who were fully vaccinated with a booster.

This Nature article discusses the benefit of a booster dose. After being boosted, “household members were about 32% less likely to get infected with Delta and 12% less likely to become infected with Omicron than if they had received just two doses. People who had received a booster were 38% less likely to spread a Delta infection to their household members, and 22% less likely to pass on an Omicron infection than were those who had had just two shots.”

Virginia added aCOVID-19 Cases by Vaccination Status dashboard on the VDH Data web page.  

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Yes. Although people up to date with COVID-19 vaccination who get breakthrough infections with the Omicron variant can sometimes spread COVID-19 to others, such people seem to be contagious for a shorter time than infected but unvaccinated people. The most recent information on the spread of the Omicron variant can be found on the CDC’s Omicron Variant: What You Need to Know webpage. 

Although effectiveness of the current COVID-19 vaccines against mild or asymptomatic Omicron or BA.2 variant breakthrough infection is slightly less, being up to date with COVID-19 vaccination is still effectively preventing severe illness, hospitalizations, and deaths. As has been the case for more than a year, most COVID-19 hospitalizations and most COVID-19 deaths are occurring in unvaccinated individuals.

Yes, there are several other ways to help protect others.

In areas where the COVID-19 Community Level is medium, people who live with or have social contact with someone who is at increased risk should consider wearing a mask when indoors with them, and also may choose to test themselves for infection before they get together. Other strategies include improving ventilation in indoor spaces and maintaining adequate distance when around them. 

For additional information, please see CDC considerations for Families with Vaccinated and Unvaccinated Members. 

For cruise ship travel, CDC recommends that you make sure you are up to date with your COVID-19 vaccines before travel.

For airline travel to other countries, COVID-19 viral testing is typically required for pre-travel screening on international airline flights. Some countries are requiring proof of vaccination before allowing travelers to enter certain facilities (e.g., restaurants). Before ANY travel to other countries, you should check closely with both your airline and with the national testing and vaccination requirements of the country or countries that you will be visiting.

For travel from other countries to the United States, all arriving passengers two (2) years and older, including U.S. citizens, and regardless of vaccination status, are REQUIRED to show a negative COVID-19 viral PCR or antigen test taken no more than 1 day before departure for the U.S., or the combination of (1) documentation of having recovered from COVID-19 in the past 90 days (i.e., their positive COVID-19 viral test result on a sample taken no more than 90 days before the flight’s departure) AND (2) a letter from a licensed healthcare provider or public health official stating that you were cleared to travel). 

NOTE: Proof of being up to date with COVID-19 vaccination will not substitute for having a negative viral PCR or antigen test before returning to the United States.

For additional information, please visit the VDH’s Travelers webpage.

The Omicron variant is up to three times more infectious than the Delta variant and the BA.2 sub-variant of Omicron is even more contagious than the Omicron variant.

However, being up to date with vaccination, including recommended booster doses, helps provide optimal protection against both the Omicron variant and the BA.2 sub-variant. 

According to the CDC, “Data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against [an Omicron variant ] infection for two doses of an mRNA vaccine is approximately 35%. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75%.“

Therefore, although vaccine effectiveness against developing a COVID-19 illness with mild or no symptoms appears to be decreased against the Omicron variant and the BA.2 sub-variant, protection of people up-to-date with COVID-19 vaccine will remain high for preventing serious illness, hospitalization, or deaths. 

Frequently updated information from CDC on the Omicron variant (also called B.1.1.529) is available at Omicron Variant: What You Need to Know.

Individuals should also follow the guidance in the CDC COVID-19 Community Levels.  

No.

Serology (antibody) testing to confirm immunity after vaccination is not currently recommended by CDC or by VDH. One important reason is that some of the currently marketed serology test kits use a different technology than others and may not be able to detect the spike (S) protein antibodies that are the most important antibodies produced by the mRNA COVID-19 vaccination process. Using such serology blood test kits could provide a false negative test result that would not reflect your actual protection provided by the COVID-19 vaccine.

This caution about the risk of false negative results of post-vaccine antibody testing is also true for the recently authorized Symbiotica SARS-CoV-2 home antibody test kit.  

Your COVID-19 vaccination will not interfere with the accuracy of your TB test. According to the CDC, inactive (non-live) vaccines will not interfere with results of either a TB skin test or a TB blood test (also known as an IGRA). TB testing can be done before or at the same time as mRNA COVID-19 vaccination, or otherwise delayed for at least 4 weeks after the completion of mRNA COVID-19 vaccination, if possible, but generally should not be canceled.

More information on this topic can be found on the CDC website.

Yes. CDC guidance is available and is based on the vaccine(s) received for the primary series, whether the primary series was completed, and whether a booster dose was received. 

To complete up to date vaccination of individuals who received all FDA-approved or -authorized COVID-19 vaccines, Pfizer-BioNTech COVID-19 Vaccine can be used in individuals ages 5 years and older and Moderna COVID-19 Vaccine can be used in individuals 18 years and older.

For individuals who received at least one COVID-19 vaccine that was not FDA-approved or -authorized, Pfizer-BioNTech COVID-19 Vaccine can be used in individuals ages 12 years and older and Moderna COVID-19 Vaccine can be used in individuals 18 years and older to bring them up to date with COVID-19 vaccination.

For a current list of WHO-EUL COVID-19 vaccines, see the WHO page “COVID-19 vaccines WHO EUL issued.” 

Although your insurance company can be billed for the process of administering your COVID-19 vaccination, you are not responsible for paying for your (or your child’s) COVID-19 vaccines or vaccinations. If you receive a bill, you should first speak to the person or facility that sent it. 

Until recently, if you were uninsured and received a bill related to COVID-19 vaccination, you could have asked your healthcare provider to bill the HRSA COVID-19 Uninsured Program instead of you. However on April 5, 2022, the HRSA Uninsured Program stopped accepting vaccination claims due to a lack of sufficient funds.

However, CDC is still requiring all COVID-19 vaccinators to provide COVID-19 at no out-of-pocket costs to patients.

The Virginia Department of Health is aware of an email scam occuring asking individuals to “validate their COVID-19 status.” The email uses VDH logos and graphics, but it is not from VDH. VDH graphics and materials will link to VDH or LHD websites.  Individuals should check the URL to ensure that it's legitimate.  If you have any questions about such emails, please contact VDH directly via email at questions@vdh.virginia.gov.

This depends. People who have been vaccinated against COVID-19 can donate COVID-19 plasma only if you meet all three of these criteria:

1. You had symptoms of COVID-19 disease and a positive test result from a diagnostic test approved or authorized by FDA, AND
2. You received the COVID-19 vaccine after your diagnosis of COVID-19, AND
3. You are within 6 months after complete resolution of your COVID-19 symptoms.

See page 6 of the January 2022 FDA guidance for more information on this topic.

No, the definition of up to date remains the same.  A person is up to date when they have received all recommended doses in their primary series of COVID-19 vaccine, and a booster dose when eligible. Getting a second booster dose is not needed to be considered up to date at this time.

A booster dose is a COVID-19 vaccine dose administered to someone who initially had  good protection from the primary vaccine series or from a first booster dose, but in whom this protection may have weakened over time. 

Standard (first) booster doses are recommended for all individuals 12 years and older. The recommended interval for the booster dose is based on the vaccine type received for the primary series. In most people, the interval is:

• At least 5 months after mRNA 2-dose primary vaccination series or

• At least 2 months after Janssen single dose primary vaccination 

Information on accessing a COVID-19 booster dose can be found at vaccinate.virginia.gov.

An additional primary series dose is a COVID-19 vaccine dose administered to someone with a moderately or severely weakened immune system because their initial immune response after completing the primary vaccine series may have been insufficient to provide them with strong protection. 

• A 3-dose primary series is recommended for people ages 5 years and older who are moderately or severely immunocompromised at the time of vaccination. The same mRNA vaccine product should be used for all three doses of the primary series. The 3rd dose is administered at least 4 weeks after the second dose. 
• For moderately or severely immunocompromised people ages 18 years and older who received a primary Janssen vaccination, a second (additional) dose using an mRNA COVID-19 vaccine is recommended at least 4 weeks later.

Those people who receive an additional dose will also be eligible for a standard vaccine booster dose (if they also meet the age and time requirements for a booster) and for a second booster dose when they are eligible. 

For COVID-19, a primary vaccine series is still defined as either:

• Two doses of an mRNA vaccine (Pfizer or Moderna) separated by at least the recommended minimum number of 21 or 28 days, respectively; or
• One dose of the Johnson & Johnson (J&J) vaccine.

PLEASE NOTE: Because of an updated risk-benefit analysis of post-vaccination blood clotting disorders, CDC recommendations now state that, in most situations, Pfizer-BioNTech or Moderna COVID-19 vaccines are now preferred over the Johnson and Johnson (Janssen) COVID-19 vaccine. Please see Johnson & Johnson’s Janssen COVID-19 Vaccine Overview and Safety.   

Individuals are considered up to date on their COVID-19 vaccines as soon as they have completed the recommended primary series and when eligible, have also received a booster dose. Second boosters (for those who are eligible) are not needed at this time to meet the definition of “up to date”.

The timing of a vaccine booster dose depends on (1) which vaccine you received as the primary vaccination, (2) the competence of the immune system of the potential booster recipient, and (3) whether you have had a recent COVID-19 infection. 

After a Pfizer-BioNTech or Moderna mRNA vaccine series: Everyone ages 12 years and older should receive a single COVID-19 booster dose) 5 months after completing the primary mRNA vaccination series. 

Adults ages 50 years and older who are not moderately or severely immunocompromised may choose to receive a second booster dose using an mRNA COVID-19 vaccine at least 4 months after the first booster dose.

People ages 12 years and older who are moderately or severely immunocompromised may choose to receive a second booster dose at least 4 months after the first booster dose.

At this time, only the Pfizer COVID-19 vaccine is authorized and recommended as a booster for individuals 12 to 17 years old. 

After Johnson & Johnson (Janssen) vaccine: All individuals 18 years of age and older who received the Johnson & Johnson single dose COVID-19 vaccine, should receive a booster dose at least two (2) months after their primary dose. 

People ages 18–49 years who are not moderately or severely immunocompromised and who received Janssen COVID-19 Vaccine as both their primary series dose and booster dose may receive a second booster dose using an mRNA COVID-19 vaccine at least 4 months after the first Janssen booster dose. 

Adults ages 50 years and older who are not moderately or severely immunocompromised may choose to receive a second booster dose using an mRNA COVID-19 vaccine at least 4 months after the first booster dose. 

Because their risk of reinfection is low in the first months after a SARS-CoV-2 infection and COVID-19 illness, people who have had a recent natural infection can consider delaying their first or second booster until 3 months have passed since that illness. Increased time between illness and vaccination booster appears to result in a better immune response.

The FDA has limited the use of the J&J COVID-19 vaccine due to safety issues. The J&J COVID-19 vaccine should only be given to individuals 18 years and older whom mRNA COVID-19 vaccines are not accessible or clinically appropriate and who would otherwise not receive a vaccine. CDC recommends that, in most situations, Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines are preferred over the Johnson and Johnson (Janssen) COVID-19 vaccine. For additional information, please see Johnson & Johnson’s Janssen COVID-19 Vaccine Overview and Safety.

No. Although vaccine manufacturers have stated that they are working on Omicron specific vaccines, even if successfully completed, that process will take at least several months more. Although the protection provided against infections from the Omicron variant infection or from its BA.2 subvariant is slightly less than against the Delta variant, booster doses with current mRNA COVID-19 vaccines protect well against serious illness, hospitalization, and death from the Omicron variants.

The best current way to protect yourself and your family from the Omicron variant is (1) to stay up to date on your COVID-19 vaccinations and (2) to continue practicing other recommended prevention measures.

The following conditions in individuals who are otherwise eligible for a COVID-19 vaccine booster dose are contraindications:

• History of a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the COVID-19 vaccine
• History of a known diagnosed allergy to a component of the COVID-19 vaccine

The following are  COVID-19 vaccine precautions (requiring extra care at the time of vaccination): 

• History of an immediate allergic reaction to any vaccine other than COVID-19 vaccine or to any injectable therapy (i.e., intramuscular, intravenous, or subcutaneous vaccines or therapies [excluding “allergy shots”])
• People with a history of a non-severe, immediate (onset less than 4 hours later) allergic reaction after a dose of one type of COVID-19 vaccine (i.e., mRNA or Janssen) have a precaution to the same type of COVID-19 vaccine
• People with an allergy-related contraindication to one type of COVID-19 vaccine have a precaution to the other type of COVID-19 vaccine (e.g., people with a contraindication to an mRNA COVID-19 vaccine have a precaution to Janssen COVID-19 vaccine and vice versa).
• Moderate or severe illness, with or without fever
• For mRNA COVID-19 vaccines, history of myocarditis or pericarditis after a dose of an mRNA COVID-19 vaccine

For complete recommendations, please refer to the CDC clinical considerations. Talk to a healthcare provider if you have questions about getting a booster dose.

The recommendations for people vaccinated outside of the United States depend on the vaccine(s) received for the primary series, whether the primary series was completed, and whether any booster dose was already received.

Please refer to the CDC guidance on this topic. 

For individuals who received any FDA-approved or FDA-authorized COVID-19 vaccines as an initial dose, Pfizer COVID-19 vaccine can be used in individuals ages 5 years and older and Moderna COVID-19 vaccine can be used in individuals 18 years and older to complete a primary vaccination series and for booster doses when eligible.

For individuals who completed a series of a COVID-19 vaccine that was not FDA-approved or -authorized, but that is WHO-authorized, Pfizer COVID-19 vaccine can be used in individuals ages 12 years and older and Moderna COVID-19 vaccine can be used in individuals 18 years and older to provide a booster dose five months after their most recent vaccine dose.

No. The current booster dose recommendations mean that COVID-19 vaccines are working as expected. Many vaccines used in the United States produce levels of antibody and cellular immunity that wane (decrease) over time and their successful long term use requires booster vaccine doses at various times. Some examples include flu (influenza), pertussis (whooping cough), tetanus, and diphtheria. Regular boosters are part of the long term planning for preventing these diseases. 

COVID-19 vaccines continue to work well to prevent severe illness, hospitalization, and death.

No. Although a driver’s license or other sort of valid identification card will be required to establish your identity, proof of prior vaccination is not required. However, bringing your CDC vaccination card to the vaccination will allow the booster dose to be added.

No.

The CDC definition of fully vaccinated remains the same. People are considered fully vaccinated: 

• 2 weeks after their second dose in a 2-dose series ofthe Pfizer or Moderna vaccines, OR
• 2 weeks after a single dose of the Johnson & Johnson’s Janssen vaccine

This definition applies to all people, including those who receive an additional (third) mRNA vaccine dose as recommended for moderate to severely immunocompromised people and those who receive a booster shot. 

However, because it is essential for maximum protection against COVID-19, individuals should stay up to date with additional or a booster dose after their primary COVID-19 vaccination series.

The COVID-19 vaccines available in the United States continue to be highly effective at preventing severe disease, hospitalization, and death. 

However, there is a concern that the protection against severe COVID-19 disease, hospitalization, and death that are benefits of the primary vaccine series could weaken over time in the months ahead. Booster vaccine doses given after the primary vaccine series appear to be able to “boost” one’s level of immune protection significantly. This boost is now especially important with the threat of the Omicron variant and the BA.2 sub-variant. It is essential that for maximum protection, individuals should stay up to date with their COVID-19 vaccinations, including boosters.

Yes. Moderately and severely immunocompromised people aged ≥12 years who: 

• Received 2 mRNA COVID-19 vaccine doses should receive a third mRNA primary dose (at least 28 days after their second dose) followed by a booster dose (at least 3 months after completing their third primary dose), for a total of four vaccine doses
• Received a Janssen COVID-19 Vaccine primary dose should receive one additional mRNA dose (at least 28 days after their primary dose) and one booster dose (at least 2 months after completing their additional dose), for a total of three vaccine doses.

People ages 12 years and older who are moderately or severely immunocompromised may choose to receive a second booster dose at least 4 months after the first booster dose. This would be a fifth dose for people who completed an mRNA primary series and a fourth dose for people who completed the J&J (Janssen) initial shot. 

Teens 12–17 years old may only get a Pfizer-BioNTech COVID-19 vaccine booster.

Note: The FDA has limited the use of the J&J COVID-19 vaccine due to safety issues. The J&J COVID-19 vaccine should only be given to individuals 18 years and older whom mRNA COVID-19 vaccines are not accessible or clinically appropriate and who would otherwise not receive a vaccine. People who are starting their vaccine series or getting a booster dose should get either Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines. For more information, please see Johnson & Johnson’s Janssen COVID-19 Vaccine Overview and Safety and CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines. 

Protection from COVID-19 vaccination can decrease over time. Since overall immune responses appear to increase with each subsequent vaccine dose, one way to respond to a decrease in immunity against infections with the Omicron variant or other variants might be to give a second booster dose. 

Public health organizations and vaccine manufacturers have been carefully watching emerging data to ensure vaccine protection remains strong against severe COVID-19 illness. Individuals who are up to date with their COVID-19 vaccinations, including booster doses, continue to have strong protection against severe illness. The current booster dose recommendation for staying up to date is especially important to get the greatest protection against the Omicron variant. 

FDA’s advisory committee met on April 6 to discuss the use of COVID-19 vaccine booster doses and the process for COVID-19 vaccine strain selection to address current and emerging variants. The committee is expected to meet again in late spring or early summer to consider updated booster formulations for this fall.

Meanwhile, people 50 years old and older and immunocompromised individuals 12 and older are now allowed to have another (second) COVID-19 vaccine booster dose. The booster dose policy is being changed because recent data shows that second booster doses are very effective in both restoring antibody levels and further reducing infection rates. These benefits are important for individuals at higher risk for severe COVID-19 illness.  

CDC’s most recent guidance on the eligibility for and timing of a second COVID-19 vaccine booster is available.

Children 5–17 years old will need two (2) doses of the Pfizer-BioNTech vaccine separated by at least 21 days apart. An extended interval is an option for individuals 12 years of age and older based on an individual’s risks and benefits (including the risk of myocarditis). An 8-week interval may be optimal for some people ages 12 years and older, especially for males ages 12 to 39 years. However, the 21 or 28 day interval between the first and second doses remains the recommended interval for: children who are moderately to severely immunocompromised and others who need rapid protection due to increased concern about community transmission or risk of severe disease.

After receiving the two doses, it is important that children stay up to date on COVID-19 vaccines by receiving booster doses when eligible in order to maintain adequate protection. 

People aged 5+ who are moderately or severely immunocompromised should get a third (additional) primary dose of Pfizer COVID-19 vaccine, 28 days after their 2nd dose. 

Everyone ages 12+ should get a Pfizer booster dose at least 5 months (or at least 3 months if immunocompromised) after the last dose in their primary series.

People ages 12 years and older who are moderately or severely immunocompromised may choose to receive a second booster dose at least 4 months after the first booster dose. This would be a fifth dose for people who completed an mRNA primary series and a fourth dose for people who completed the J&J (Janssen) initial shot.

Yes. Minors (those less than 18 years old) in the Commonwealth of Virginia may not consent to their own immunizations to prevent disease. There are some exceptions to this restriction. For example, any minor who is or has been married is considered to be an adult for the purpose of giving consent to their own surgical and medical treatment. 

The Commonwealth does allow someone acting “in loco parentis” per:§ 32.1-46, which covers vaccination in accordance with the Immunization schedule developed by and published by the Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians  (AAFP). In an effort to maintain consistency with similar approaches to vaccination, a minor may present for COVID-19 vaccination with either a parent, guardian, or someone standing in loco parentis.

Sites run by the Virginia Department of Health require the parent or guardian to verbally confirm a minor’s date of birth; however, other providers may require additional proof of age.

You should check with the facility that is offering the vaccination about requirements for proof of age.

For minors getting vaccinated at VDH-sponsored or VDH-supported community events and health department clinics: The parent or guardian does not have to be present at the time of vaccination, but someone acting in loco parentis must accompany the minor.

For minors getting vaccinated at VDH sponsored or supported school vaccination events: Clinics occurring during the school day while school is in session and fully staffed do require parental consent but do not require the presence of a parent, guardian, or someone acting in loco parentis.

You should check with the facility that is offering the vaccination about consent and who needs to accompany the adolescent.

COVID-19 vaccine dosing is based on your child’s age, and not their weight or size. 

Side effects seen in younger children after vaccination against COVID-19 are similar to those seen in adolescents and young adults. Reported side effects following vaccination are less frequent in children aged 5–11 years compared with young adults aged 16–25 years.

Detailed comments on expected vaccine side effects are available in the Vaccine FAQs section on Side Effects and Adverse Events After COVID-19 Vaccine.  

As happens occasionally with other vaccines such as the influenza vaccine, fainting soon after injection has also been noted among a small number of COVID-19 vaccine recipients, especially among adolescents and other young adults. 

Some of the expected side effects could interfere with your child’s ability to do daily activities, but they should go away in a few days.

Detailed information on expected vaccine side effects are available in the Vaccine FAQs section on Side Effects and Adverse Events After COVID-19 Vaccine.  

Remember to sign your vaccinated child up for v-safe (vsafe.cdc.gov), where you can use your smartphone to tell CDC about any side effects after they get the COVID-19 vaccine. You’ll also get reminders from v-safe about their second vaccine dose.

You will need your smartphone and information about the COVID-19 vaccine that your child received. This information can be found on the vaccination record card they receive at the time of vaccination; if you cannot find their vaccination record card, please contact your healthcare provider. COVID-19 vaccination records in the Virginia Immunization Information Systems (VIIS) are also available through the COVID-19 Vaccination Record Request Portal. You can access the portal by visiting vaccinate.virginia.gov. 

For instructions on how to register your child for v-safe, please visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/v-safe-register-dependents.html.

Myocarditis is inflammation of the heart muscle, and pericarditis is inflammation of the outer lining of the heart. In both cases, the body’s immune system causes inflammation in response to an infection or some other trigger. Cases of myocarditis and pericarditis in adolescents and young adults have been reported more often after getting the second dose than after the first dose of one of the two mRNA COVID-19 vaccines, Pfizer or Moderna. These reports are rare and the known and potential benefits of COVID-19 vaccination outweigh the known and potential risks, including the possible risk of myocarditis or pericarditis. 

In addition, myocarditis and other heart problems are more common and more severe after COVID-19 illness than after COVID-19 vaccination. According to a recent CDC MMWR, young men (ages 18-29 years old) had 7-8X the risk of heart complications after infection compared to after vaccination. 

If your child is 12 years of age or older, talk to their healthcare provider about an extended interval between the first and second vaccine doses. An 8-week interval may be optimal, and is now allowed, for people ages 12 years and older. Males ages 12 to 39 years, may especially benefit, with a lower risk of myocarditis. However, the 21 or 28 day interval between doses remains the recommended interval for: children who are moderately to severely immunocompromised and for others who need rapid protection due to increased concern about community transmission or risk of severe disease.

Learn more about myocarditis and pericarditis. Seek medical care if you or your child have symptoms of these conditions within a week after COVID-19 vaccination.

Children should receive the vaccine dosage and formulation based on their age on the day of vaccination with each dose. If a child turns 12 years old between their first and second dose, they should receive the age-appropriate 30 µg Pfizer COVID-19 Vaccine formulation for their second dose to complete their series. However, the FDA authorization allows children who will turn from 11 years to 12 years of age between their first and second dose in the primary regimen to receive, for either dose, either: (1) the Pfizer COVID-19 Vaccine formulation for children aged 5–11 years (each 0.2 ml dose containing 10 µg); or (2) the Pfizer COVID-19 Vaccine formulation authorized for use in individuals 12 years of age and older (each 0.3 mL dose containing 30 mcg). If such dosing occurred, the child is considered fully vaccinated. This is not considered an error.

There are no plans to mandate that K-12 school children receive a COVID-19 vaccine at this time. The General Assembly would need to approve that requirement through Virginia’s immunization code.

COVID-19 vaccines protect children 12–18 years old against severe outcomes of COVID-19 infection. A recent study of adolescents hospitalized with COVID-19 found that only 4% of them had been up to date in their COVID-19 vaccination status. In a comparison of this group with hospitalized adolescents who did not have COVID-19, the effectiveness of vaccines in preventing hospitalization was found to be 94%. Vaccine effectiveness in preventing adolescent COVID-19 admission to an ICU was 98%, and its effectiveness in preventing adolescent death from COVID-19 was 100%. 

In a March 2022 CDC report, data show that two doses of Pfizer-BioNTech COVID-19 vaccine reduced the risk of Omicron infection by 31% among children aged 5–11 years and by 59% among persons aged 12–15 years. Fully vaccinated participants with Omicron infection spent an average of one half day less sick in bed than did unvaccinated participants with Omicron infection.

A preprint study conducted in New York, shows that vaccine effectiveness against COVID-19 cases dropped (waned) quickly, but especially in younger children (5–11 years). Yet the study showed that vaccine protection against severe COVID-19 outcomes remained especially high in adolescents. 

The risk of children getting severely ill from COVID-19 was lower in the past than in unvaccinated older people, but it is not zero. 

Children who have COVID-19 have a risk of becoming sick, hospitalized, or in some cases, dying. Children with diabetes and obesity are likely to experience severe COVID-19. Children may also develop long-term illness, such as multisystem inflammatory syndrome in children (MIS-C) or long COVID. Long COVID is when individuals develop symptoms such as fatigue, chest pain, headaches, or shortness of breath that last for weeks or months, and may not appear until several weeks after infection. In contrast, the vaccine has been proven to be safe and effective in children ages 5 years and up. 

CDC data from April 2022 shows that during the Omicron surge, hospitalization rates from COVID-19 in children aged 5–11 years were approximately twice as high among unvaccinated as among vaccinated children. Thirty percent of hospitalized children had no underlying medical conditions. 

The COVID-19 vaccine is safe and effective at preventing severe illness and death. More than 9 million children aged 5–11 years have received a COVID-19 vaccine so far in the United States. COVID-19 vaccination can help our students stay in school,  minimize interruptions (such as having to quarantine after an exposure), and decrease the likelihood of COVID-19 transmission.

Yes. As many as 2.7% (almost 10 million people) of the adult U.S. population have some variety of weakened immune systems.

Many people with weakened immune systems are at greater risk from SARS-CoV-2 virus infection and severe COVID-19 disease. Such people include: 

1. those who have a weakened immune system because of a disease they were born with (e.g., Down’s Syndrome or primary immunodeficiency) or that they became ill with (e.g., HIV infection or blood cancer) later on;
2. those whose immune systems are weaker because of a medicine they are taking to prevent rejection of a solid organ transplant (e.g., kidney or liver transplant) or from medicine or radiation needed to control a disease such as rheumatoid arthritis or cancer.

People with weakened immune systems are also at higher risk from COVID-19 because they may not be able to gain the full protection of being fully vaccinated or even up to date with COVID-19 vaccine. 

People with weakened immune systems can also sometimes stay infected with – and can continue to spread - COVID-19 disease and SARS-CoV-2 virus for prolonged periods, thereby increasing the risk of exposing others to the virus.

Yes.

After completing the primary vaccine series, some moderately or severely immunocompromised people should get an additional primary series shot. 

• The additional dose should be administered at least 28 days after the second dose of either the Pfizer or Moderna vaccine; or at least 28 days after the single initial dose of the Johnson & Johnson vaccine. 
• The additional dose should be the same mRNA vaccine as the primary series.  For J&J (Janssen) vaccine recipients, the additional dose should be any mRNA COVID-19 vaccine.  

However, even those people with weakened immune systems who receive an additional dose of an mRNA vaccine still might not have strong protection against COVID-19 after vaccination. These individuals should speak to their healthcare provider about additional prevention measures, including having a plan for testing, or the need for early treatment if infected. In areas where the COVID-19 Community Level is high or medium, people at increased risk should wear a mask or respirator that provides them with greater protection, like an N95 or KN95 and may choose to avoid nonessential indoor activities. 

• Their household members, friends, and other close contacts who are vaccine-eligible should get up to date on COVID-19 vaccination to help provide maximal protection to their immunocompromised loved ones and colleagues.
• The individuals who received mRNA COVID-19 vaccine doses should also get a standard booster dose (at least 3 months after completing their third primary dose), for a total of four vaccine doses
• The individuals who received a Janssen COVID-19 Vaccine primary dose followed by one additional mRNA dose, should receive one booster dose (at least 2 months after completing their additional dose), for a total of three vaccine doses.
• If a second booster dose is later considered, it should be given no earlier than four (4) months after the first (standard) booster dose. 

People ages 12 years and older who are moderately or severely immunocompromised may choose to receive a second booster dose at least 4 months after the first booster dose. This would be a fifth dose for people who completed an mRNA primary series and a fourth dose for people who completed the J&J (Janssen) initial shot.

The American College of Rheumatology has guidelines around vaccination timing for people with autoimmune and inflammatory conditions as well as recommendations for which medications should be paused when patients get the vaccine. Other guidance is available from the International Organization for the Study of Inflammatory Bowel Disease, and the American Society of Transplantation and other transplantation groups. The Leukemia and Lymphoma Society has released a set of COVID-19 FAQs.

You should discuss your personal protection and your COVID-19 vaccination situation with your healthcare provider. Any revaccination or additional vaccination decided on should be done with an mRNA vaccine.

No. Proof of medical condition is not required to receive a third (additional) dose. However, individuals may need to state that they have a moderate or severe immunocompromising condition. You should also bring photo identification to confirm your identity as well as your CDC vaccination card, so that this additional dose can be added.

Yes. 

Moderately and severely immunocompromised people aged ≥18 years who received a single dose J&J COVID-19 vaccine primary series should receive a second primary dose (of an additional mRNA vaccine) at least 28 days after the 1st J&J dose. Then, they should also receive a COVID-19 booster vaccine (Pfizer-BioNTech, Moderna or J&J) at least 2 months (8 weeks) after receiving their second primary dose.

Certain scenarios: 

• If an individual already received two doses of the Janssen COVID-19 Vaccine, they should receive a third dose (additional mRNA vaccine) at least 2 months after the 2nd dose.
• If an individual already received one dose of Janssen COVID-19 Vaccine and one dose of an mRNA COVID-19 Vaccine (given as a standard booster dose), they should receive a third dose (additional mRNA vaccine) at least 2 months after the 2nd dose.
• If an individual already received one dose of Janssen COVID-19 Vaccine and one dose of an mRNA COVID-19 Vaccine (given as additional dose), they should receive a booster dose of any COVID-19 vaccine 2 months after the 2nd dose.

Also, people ages 12 years and older who are moderately or severely immunocompromised may choose to receive a second booster dose no earlier than four (4) months after the first booster dose. This should be an mRNA booster. 

Additional guidance can be found in the CDC clinical considerations. 

Please note: The FDA has limited the use of the J&J COVID-19 vaccine due to safety issues. The J&J COVID-19 vaccine should only be given to individuals 18 years and older for whom mRNA COVID-19 vaccines are not accessible or clinically appropriate and who would otherwise not receive a vaccine.

People who were vaccinated outside the United States and completed a COVID-19 vaccination that is FDA-approved or FDA-authorized and who are moderately or severely immunocompromised and who: 

• Received 2 mRNA COVID-19 vaccine doses should receive a third mRNA primary dose followed by a booster dose, for a total of four vaccine doses
• Received a Janssen COVID-19 Vaccine primary dose should receive one additional mRNA dose and one booster dose, for a total of three vaccine doses.

People ages 12 years and older who are moderately or severely immunocompromised and who completed a COVID-19 vaccination listed for emergency use by WHO but not approved or authorized by FDA should also receive:

• A single dose of an mRNA COVID-19 vaccine at least 28 days after receiving the last dose of the non-FDA-approved or -non-FDA-authorized primary series.
• An mRNA booster dose at least 3 months after their last primary series dose, for a total of four vaccine doses.

Additional guidance can be found on the CDC website.

A decision about receiving an additional dose or booster dose should be discussed with your healthcare provider.

No.

Antibody testing to document the immune response after COVID-19 vaccination of people with weakened immunity is not recommended by the CDC, FDA, or VDH.

Our bodies produce several different types of antibodies against the SARS-CoV-2 virus that causes COVID-19. Some of the available COVID-19 serology tests do NOT measure the SARS-CoV-2 spike antibody which is the only antibody that the body produces after COVID-19 vaccination. A negative serology test after vaccination, if it is not measuring the correct (vaccine-generated spike) antibody, could be a false negative.

Several studies have indicated that the cellular immune system, another critical part of your immune system, usually responds well to COVID-19 vaccination and it is entirely possible that even if your body does not make antibodies well after COVID-19 vaccination, your cellular immunity may be responding well to the vaccine.  A negative antibody test by itself is not a certain indicator that your immune system is not responding at all to the vaccine.

The American Society of Transplantation “strongly caution against concluding that low antibody response rate to SARS-CoV-2 vaccination will lead to reduced clinical effectiveness until more information is available.”

COVID-19 vaccination records in the Virginia Immunization Information Systems (VIIS) are available through the COVID-19 Vaccination Record Request Portal. 

Enter your name, date of birth, and ZIP code. If there is a match, the system will send a verification code to the phone number associated with your vaccination record, through either a text message or an automated voice call. This prevents other people from accessing your record. Once you enter the verification code, you can view, save, and print your Vaccination Record with QR code. With iOS 15, you can securely store verifiable versions of your COVID-19 test results and immunization records in the Health app on your iPhone or iPod touch.

The request portal is also accessible via Virginia’s free COVIDWISE app, along with information about vaccines and other frequently asked questions. In the app, tap “Virtual VDH” for these options.

Vaccine providers in Virginia submit vaccination records to the Virginia Immunization Information System (VIIS), but they may have provided information that's incomplete, out of date, or incorrect. So, it's likely we have your record if you were vaccinated in Virginia, even if it’s not available through the request portal. For example, your name or phone number may have been entered incorrectly or may have changed. If you can’t find your record, first try the search again without entering a ZIP code. If the record still isn’t found, you can contact your vaccine provider to update their vaccination record or call 877-VAX-IN-VA (877-829-4682) for help. Call center hours are Monday through Friday from 8 a.m. to 6 p.m. ET.

Some doses administered outside Virginia to Virginia residents may be in VIIS. Doses administered directly by federal agencies such as the Department of Defense or Department of Veterans Affairs are not reported to VIIS.

If you would like a record of other vaccinations (besides COVID-19), you may submit your request online. 

If the information on your vaccination record is incorrect (e.g., missing dose, wrong date or incorrect brand), you should contact your vaccine provider to update their record or call 877-VAX-IN-VA (877-829-4682) for help. Call center hours are Monday through Friday from 8 a.m. to 6 p.m. ET.

Virginia’s COVID-19 vaccination records include QR codes – a type of barcode that can be scanned with smartphones. QR codes – short for “quick response” – are commonly used in retail, logistics, and other sectors. The technology allows anyone to show proof of vaccination with a digital or printed QR code instead of a paper card, and without the need for an app. As more and more employers and businesses respond to calls to require that employees and customers be vaccinated, QR codes will help improve the consistency and security of vaccination information while protecting individual privacy.

A person vaccinated in Virginia can visit vaccinate.virginia.gov to obtain their free vaccination record with QR code, which can then be saved to a phone gallery, printed on paper, or stored in a compatible account, such as Google Pay, CommonHealth, or Apple Health. 

QR codes contain the same information as paper records, but in a format that offers greater security and efficiency. Because the QR code is digitally signed by the Virginia Department of Health, it cannot be altered or forged. Information from QR codes is only available if and when the individual chooses to share it.

There are a number of ways you can save your QR code: 

1. Print it
2. Screenshot it and store it in your photo album
3. Save it 
   1. To your computer
   2. To your smartphone as a file (iPhone/Android)
   3. To your Google Pay Wallet
   4. To your Apple Health account (requires iOS 15)

For help with securely storing verifiable versions of your COVID-19 test results and immunization records in the Health app on your iPhone or iPod touch, please visit https://support.apple.com/en-us/HT212752.

You are not required by the Virginia Department of Health to obtain a Vaccination Record with QR Code, or to use it for any particular purpose. Your record, and the QR code within it, are options provided to you to document your vaccinations and provide proof to those with whom you choose to share it. 

The information listed on the QR code is the information shown on paper vaccination records or cards, which includes name, date of birth, vaccination date, vaccine manufacturer, lot number, and provider for each dose of vaccine received. The QR code does not include social security number, immigration status, or other information not found on paper vaccination records.

Because the QR code is digitally signed by the Virginia Department of Health, it cannot be altered or forged.

Your vaccination history is stored directly within the QR code, which you control. It’s completely up to you to decide whether and when to show someone else your QR code.

This COVID-19 Vaccination Record with QR Code can only be scanned by apps or websites that agree to the privacy protections required by the SMART Health framework, such as the SMART Health Verifier App.

You can obtain your COVID-19 Vaccination Record with QR Code at vaccinate.virginia.gov on your smartphone, or tablet or computer browser. There is also a link to the COVID-19 Vaccination Record Request Portal in the free COVIDWISE app (tap “Virtual VDH” at the bottom).  You can also call 877-VAX-IN-VA (877-829-4682) for help (call center hours are Monday through Friday from 8 a.m. to 6 p.m. ET.) 

Vaccination Records with QR Codes are available to anyone whose vaccination record is in the Virginia Immunization Information System (VIIS) and includes a working phone number.

You should only show any vaccination record to a person, business, or organization you want to know your vaccination information, and only after they tell you what they intend to do with your data and if they will keep it.

Clinics vary in the length of time it takes to submit dose information to the Virginia Immunization Information System. Records are usually updated within 24-72 hours after a dose is administered.

Your COVID-19 Vaccination Record does not automatically update. If you receive an additional dose of the COVID-19 vaccine, visit the COVID-19 Vaccination Record Request Portal again at vaccinate.virginia.gov to obtain your updated Vaccination Record with QR Code. 

Businesses and employers that choose to verify an individual’s vaccination status via QR code can download the free SMART Health Card Verifier App to do so.

Businesses and employers validating vaccination records are encouraged to require a second form of government identification (e.g. government issued driver’s license) to compare to the name and date of birth on the vaccination record.

No. The purpose of this system is to allow you to access your own vaccination record and to have options for presenting it to others if and when you choose to do so.

The Smart Health Verifier App may be used by businesses to verify an individual's COVID-19 Vaccination Record with QR Code. Individuals do not need to test their own QR code with the Smart Health Verifier App. If an individual would like to test their COVID-19 Vaccination Record with QR Code using the Smart Health Verifier App on their smartphone, it is recommended the individual print the record from a computer or smartphone prior to scanning it with the Verifier App because it is likely that the computer screen resolution of the individual may not allow the QR Code to be read by the Verifier App. Also, the Verifier App does not allow the COVID-19 Vaccination Record with QR Code to be uploaded. The Verifier App is only for verification purposes. Please call 877-VAX-IN-VA (877-829-4682), Monday through Friday from 8 a.m. to 6 p.m. ET with any additional questions.