People who have a medical condition or are receiving therapies that affect the function of their immune system are at increased risk from severe COVID-19 illness. Vaccination is highly recommended but depending on the type and the level of immunocompromise they may not produces as good a protective response as a healthy person. This means that they are less well protected by the vaccine or their protection wanes to below protective levels faster. Extra doses of vaccine can help to overcome this reduced response.
More detail is available here.

Third primary doses

As part of the primary schedule, a third dose of Comirnaty (Pfizer mRNA COVID-19 vaccine) is recommended for people aged from 5 years were severely immunocompromised in proximity to their first or second primary doses. [For further detail see the Immunisation Handbook 2020 Chapter 5 (section 5.5.9)]

The third dose should be given between 8 to 12 weeks (ie between 2 to 3 months) after the second dose.

If there are current or planned immunosuppressive therapies, aim to delay the third dose of vaccine until two weeks after the period of immunosuppression, in addition to the time period for clearance of the therapeutic agent.


Other COVID-19 vaccines, Nuvaxovid (Novovax) and Vaxzevria (AstraZeneca) can only be given with a prescription to those aged 18 years or older as an alternative to Comirnaty.

If 3rd primary dose was given over 3 months post second dose:

If the third dose has been given later than 3 months post the second dose it essentially acts as a booster dose (not part of a primary course). However, IMAC does support that a fourth dose can still be offered anytime from 3 months (ideally 6 months) post the third dose. This would then be recorded as their booster dose (see operational note).
More detailed information is available in this fact sheet on Additional doses for severely immunocompromised people.

Booster doses

Every aged from 16 years is recommended to receive a booster dose after their primary series. This includes people who had three primary doses. Individuals who are not eligible for a third primary dose but have moderately immunocompromising conditions are particularly recommended a booster dose. This includes:
•    People aged 65 years or older
•    Māori or Pacific peoples aged from 50 years
•    Anyone aged from 16 years who is eligible for funded influenza vaccine, including in pregnancy.

For those aged over 18 years, a booster can be given from 3 calendar months after their last primary dose.

For 16-17-year-olds who finished their primary course, can receive a booster at least 6 months after the third dose.  For those aged 16-17 years who are at highest risk from severe COVID-19, a booster dose may be considered from 3 calendar months after dose 3, this requires a prescription and taking in consideration current or planned immunosuppressive therapies.

A booster dose is not routinely recommended for those aged 12-15 years but based on clinical discretion can be given off-label under prescription.

If preferred or indicated as an alternative to Comirnaty, another COVID-19 vaccine, Nuvaxovid (Novovax), can be given as a booster dose for those aged 18 years or older. The third vaccine available, Vaxzevria (AstraZeneca) can only be given as booster dose in a mixed schedule (ie if Comirnaty or a different COVID-19 vaccine was given as dose 1 or 2) with a prescription to those aged 18 years or older.

Second booster dose

A second booster dose is recommended for severely immunocompromised people, aged 16 years and above, who received a three-dose primary course and a fourth dose as a first booster (ie this will be a fifth dose, for this group).
A second booster dose is also particularly recommended for:
•    people aged 65 years and older
•    Māori and Pacific peoples aged 50 years and older
•    residents of aged care and disability care facilities aged from 16 years.

Other people aged from 16 years who can receive a second booster dose, who may be immunocompromised are:
•    those who have a medical condition that increases the risk of severe breakthrough COVID-19 
•    those who live with disability with significant or complex health needs or multiple comorbidities.

For further details of clinical criteria supporting second booster dose eligibility see here

If preferred or indicated as an alternative to Comirnaty, another COVID-19 vaccine, Nuvaxovid (Novovax), can be given as a booster dose for those aged 18 years or older.

Operational note

Four doses in a series is off-label so at least one of those needs to be scripted. For example:

  • If an immunocompromised patient gets a scripted third primary dose, then the fourth would be a booster and can be unscripted. 
  • If they have a 2-dose primary schedule and then a booster that is later is identified as a third primary dose, then their fourth dose would need a prescription. In this case the third dose will be entered into CIR as their booster and the fourth dose will be recorded as an additional vaccine in the primary/standard case schedule.
     

Spacing of booster doses 

The gap between a third primary dose and a booster differs depending on age, clinical circumstances and type of COVID-19 vaccine.

Further details for Booster Dose Timing can be found here: Ministry of Health Guidelines for Booster dose timing
 

 

5–11 years

12–15 years

16–17 years

18+ years

Vaccine

Comirnaty Paediatric (10mcg)

Comirnaty 12+

(30mcg)

Comirnaty 12+

(30mcg)

Comirnaty 12+

(30mcg)

Schedule

2 doses

8 weeks apart

2 doses

3–8 weeks apart

2 doses

3–8 weeks apart

2 doses

3–8 weeks apart

3rd primary dose for immunocompromised (specific criteria must be met)

 

8 weeks after 2nd dose

 

8 weeks after 2nd dose

 

8 weeks after 2nd dose

 

8 weeks after 2nd dose

Booster

 

 

n/a

Only in consultation with healthcare provider

Single dose administered at least 6 months after primary course

Single dose administered 3 months after primary course if 18 years

2nd Booster (specific criteria must be met)

 

 

n/a

Only in consultation with healthcare provider

Minimum of 6 months after first booster

Minimum of 6 months after first booster

Further information

Ministry of Health information on immunocompromise

Ministry of Health information on third primary doses

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Last updated: 02 August 2022