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'Fully vaccinated' for COVID? Now you need a booster to be 'up to date'

More colleges, companies and countries are requiring booster shots, and the CDC has replaced "fully vaccinated" with "up to date."

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"Fully vaccinated" doesn't mean three shots, but many places now require boosters.

Sarah Tew/CNET
For the most up-to-date news and information about the coronavirus pandemic, visit the WHO and CDC websites.

As COVID-19 cases in the US spike due to the omicron variant, health officials, including White House chief medical adviser Dr. Anthony Fauci, are moving away from the phrase "fully vaccinated" to describe the status of protected individuals. On Jan. 5, the Centers for Disease Control and Prevention replaced the term "fully vaccinated" for maximum vaccine protection with the more general descriptor "up to date."

"We're using the terminology 'keeping your vaccinations up to date' rather than ... 'fully vaccinated,'" Fauci said at a National Institutes of Health presentation. "Right now, optimal protection is with a third shot of an mRNA or a second shot of a J&J." The mRNA vaccines are Moderna and Pfizer.

Mounting evidence shows COVID vaccine protection decreases over time and that booster shots are needed to "top up" COVID-19-fighting antibodies, especially against omicron. The US Food and Drug Administration expanded the authorization of boosters to include everyone 12 and older at least five months after receiving a second dose of the mRNA vaccines, or two months after receiving the Johnson & Johnson vaccine.

Breakthrough cases of COVID-19 in people who've completed their initial vaccinations have risen notably with omicron. On Thursday, Oregon's Department of Health announced that breakthrough infections accounted for 23.6% of new COVID-19 cases for the week ending Jan. 8. 

Many schools, businesses, and countries are requiring booster shots. The Verge reported Friday that Apple now requires all store and corporate employees to be boosted.

On Thursday, Puerto Rico Governor Pedro Pierluisi announced booster shot requirements for all public school students 12 and older as well as all residents working in tourism or entertainment, according to AP. Spain also recently declared that all visitors to the country must be boosted if it's been 270 days since initial vaccination.

Last fall, Connecticut's Wesleyan University became the first college to make boosters mandatory for students. Many other colleges followed suit, including all of the Ivy League schools. More colleges and universities are announcing booster requirements every day -- the website University Business currently lists 326 colleges that require booster shots for students and staff.

The CDC site still states that adults are "fully vaccinated" two weeks after a second dose of the Pfizer-BioNTech or Moderna vaccines or a single dose of the J&J/Janssen vaccine.

"Individuals are considered fully vaccinated against COVID-19 if they've received their primary series," CDC director Dr. Rochelle Walensky said at the Jan. 5 White House COVID briefing. "That definition is not changing ... but we are now recommending individuals stay up to date with additional doses they are eligible for." 

For more, here's the latest on the Moderna booster shots, what you need to know about the Pfizer antiviral pill and how to pick between the vaccine boosters. The article continues below.

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Can you get COVID if you are fully vaccinated or receive a booster?

The highly contagious omicron variant is currently the dominant COVID-19 strain in the US, representing nearly 60% of new infections. As such, COVID-19 cases have rocketed to all-time highs, according to the CDC, which reported a seven-day moving average of 794,587 new cases on Jan. 13 --that's a 653% increase from Dec. 15, when the rolling average was 121,699 new daily cases. 

While two doses of the Moderna or Pfizer vaccine (or one of J&J) combined with a booster doesn't provide complete protection from COVID-19, the vaccines offer a sturdy defense against illness.

In a Jan. 11 Senate hearing, Fauci said that an unvaccinated person is 10 times more likely to be infected with COVID-19, 17 times more likely to be hospitalized and 20 times more likely to die from COVID.

How many COVID vaccine doses do you need to be considered 'fully vaccinated'?

According to the CDC's previous messaging, you're fully vaccinated two weeks after you receive the second dose of the Moderna or Pfizer vaccine, or two weeks after a single dose of Johnson & Johnson's vaccine.

The CDC also considers you fully vaccinated if you received any single-dose vaccine listed for emergency use by the World Health Organization or any combination of the two-dose vaccines approved by the FDA or listed by the WHO for emergency use.

Though the official definition of "fully vaccinated" isn't likely to change, Fauci has said three shots should be considered the new baseline -- part of the primary series of vaccinations rather than a "booster."

"It should be a proper one from the get-go -- three shots," he said in September.   

Israel's national coronavirus czar, Dr. Salman Zarka, told his country it should prepare for a fourth dose of an mRNA vaccine. Fauci has said that the need for a fourth jab is "conceivable" in the US, too, but not just yet.

"In the future, we might need an additional shot, but right now, we are hoping that we will get a greater degree of durability of protection from that booster shot," Fauci said at a White House briefing Dec. 29. "We're going to take one step at a time, get the data from the third boost and then make decisions based on scientific data." 

Why would the definition of 'fully vaccinated' change from two doses of the mRNA vaccines to three?

As preliminary studies show omicron's ability to infect those who are considered fully vaccinated, the definition began shifting -- if not formally, then practically -- from two doses of the Pfizer and Moderna COVID-19 vaccine to three.

"As far as I'm concerned -- I make it very clear -- if you want to be optimally protected, get boosted," Fauci said on CNN's State of the Union, when asked if three shots will become the standard.

"It's increasingly clear that if you have three shots, you're in pretty good shape," Dr. Robert Wachter, chair of the University of California at San Francisco's department of medicine, said last month during an online COVID-19 discussion. "I think we will stop calling people with two shots 'fully vaccinated' within a week or two," Wachter added. "Omicron is going to make that case quite vividly."

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How many shots to be protected from omicron?

Sarah Tew/CNET

Will three vaccine doses become standard? Four?

With the CDC's change of terminology, three doses has become the de facto new standard. "Although two doses of the vaccine may still offer protection against severe disease caused by the omicron strain, it's clear from these preliminary data that protection is improved with a third dose of our vaccine," Pfizer Chairman Albert Bourla said in a statement on early results about the Pfizer vaccine's continued effectiveness.

Will there be a fourth shot? Israel has already started rolling out a fourth vaccine shot for medical workers, people of 60 years or older and people who are immunocompromised. The country recently began a study on the effectiveness of a second booster, testing 154 healthcare workers at the Sheba Medical Center. The Israeli newspaper Haaretz reports that a fourth vaccine dose seems as safe as the third dose and increases vaccine protection fivefold.

At last week's National Institutes of Health presentation, Fauci stressed the importance of first collecting and analyzing data from the third shot before considering a fourth dose: "I would say that we need to find out what the durability of protection of the third shot is before we starting thinking about the fourth shot."

For more, here's what we know about the omicron variant and how the new mutation compares with delta. And here's how to store your vaccine card on your phone.

Will we need an omicron-specific booster to guard against the virus?

If two doses of the Moderna or Pfizer COVID-19 vaccine are not enough to guard against omicron, would we need a variant-specific booster to restore protection? According to Fauci, "At this point, there is no need for a variant-specific booster."

But getting people to upgrade from two doses to three will take additional effort: The CDC website says almost 209 million Americans right now are "fully vaccinated" with the Moderna, Pfizer or Johnson & Johnson vaccines. That's 62.9% percent of the total US population. However, only 79 million in the US have received a booster -- 37.8% of the so-called fully vaccinated, or about 24% of the total US population. 

Moderna has said it is studying an omicron-specific vaccine, as well as a multivalent shot that could protect against the alpha and delta strains, but clinical trials aren't expected to start until next year. 

When can I get a booster shot?

The CDC says you can "ensure you are optimally protected against COVID-19" by getting vaccinated and getting a booster. If you got one of the mRNA vaccines from Moderna or Pfizer, the CDC says you should get a booster at least five months after your second dose. If you got the Johnson & Johnson vaccine, see the next section.

The Moderna vaccine, Spikevax, has been authorized only for adults 18 and up. The FDA has approved the Pfizer vaccine for people 16 and up, and given emergency authorization for children 5 to 15 years old. 

On Jan. 5, the CDC expanded its recommendation on booster shots to include teens ages 12 to 17. In the CDC press release, Walensky said, "It is critical that we protect our children and teens from COVID-19 infection and the complications of severe disease. ... This booster dose will provide optimized protection against COVID-19 and the Omicron variant. I encourage all parents to keep their children up to date with CDC's COVID-19 vaccine recommendations."

What about the Johnson & Johnson vaccine?

The CDC website indicates "optimal" protection after receiving a second shot of the one-dose J&J/Janssen COVID-19 vaccine at least two months after the first.  

Last year, the agency recommended Moderna or Pfizer's mRNA vaccines  over Johnson & Johnson''s viral-vector shot, citing a rare but dangerous blood-clot side effect. But a booster of Johnson & Johnson's vaccine provides strong protection against the omicron variant of COVID-19 -- stronger, even, than Pfizer's jab -- according to new research. 

A Dec. 30 study of 69,000 South African health care workers found that, among individuals who already received one dose of the J&J vaccine, a booster given six to nine months later improved their odds against hospitalization from 63% to 85%. 

A separate study by Boston's Beth Israel Deaconess Medical Center found a J&J booster given to individuals who were initially given two doses of Pfizer's mRNA vaccine generated a 41-fold increase in antibody response within a month, compared with only a 17-fold increase when given a booster of the Pfizer vaccine. 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.