• The Centers for Disease Control and Prevention (CDC) has recommended Pfizer COVID-19 vaccine booster shots for adults over 65 and other high-risk individuals.
• People determined to be immunocompromised are eligible to receive a third dose of the Pfizer and Moderna vaccines under the emergency use authorizations amended on Aug.12.
• Epilepsy is not explicitly identified as a high-risk condition by the CDC, but individuals with the condition may be eligible for a booster or third vaccine dose based on other health conditions and factors.

People with epilepsy may be eligible for a third dose of the Pfizer or Moderna vaccine 28 days after their second shot. They may also be eligible for a booster shot of the Pfizer vaccine six months after their second Pfizer shot. Eligibility for either depends on their age, occupation, and individual health status.

A COVID-19 vaccine booster is intended for those who developed adequate immunity after their initial vaccine doses but then experienced a decrease in immunity over time. An additional dose of the vaccine, by contrast, may be recommended for those who did not develop an adequate immune response after the two-dose vaccination series.

Pfizer Booster Shots

The Centers for Disease Control and Prevention recommended booster shots of the Pfizer COVID-19 vaccine at least six months after a second dose for the following groups:

• People 65 and older
• Residents of long-term care facilities
• People ages 50 to 64 with underlying medical conditions that place them at high risk for severe COVID-19

The CDC recommendations state that people ages 18 to 49 with underlying medical conditions and people ages 18 to 64 who are at risk of COVID-19 exposure due to their work or living arrangements may receive a booster shot of the Pfizer vaccine “based on their individual benefits and risks.”

The CDC’s list of underlying medical conditions does not specifically include epilepsy; however it does list neurological conditions generally. The list of underlying conditions also includes pregnancy, asthma, and diabetes, among several other conditions. The CDC recommends that individuals speak with their doctor to determine if they’re eligible for a booster dose of the Pfizer vaccine.

The CDC and U.S. Food and Drug Administration (FDA) have not released booster recommendations about the Moderna vaccine or the single-dose Johnson & Johnson vaccine. Both Moderna and Johnson & Johnson have submitted data on booster shots to the FDA for review.

Third Doses for Immunocompromised People

The FDA amended the Pfizer and Moderna vaccines’ guidelines on Aug. 12 to allow a third vaccine dose at least 28 days after the second dose for certain immunocompromised individuals. There is not yet guidance from the FDA or CDC on additional doses for immunocompromised people who received the Johnson & Johnson vaccine.

Individuals defined as immunocompromised include:

• People in cancer treatment
• People who received a stem cell transplant in the past two years
• People who are organ-donor recipients and taking immunosuppressive drugs
• People taking high-dose steroids or other immunosuppressive drugs

The CDC recommends individuals consult their doctors to determine if a third dose is appropriate for them.

Should People With Epilepsy Receive a Third Dose or Booster Shot?

Individuals with epilepsy should consult their doctors to understand if they are eligible under current guidelines for a booster shot or third dose. A person may not be eligible based on having epilepsy, but they may qualify due to their age, occupation, or another health condition.

Are People With Epilepsy Immunocompromised?

According to the Epilepsy Foundation, “There is no evidence that people with epilepsy alone have a weakened immune system. They should not be considered ‘immunocompromised’ and would not have an ‘immune deficiency’ from having seizures.”

The Epilepsy Foundation does note that some people with epilepsy may take medications, such as steroids, that could affect the immune system. However, most seizure medicines do not affect the immune system.

Learn More

In March, MyEpilepsyTeam talked to Dr. Jonathan Edwards about COVID-19 vaccination for people with epilepsy, including concerns about seizures. Dr. Edwards is chair of the Department of Neurology at the Medical University of South Carolina.

“This is a great vaccine in terms of efficacy — but there are other reasons to get vaccinated that I think people don't talk about enough — and that’s to protect others as much as we’re protecting ourselves,” Dr. Edwards said.