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Do I need a 5th COVID Vaccine AND Evusheld if I have lupus? [December 2023 UPDATE]

The coronavirus that causes COVID-19 has mutated numerous times since its emergence in 2019. Therefore, in 2023, the vaccine for COVID-19 was adjusted to be effective against the most prevalent strain present in the Fall of 2023. The current plan is to adjust the vaccine yearly each Fall so that it is effective against the most prevalent strain. This is a similar practice as that taken with the flu shot.

AstraZeneca, the producer of Evusheld, a monoclonal antibody that helped to reduce the chances for infection from COVID-19, developed a new monoclonal antibody that targets the portion of the coronavirus that has remained constant and not mutated. We are awaiting its release to the public at this time. Hopefully, it will be available soon.


As of this moment, 90% of the COVID infections in the US are due to the Omicron variants. The older vaccines and Evusheld do not provide adequate Omicron protection. Evusheld is no longer recommended. The newer COVID vaccines (available since SEP 2022) have added Omicron protection. The CDC has changed its COVID vaccine recommendations.

For those who get Pfizer or Moderna, it recommends that immunocompromised patients get a primary vaccine series of three shots followed by a booster shot at least 2 months after the primary series (a total of 4 shots).

Those who receive the Novavax or J & J should get a total of 3 vaccines, with the last one being either a Pfizer or a Moderna bivalent (Omicron protection) given at least 2 months after the primary series.


MoreThanLupus posted a Q and A. The answer is:

The CDC now recommends that immunocompromised people should get a 5th COVID vaccine 4 months after your fourth COVID vaccine. You should get a 4th COVID vaccine 4 months after your third vaccine if you initially received the J&J vaccine.

Examples of being immunocompromised include being on immunosuppressant drugs (such as methotrexate, mycophenolate, azathioprine, belimumab, or rituximab), having an immunodeficiency problem (like hypogammaglobulinemia or common variable immunodeficiency), or have other immune system deficiency problems such as advanced age, diabetes, alcoholism, malnourishment, and many others.

I recommend a 5th COVID vaccine and Evusheld to all my immunosuppressed patients. The research is quite impressive. Over 5000 people received either Evusheld or placebo, then followed over 6 months and longer. It cut COVID infections by 82%, and there was only a 1% difference between Evusheld and placebo regarding side effects. The few Evusheld patients infected had mild infections, while there were two COVID deaths and five COVID ICU admissions in those who got placebo shots (fake shots).

You can read more about both of these in my blog posts, including the benefits of Evusheld and who are the best patients to receive it:


  1. Thank you Dr. Thomas for all the very helpful information you share. I am wondering if you are recommending a second bivalent covid boosters for your SLE patients that are only taking hydroxichloroquine as the new recommendations are for 65 and older or immunocompromised. I remember reading in your past posts that those of us with SLE have an abnormal immune system. I’m wondering if having SLE qualifies me for that 2nd booster. I appreciate your help.

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