A fourth shot of the COVID vaccine is being recommended for certain Americans, according to new guidelines from the Centers for Disease Control and Prevention.

The CDC is now advising individuals who are over the age of 18 and moderately or severely immunocompromised to get a fourth dose of the COVID vaccine six months after their third dose of the Moderna or Pfizer vaccine. The fourth dose can be of any of the three available vaccines, including the Johnson & Johnson shot, ABC News reports.

The CDC released the new guidelines on Tuesday, saying that severely and moderately immunocompromised individuals include those who have cancer, recipients of organ transplants or are being treated for HIV, as well as other conditions.

The dose of the COVID vaccine would be in addition to the booster shots that were authorized by the CDC in August for immunocompromised people.

Immunocompromised people make up about 2% of the U.S. population, the CDC said.

The fourth dose is separate from the booster shot as the CDC said the booster was necessary due to immunocompromised people possibly not having a complete immune response from the first two doses of the vaccine.

According to the CDC, over 13.7 million people have received booster doses.

The CDC reported that side effects from the booster shots are similar to that of the second dose of Pfizer or Moderna vaccines and that of the single dose of the Johnson & Johnson shot, including arm pain, fatigue and headache.

The recommendation from the CDC comes after a study from Johns Hopkins University suggested that vaccinated immunocompromised individuals were 485 times more likely to be hospitalized or die from COVID than other vaccinated people, The Independent reported.

The CDC has said that fully vaccinated, immunocompromised people account for about 44% of COVID breakthrough cases that require hospitalization and are more likely to transmit the virus to people who are in close contact with them, CNN reported.

More than 190.7 million people are fully vaccinated against COVID-19, making up 57.5% of the U.S. population, according to the CDC.

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