Prepare for COVID-19 Season: 6 Facts People With Graft-Versus-Host Disease Should Know

If you’re living with graft-versus-host disease (GVHD), staying protected against COVID-19 continues to matter — especially as new variants circulate. The U.S. Food and Drug Administration (FDA) has approved a new set of COVID-19 vaccines for the 2025-2026 season, and the Centers for Disease Control and Prevention (CDC) has released updated vaccine guidance.

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Here’s what you should know about this year’s booster, how it works, who qualifies, and how to make a plan with your care team.

1. New Boosters Target the LP.8.1 Variant This Season

The COVID-19 vaccines are reformulated each year to better match the most commonly circulating virus strains. For the 2025-2026 season, the FDA directed vaccine manufacturers to update their formulas using a monovalent JN.1 lineage, specifically the LP.8.1 strain.

The FDA has approved 2025-2026 booster formulas for:

• Pfizer’s Comirnaty — A messenger RNA (mRNA) vaccine for people ages 5 to 64 years with at least one condition that raises the risk of severe COVID-19, and for all adults 65 and older
• Moderna’s Spikevax — An mRNA vaccine for people ages 6 months to 64 years with a high-risk condition, and all adults 65 and older
• Moderna mNexspike — A lower-dose mRNA vaccine for people ages 12 to 64 years with a high-risk health condition, and all adults 65 and older
• Novavax’s Nuvaxovid — An adjuvanted, protein-based vaccine for people ages 12 to 64 years with a high-risk health condition, and all adults 65 and older

How Are the Boosters Different?

The main difference is how they’re made. Pfizer and Moderna use mRNA technology, which gives your cells instructions to make a harmless piece of the virus so your immune system learns to fight it. The Novavax vaccine is protein-based (a more traditional vaccine type). It delivers a purified piece of the virus protein with an adjuvant to boost your immune response.

For most people, any of the three options offers similar protection against severe illness. All are approved for high-risk groups, including people with GVHD.

2. People With GVHD May Be at Higher Risk for Severe COVID-19

COVID-19 doesn’t just affect the lungs. It can trigger widespread inflammation and disrupt immune responses throughout the body. For people living with GVHD who’ve undergone an allogeneic hematopoietic cell transplant (HCT), risk is higher. This is because GVHD and the medicines used to control it (for example, systemic steroids, calcineurin inhibitors, ruxolitinib, other immunosuppressants) can weaken immune defenses.

You may be at higher risk of severe illness from COVID-19 if:

• You’re immunosuppressed due to GVHD or its treatment — People who have HCT or active GVHD,or are on immune-suppressing therapy are considered moderately or severely immunocompromised and are at increased risk for severe outcomes. Vaccine responses can be lower in HCT recipients, especially early after transplant.
• You’ve recently had HCT — Expert transplant societies recommend restarting the COVID-19 vaccine series beginning approximately three months after HCT, because immunity from prior vaccination is often lost and responses improve as immune function recovers.
• You have other health conditions linked with worse COVID-19 outcomes — These may include older age, lung or kidney disease, diabetes, and obesity, which are common in people with GVHD.

Can COVID-19 Be Cured?

While most people recover fully from a COVID-19 infection, some develop long COVID, a condition where symptoms persist or reappear weeks or even months after the initial infection. These may include fatigue, brain fog, shortness of breath, and joint pain.

There are treatments available for COVID-19, including antiviral medications like nirmatrelvir/ritonavir (Paxlovid), remdesivir (Veklury), and molnupiravir (Lagevrio). These treatments work best when started early — ideally within the first few days of symptoms.

Not everyone can take these medications. They may interact with other prescriptions or be unsafe for people with certain health conditions. Your doctor can help determine whether one of these treatments is right for you.

3. Health Experts Agree COVID-19 Vaccines Are Safe for People With GVHD

Leading health authorities — including the CDC, the American Society for Transplantation and Cellular Therapy in collaboration with the American Society of Hematology, and the European Society for Blood and Marrow Transplantation — agree that COVID-19 vaccines are recommended for people after HCT and for those with GVHD.

Experts recommend people with GVHD:

• Stay up to date with COVID-19 vaccines — Everyone 6 months and older should receive the current-season COVID-19 vaccine. If you’re moderately or severely immunocompromised (which includes most people with active GVHD or on immunosuppressants), the CDC provides an adjusted schedule that may include additional doses under shared clinical decision-making. Vaccination should not be delayed because you are taking immunosuppressive therapy.
• After HCT, start vaccination around three months unless your transplant team advises otherwise — Many HCT programs revaccinate at around three months post-transplant and repeat a full COVID-19 series, regardless of whether you had the vaccine before your transplant. Your team will advise you on the timing based on GVHD activity and overall immune recovery.
• Know that the vaccines are not live — Both mRNA and protein-subunit vaccines are safe to use with GVHD and typical post-transplant medicines.
• Know that you may need extra protection — Beyond additional vaccine doses, preexposure prophylaxis with pemivibart (Pemgarda) is authorized by the FDA for moderately or severely immunocompromised people who are unlikely to respond adequately to vaccination. (It typically should be taken at least two weeks after any COVID-19 vaccine.)
• Have a plan for early treatment if you test positive for COVID-19 — Immunocompromised people benefit most from prompt testing and starting outpatient antivirals within five to seven days of symptom onset. Your transplant team can help you identify any possible drug interactions with immunosuppressants you might be taking.
• Stay in close contact with your transplant team — They’ll help with timing around steroid pulses, ruxolitinib, or other therapies; determine revaccination steps; and decide whether preexposure monoclonal prophylaxis is appropriate for you.

Separately, the CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that people decide whether to get a COVID-19 vaccination based on individual decision-making. This approach is similar to guidance around the annual flu shot: You and your doctor can work together to decide what’s right for you.

4. If You’re Living With GVHD, Timing Matters

If you’re considering the updated COVID-19 vaccine, here are important timing steps to talk through with your care team:

• Ask if you qualify based on your age and health history.
• Plan around your treatment cycles. Your doctor may recommend receiving the vaccine during a time when your immune system is more stable.
• Check the timing of your last COVID-19 dose. The updated booster should be given at least two months after your most recent shot.

You can also add extra layers of protection by:

• Wearing a high-quality mask in crowded or poorly ventilated spaces
• Practicing frequent and thorough hand-washing
• Improving ventilation by opening windows or using air filters
• Testing right away if you have symptoms or believe you’ve been exposed

These added steps help lower your risk during treatment weeks or in high-risk situations.

5. Your Doctor Can Help Personalize Your Plan

Every person’s journey is different — and so is their COVID-19 risk. Your care team can help you figure out:

• When to get the updated vaccine
• How it fits into your treatment schedule
• What precautions make the most sense for your lifestyle and health goals

Bringing the FDA guidance with you to your next doctor visit can be helpful. It gives you and your provider a starting point to talk about timing, eligibility, and any questions you may have.

6. Most Insurance Plans Cover COVID-19 Boosters

If the CDC recommends a COVID-19 booster for you, most insurance plans — including Medicare, Medicaid, and private health insurance — will cover it at no cost. This includes the updated vaccines for the 2025-2026 season. Coverage generally applies as long as the shot is given by a provider in your insurance network.

That said, plan details can vary. Call your insurance provider or check your plan’s website to confirm coverage and avoid any surprises. If you don’t have medical insurance, free COVID-19 vaccines may still be available through public health clinics or federal programs.

Find Your Team

On myGVHDteam, people share their experiences with graft-versus-host disease, get advice, and find support from others who understand.

What influenced your choice to get — or not get — the new COVID-19 booster? Let others know in the comments below.