COLUMBUS, Ohio (WCMH)–Late Thursday, the CDC gave final approval for booster shots of the Moderna and Johnson and Johnson vaccines.

The Ohio Department of Health said it issued guidance to more than 3,500 vaccine providers on Friday.

With the approval of the additional booster shots, that answer to who is eligible for one has gotten a little bit more complicated.

“Thinking about getting a booster heading into the football season, holiday season, is very important to think about as far as topping off your antibody levels, especially if you’re going to be indoors with a lot of people,” said Dr. Joseph Gastaldo with OhioHealth.

The need for a booster seems to be especially important for those who got the “one and done” Johnson and Johnson shot.

Moderna and Pfizer boosters are being recommended for at Americans 65 and up or those with weakened immune systems or those who work in areas with high risk to exposure like hospitals or schools. Those shots are being recommended six months after the initial two doses.

When it comes to the J&J boosters, the CDC said anyone who got the one-shot should get a booster and only after just two months.

“There’s real-world data showing the J&J vaccine doesn’t give the same degree of protection as the mRNA vaccines and I think if the J&J vaccine came out today, it would be a two dose vaccine,” Gastaldo said.

“The level of protection that is afforded by the (J&J) vaccine is lower than what we get with the mRNA vaccines already at baseline,” said Dr. Carlos Malsvestutto with The Ohio State University’s Wexner Medical Center. “It’s somewhere around 74-percent compared to 94, 95-percent for the Pfizer and the Moderna vaccines.”

Adding another layer of complexity, the ability to mix and match vaccine types.

“You can do a booster with J&J, you can do a booster with Pfizer, you can do a booster with Moderna. Studies have been done that found it to be safe,” Gastaldo said.

Some studies mixing and matching vaccines may actually have benefits.

“They actually had higher levels of antibodies than if they had just received the same vaccine as the second dose. If they did the same vaccine, they will get an increase in antibody levels that is about four to six-fold higher but if they receive another vaccine… then the boost is actually much higher. They get a much higher increase in the number of neutralizing antibodies,” Malsvestutto said.

The Ohio Department of Health has released a FAQs section on its website with more information including who should get a booster shot and when.