Considerations for your fall Covid-19 vaccineTiming, mixing, and more. Dr. Katelyn Jetelina, M.P.H. Ph.D.-Your Local Epidemiologist

[lankisterguy]

Considerations for your fall Covid-19 vaccine Timing, mixing, and more. KATELYN JETELINA SEP 14, 2023

Everyone over 6 months is eligible for an updated Covid-19 vaccine this fall. We can leverage scientific data to optimize timing, choice, and, thus, protection.

To view the graphics and charts that go with the text below please go to:

yourlocalepidemiologist.sub...

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Here is the lowdown.

How long after infection/vaccination should I wait?

This is tricky.

We have frustratingly scarce scientific guidance on timing. What we do have tells us this:

Minimum wait: 2-3 months. A Covid-19 vaccine doesn’t add much benefit within 2-3 months of infection. We don’t have to wait 2-3 months after infection—we won’t “exhaust” or “overwhelm” our immune system. But waiting will ensure we broaden B cells (our second line of defense; our antibody factory that stores some long-term-memory). With an updated vaccine formula, we want our factory updated.

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Maximum wait 8-12 months: The longer we wait, the more we get out of the vaccine. One study found that waiting 8 months increased neutralizing antibodies 11 times more than waiting 3 months after infection. Another study found a 12-month interval improved vaccine effectiveness against hospitalization.

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BUT waiting is a gamble. Even if a vaccine sooner is not as good as it could be, it’s better than waiting too long and catching Covid with limited protection, especially for high-risk people.

SO, this is what I’m suggesting to my family:

Over 65 or at risk for severe disease: Get vaccine 4 months after infection/previous vaccine. Don’t wait more than 6 months. (Go here to understand why older adults need more urgent protection.)

Under 65 and not high risk: Wait at least 6 months. Ideally, get vaccinated once a winter wave starts taking off. (Getting it by Halloween is a good bet.) This is what I will be doing with my family. But remember, we have very little/no protection against infection until we do. So, other layers of protection are especially needed.

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Do I wait for Novavax?

There is some evidence that mixing Novavax with mRNA is better and some evidence that staying with mRNA is better. It’s a bit hard to know which one is “right.”

High-risk people: The data pool is so narrow I’m uncomfortable suggesting that high-risk people wait for Novavax; we don’t know if it’s immunologically better. So don’t wait for this option if it’s been >6 months since your last vaccine and/or infection.

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Other reasons people may want to wait on Novavax:

Side effects. The mRNA vaccines are the most reactogenic vaccines we’ve ever had (i.e., a lot of side effects). They kick my butt, so I will be waiting for it.

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Hesitant about mRNA biotechnology.

What about mixing the mRNA vaccines?

If you’ve only had an entire Moderna series, you may see marginal benefit from getting a Pfizer bivalent booster (and vice versa). But, to be honest, the science is mixed and isn’t very strong. So just get the vaccine that is most easily accessible.

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What about mixing with the flu vaccine?

You can get the flu vaccine (and other routine vaccines) and the Covid-19 vaccine at the same visit. It’s recommended to get them in different arms.

There have been studies on the safety and effectiveness of the co-administration of these two vaccines. In one database, about 454,000 people got the flu and Covid-19 vaccines. Both worked great. The rate of side effects was the same or a little higher among those that co-administered; however, no specific safety concerns were identified.

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(CDC) Under 5 years old and not yet vaccinated for Covid-19

I’m getting a ton of questions from parents whose kids have yet to be vaccinated for Covid-19. First, I’m glad you’re taking this step—it will help protect against severe disease and reduce the duration of illness and transmission.

I agree that guidance is confusing, but I found this CDC slide helpful:

Your unvaccinated younger child (<5 years) needs more doses than, for example, an older child because they are more likely to be immune naive (i.e., never have had this virus). Multiple shots the first time ensure the immune system creates a durable memory.

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Bottom line

Fall is here. Our priority is preventing severe disease among high-risk people, and we can be smart about it. But if this feels too much like gymnastics, get your shot before Halloween. It will help you and those around you.

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Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, M.P.H. Ph.D.—an epidemiologist, wife, and mom of two little girls. During the day, she is a senior scientific consultant to several organizations. At night, she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members

[PSP52]

Thanks so much for this information

[Stamphappy]

Timing of vaccinations has really been on my mind. How long should we wait between getting the RSV vaccine & Covid/flu vaccines?Thank you so very much for this post ❤️

[annmcgowan in reply to Stamphappy]

Hi can I ask if the RSV vaccine is available to all in the USA? I mentioned it to my haematologist here in the U.K. yesterday and he had not heard of it.

Ann

[lankisterguy Volunteer in reply to annmcgowan]

Hi Ann / annmcgowan

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In August this year our CDC & FDA approved 2 vaccines for RSV :

Vaccine recommendations

There are two RSV vaccines licensed for use in adults aged 60 years and older in the United States: RSVPreF3 (Arexvy, GSK) and RSVpreF (Abrysvo, Pfizer). For additional details on the recommendations of the Advisory Committee on Immunization Practices (ACIP) for RSV vaccination, see Adult RSV ACIP Vaccine Recommendations | CDC.

Adults aged 60 years and older:

CDC recommends that adults 60 years of age and older may receive a single dose of RSV vaccine using shared clinical decision-making (SCDM). This means that health care providers and their patients should have a conversation to determine if RSV vaccination will be beneficial. This recommendation differs from routine age-based and risk-based vaccine recommendations for which the default decision is to vaccinate all persons in a specified age group or risk group. Under SCDM, there is no default. Rather, the decision whether to vaccinate a patient is individually based and informed by discussions between the patient and health care provider (anyone who provides or administers vaccines, including primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists).

The decision may be informed by a patient’s health status, their risk of severe RSV disease (see Risk Factors for Severe RSV disease below), the health care provider’s clinical judgment, the patient’s preferences, the safety profile of the RSV vaccine products (see Vaccine Safety section below) and other factors. The SCDM recommendation for RSV vaccination is intended to allow providers and patients flexibility based on what is best for each individual patient.

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and our Medicare health insurance will pay for it (that covers most USA citizens over 65) - the other insurances apparently are still figuring out their policies on paying.

See cdc.gov/rsv/clinical/index....

SNIP: In Older Adults and Adults with Chronic Medical Conditions

Adults who get infected with RSV usually have mild or no symptoms. Symptoms are usually consistent with an upper respiratory tract infection which can include rhinorrhea, pharyngitis, cough, headache, fatigue, and fever. Disease usually lasts less than 5 days.

Some adults, however, may have more severe symptoms consistent with a lower respiratory tract infection, such as pneumonia. Epidemiologic evidence indicates that people 60 and older who are at highest risk of severe RSV disease include those with any of the following chronic conditions:

Lung disease (such as chronic obstructive pulmonary disease [COPD] and asthma)

Chronic cardiovascular diseases (such as congestive heart failure and coronary artery disease)

Diabetes mellitus

Neurologic conditions

Kidney disorders

Liver disorders

Hematologic disorders

Immune compromise

Other underlying conditions that a health care provider determines might increase the risk for severe respiratory disease

Other underlying factors that the provider determines might increase the risk of severe RSV-associated respiratory illness may include the following:

Frailty

Advanced age

Residence in a nursing home or other long-term care facility

Other underlying factors that a health care provider determines might increase the risk for severe respiratory disease

RSV can sometimes also lead to exacerbation of serious conditions such as:

Asthma

Chronic obstructive pulmonary disease (COPD)

Congestive heart failure

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Len

[annmcgowan in reply to lankisterguy]

Thank you so much for your reply Len. I will share this with my haematologist when we next meet if that’s ok with you? It looks like these vaccines are not yet available in the U.K.

Kind regards

Ann

[lankisterguy Volunteer in reply to annmcgowan]

Hi Ann,

You have my blanket permission to use and share anything I write myself or post from other sources here. And I suspect the Admins, Volunteers and members would say the same, but I cannot speak for them.

Len

[annmcgowan in reply to lankisterguy]

Thanks Len.

Ann

[RosettaClapp in reply to annmcgowan]

Covid vaccine rollout began 11th Sept in UK.. 18th for those not in residential care

[annmcgowan in reply to RosettaClapp]

Thanks I get mine with the flu jab tomorrow.

Ann

[SofiaDeo in reply to Stamphappy]

I just saw my specialist, and he told me he didn't see a reason to space them unless I wanted to, like if I was one who got "vaccine reactions" and wanted to get several together to minimize this. I am not currently in treatment. I generally don't get any kind of malaise or pain after vaccines, pre as well as post CLL diagnosis. I had an achy arm after my first pneumococcal vaccine, none that I recall from the Prevnar 20 last year.

I personally am going to space them. If I do ever react to one, I would like to know which one. Since this is newer tech, excipients, etc.

[Stamphappy in reply to SofiaDeo]

Thanks, SofiaDeo 😊 for your thoughtful response. I must say, I am anxious to get my vaccines because we've decided to go up North to see the Fall colors. The covid vaccine knocks me flat on my back for a good week every time 😔 and after that, I'm exhausted for a week longer. I'm going to get covid & flu at the same time & rsv later. The sooner I can be vaccinated, the better. We plan to take all precautions & stay away from crowds or large towns. I'm still in w&w ( thank God) and want to enjoy nature while covid is low in our state.So nice to hear from you! I hope your treatment break lasts a really really long time & that better treatments are available when you need them ❤️ Take care.

[Stamphappy]

Len beat me to responding. Thanks Len!

[db601]

Thank you! Really helps.

[Kjke]

Thanks for this comment Lankisterguy.

[Astro617]

Thanks so much for posting this! I had my 2nd bivalent booster in June and I've been trying to decide when to get the new shot.

[Muddywater]

I’m booster booked for 27th Sept and deciding whether to have flu jab at same time or wait a few weeks. Had a bad reaction to previous booster and concerned that it could be worse alongside flu jab, so interesting that the article is suggesting the combination should be no worse than an individual jab(s). So do I have potentially one ‘big’ reaction or two smaller ones as I also have a reaction to the flu vaccine? Ummm decisions, decisions…

Thanks for the info Len, it does kinda helps with my thought process.

[MisfitK in reply to Muddywater]

If you have the time, I'd slide the flu vax 2-4 weeks later. As long as you have it before Halloween, you should be good.

If time is an issue, I'd do the combo.

[Muddywater in reply to MisfitK]

Cheers MisfitK I think I’m tending to go for them spaced out a few weeks apart.

[Stamphappy in reply to Muddywater]

Covid vaccines, pfizer or moderna, have both knocked me flat. At the same appointment, last Fall, I got pfizer covid vaccine & flu shot. My reaction was no worse than when I had covid shots alone. So, 🤷‍♀️ I'm getting Moderna & flu shots at the same time this year.