do I need the spring Covid shot?

[Claybuster]

I have had 7 covid shots since the start of Covid. On October 10 of 2023 I received the Moderna bivalent booster, as well as the flu shot and RSV shot. I came down with Covid, for the second time, on March 20 of 2024. First time was April of 2022, I am doing fine now. My wife tells me she received notification from our pharmacy that all those 65 and older should get another booster before June. Because I had Covid a little over a month ago, is there any benefit to getting the spring shot, or should I wait until the fall Covid shot is offered?

[MisfitK]

You should wait.

The last guidance I saw (and it's been awhile) was to avoid a Covid shot until it's been 3 months since you've had a diagnosed case of Covid. Since you just got Covid last month, I wouldn't feel comfortable getting a vax for it til late June at the earliest...and by then, you should probably just wait for the fall shot in Aug/Sept.

[Claybuster in reply to MisfitK]

Thank you. That was basically my thoughts.

[J1015 in reply to MisfitK]

Thanks for posting. I had the bivalent vaccination a couple of weeks before Christmas and also had a very mild case of Covid in February. Was wondering if I should get a spring booster. Guess I will wait. Thank you for addressing this.

[Agfar]

I had my COVID booster last week (in the UK) and was asked if I'd had COVID in the last four weeks. I hadn't had COVID in that timescale so was given the vaccine. I deduce from that if I'd had COVID five weeks ago I may well have been given the vaccine. I believe having the virus us like having a booster but asking a healthcare provider would be the best idea.

[CLLerinOz Administrator Volunteer]

There's not really an easy answer to your question, Claybuster because the CDC's advice has become more nuanced, based on things including a person's vaccination history, age, whether they're immunocompetent or immunocompromised and time since infection. It's also made difficult because, as it's transmitted, the virus keeps mutating.

If I'm reading the current information correctly (including some for those aged 65 and over in the US that was released last week), it looks as if, should you wish to and in discussion with your doctor, you'd technically have time to consider getting an updated vaccine before you get another one in the Fall - it would be a bit tight but doable.

I'm basing that on the fact that you could consider delaying your next vaccine until 3 months from symptom onset of your recent infection cdc.gov/vaccines/covid-19/c... and then get another vaccine at least two months later. cdc.gov/mmwr/volumes/73/wr/...

Having said that, there are some who advise separating the vaccines by more, not less, time.

Also, the variant landscape has changed and, in its very recent recommendation to update vaccines based on the JN.1 variant, WHO said that the "ability for XBB.1.5 vaccination to protect against symptomatic disease may be less robust as SARS-CoV-2 evolution continues from JN.1". cidrap.umn.edu/covid-19/who...

It's likely that countries like the US will start to use the new JN.1 based vaccines as they become available but I don't think there's any way of knowing yet whether that will be ahead of the Fall programme.

It really comes down to whether the timing you'd need to follow to fit in a vaccine before the Fall might give you a better outcome than skipping the XBB.1.5 vaccines altogether and waiting for a JN.1 based vaccine and that's a conversation best had with your doctor. The protection from the XBB.1.5 vaccines will be 'less robust' against JN.1 variants but that doesn't mean they'll offer no protection at all. Be mindful, too, that, while the risk of re-infection, in general, is reduced in the weeks and months after an infection, the emergence of new variants can affect how long and how strong your immunity from a previous infection might be.

CLLerinOz

[Claybuster in reply to CLLerinOz]

Thanks. A lot to contemplate.

[skipro]

both my oncologists say NOT to get it because it doesn’t work against the current variants.

[CLLerinOz Administrator Volunteer in reply to skipro]

Here's what WHO said on 15 April 2024:

"The majority of these studies have found JN.1 to be more evasive than other recently circulating Omicron sublineages, such as EG.5 or XBB.1.5. However, several studies have found similar neutralization of JN.1 and one or several recent Omicron sublineages. Where JN.1 has been found to be more immune evasive, the drop in neutralization titer is typically modest and many individuals retain some neutralization.

Vaccination with an XBB.1.5 monovalent booster has been shown by multiple studies to increase neutralization titers against JN.1 (5-6, 11-17). Effectiveness of the XBB.1.5 monovalent booster at protecting from symptomatic JN.1 infection has been estimated at between 19% to 49% in different studies from the US (26-27).

Pre-existing SARS-CoV-2-specific T cells are predicted to cross-recognize BA.2.86, whereby 72% and 89% of CD4 and CD8 SARS-CoV-2 responses are still conserved in BA.2.86 (28).

** see footnote for more explanations:

** Antibody escape

Level of risk: Moderate, as it is estimated that JN.1 has increased immune evasion relative to co- circulating variants.

Confidence: High, as there are increasing data on cross neutralization of JN.1 from varied population immunity backgrounds"

who.int/docs/default-source...

While it's disappointing to see the drop in the XBB.1.5 booster's effectiveness at protecting from symptomatic JN.1 infection, it's encouraging to see that SARS-CoV-2-specific T cells are still conserved and will help prevent more serious COVID-19.

I'm not yet sure of how the "FLIP" mutations emanating from the JN.1 line of variants will affect things. We await further information, I think, but it's reasonable to think that the T cell response will be conserved to a large extent.

Whether that's enough to go ahead with another booster is the question, I guess, and that will depend on a person's previous vaccination and infection history - ie whether and when they've already received an XBB.1.5 vaccine and/or been infected."

CLLerinOz

[CLLerinOz Administrator Volunteer in reply to CLLerinOz]

Some early data about the KP.2 variant, an offspring of JN.1, has been published but it is a pre-print (so not yet peer reviewed). However, in this early indication, there are signs that it is better able to evade immunity from vaccination and/or previous infection.

"KP.2 shows the most significant resistance to the sera of monovalent XBB.1.5 vaccinee without infection (3.1-fold) as well as those who with infection (1.8-fold). Altogether, these results suggest that the increased immune resistance ability of KP.2 partially contributes to the higher Re more than previous variants including JN.1."

"Yu Kaku, Keiya Uriu, Yusuke Kosugi, et al. Virological characteristics of the SARS-CoV-2 KP.2 variant, bioRxiv (2024), doi: 10.1101/2024.04.24.590786, biorxiv.org/content/10.1101...

Some more information is contained in the following article that was published by News Medical Life Sciences: news-medical.net/news/20240...

Like many studies, this one concentrates on antibodies and doesn't provide information about T cell protection. In the WHO's latest update about vaccine formulations, the organisation noted that:

"Although neutralizing antibody titres have been shown to be important correlates of protection from SARS-CoV-2 infection and of estimates of vaccine effectiveness, there are multiple components of immune protection elicited by infection and/or vaccination. Data on the immune responses following XBB or JN.1 descendent lineage infection or XBB.1.5 vaccination are largely restricted to neutralizing antibodies and data on other aspects of the immune response, including cellular immunity, are limited."

who.int/news/item/26-04-202...

CLLerinOz