While the number of Canadians who have received their third dose of the COVID-19 vaccine continues to increase, competing with it is the rise of the Omicron variant.
Health officials continue to urge Canadians to get their third dose as a way of protecting against severe infection. While symptoms of Omicron may be milder compared to other variants, concerns remain over its high rate of transmissibility.
So, what should someone do if they start to develop COVID-19 symptoms right before they’re scheduled to get their third dose?
“People who have symptoms, with the prevalence of disease that we have, likely do have COVID and if you likely have COVID, now isn’t the time to rush to the booster,” Dr. David Carr, an emergency physician at the University Health Network in Toronto, told CTVNews.ca in a phone interview on Wednesday. “We wouldn’t recommend getting a booster shot in the course of an active infection.”
Instead, both Carr and Dr. Gerald Evans, chair of Queen’s University’s infectious diseases division in Kingston, Ont., recommend that anyone experiencing COVID-19 symptoms should hold off on getting their third dose until they have recovered. This applies whether or not the symptoms are actually related to COVID-19 or a different virus, both said.
Part of the reason for this is a “reduced immunogenicity effect” that often comes with getting any kind of vaccine while experiencing a viral infection, said Evans, particularly if the infection is severe.
“We don’t give it to you while you’re acutely ill because the vaccine seems to have less of an effect in producing the response we want from the immune system,” he told CTVNews.ca on Wednesday in a phone interview. “Your immune system doesn’t seem to respond as well to the vaccine as it would when you’re feeling well.”
Generally speaking, this applies to any vaccine, both experts said. Another reason for this is that it can lead to confusion over whether any side-effects are related to the vaccine or a progression of the illness, said Carr.
“It confuses the clinical picture [and] can re-challenge your immune system, it’s just not the right time,” he said. “As a general rule of thumb, we don’t want to introduce a vaccine when someone’s not feeling well.”
HOW LONG SHOULD YOU WAIT?
Carr said that as a general principle with vaccines, it’s recommended to wait about a month after the onset of symptoms before getting vaccinated. If someone is infected with COVID-19, this provides them with more than enough time to recover, he said, and those who are infected with the virus should not be concerned about getting reinfected so soon after.
“A common parameter with most cases in virology is if you just had the illness, you’re probably not going to get the exact same illness right away, you have high levels of circulating antibodies that are going to protect you,” he said. “If you had COVID with Omicron today, I can’t see you being reinfected in three weeks, that’s just not going to happen.”
But Evans said that thanks to post-vaccine surveillance following the billions of doses that have been administered worldwide, data suggests that there don’t seem to be any issues with getting a COVID-19 vaccine as soon as the more serious symptoms have recovered.
Symptoms of COVID-19 often include a new or worsening cough and fever, as well as a sore throat and nasal congestion, said Evans. Once these symptoms show signs of starting to resolve, it’s OK to go ahead with getting a third dose of the vaccine, he said.
“Once your throat’s not so sore anymore, your nasal congestion is clearing up, you can breathe well [and] you’re not coughing anywhere near as much as you did…then that’s a reasonable time to book your vaccine,” he said.
But that doesn’t necessarily mean people need to wait until they’re feeling entirely back to normal again before getting their third dose, Evans said.
“Even the healthiest people, after they get a cold or the flu, oftentimes have some sort of lingering symptoms that can go on for a number of weeks,” he said. “[Maybe] that cough has lingered on a little bit, or they’re a bit more fatigued than they were before they were sick…don’t worry about those.”
According to recommendations from the U.S. Centers for Disease Control and Prevention, if someone is experiencing any “moderate or severe illness,” it’s advised to wait until they recover before getting a COVID-19 vaccine. But for people with mild illnesses, or who have begun to see their symptoms improve, it’s possible to be vaccinated. Anyone who is, in fact, sick with COVID-19 is advised to postpone their vaccine until they have recovered from acute symptoms.
WHAT ARE THE NEXT STEPS?
If someone starts experiencing COVID-19 symptoms, the first step would be to confirm whether or not they are COVID-19-related by using either a rapid antigen or PCR test, Carr said. This is especially the case for people who aren’t vaccinated, as they are at “substantially higher risk for severe disease,” he said.
Still, Carr said that challenges around access and eligibility requirements can make it difficult for some people to get tested. If it’s not possible to get tested right away, he recommends following local public health guidelines and self-isolating for the required amount of time until symptoms have improved for at least 24 hours. He also suggests calling a family physician for further guidance, if needed.
From there, Evans advises to continue watching how symptoms develop over time; only when they start to clear should someone get their third dose, he said.
“Be patient, put off your vaccine and rebook,” said Evans.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
