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When Should You Get The New Bivalent Covid-19 Vaccine Booster?

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They say that timing is everything in life. That certainly applies to investing in the stock market, meeting your significant other, and deciding whether to wear clothes. But should it apply to when you get the bivalent Covid-19 vaccine booster? Should you worry about getting it too early or too late? Or should you just get it as soon as possible? Well, getting it now versus later is a good idea with three possible exceptions. Here’s why.

Getting the bivalent booster is indeed a bit like choosing whether to wear clothes. You don’t want to have any should’ves, could’ves, would’ves in the future. You don’t want to be saying, “perhaps I should have been wearing clothes when I ran into my boss in the elevator” or “what could have happened had I been wearing clothes while running into my potential soulmate in the museum?” Similarly, you don’t want to be lying in the hospital one day thinking, “yeah, probably should’ve gotten the booster earlier.” At the same time, it is unlikely that you will end up regretting doing either thing too soon. There may not have been too many times in your life when you have said, “If only I hadn’t been wearing clothes at the time.”

In a similar vein, let’s look at the current situation. It’s mid-October right now with November just over two weeks away. While you may be able to lose a guy in 10 days, it could take longer, at least two weeks, to get full immune protection from vaccination against Covid-19. Therefore, if you want to be protected as much as possible come November, it’s a good idea to get fully up-to-date on your vaccinations now.

And what might happen in November besides National Fun with Fondue Month? The answer rhymes with “a bro bid 19 merge.” For the past two years, November has seen Covid-19 surges. Take a look at the steep upward curves in the number of new reported Covid-19 cases each day that occurred in November 2020 and November 2021. Hmm, do you think it’s a coincidence that November is when the weather tends to get much colder and drier and activities typically move indoors? November is also traditionally a heavy travel month. Such conditions can really promote the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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Upward swings in Covid-19 hospitalizations and cases have already been happening in Europe as I mentioned on September 26 for Forbes. Throw in the fact that many people in the U.S. and Europe have ditched Covid-19 precautions such as face mask wearing as if they were micro-sunglasses or cheetah-print slip skirts and conditions in general are ripe for yet another Covid-19 surge in the U.S. next month.

So, in the words of 2Unlimited, y’all ready for this potential next Covid-19 surge? Not exactly, if you haven’t gotten the bivalent booster yet. Unless you’ve recently had Covid-19, chances are your immune system is not that familiar with the most common circulating version of the SARS-CoV-2: the BA.5 Omicron subvariant. Over the past week, the BA.5 has constituted 67.9% of all Covid-19 samples reported to the Centers for Disease Control and Prevention (CDC). Previous Covid-19 vaccinations could offer at least some protection against the original SARS-CoV-2, the one that spread in early 2020. However, relying on just this protection can be sort of like your smartphone relying on an operating system from 2020 that hasn’t been updated since. Plus, your immune protection from Covid-19 vaccination may have waned and weakened over time. This could leave you vulnerable like a person without clothes this coming month.

According to CDC data, as of today, less than 5% of the U.S. population has gotten the bivalent boosters so far. That’s pretty darn low and leaves the U.S. vulnerable to what’s apparently happening in Munich, Germany, right now. As Peter Hotez, MD, PhD, Dean of the National School of Tropical Medicine, tweeted today, “if all eligible Americans get their new bivalent booster we might avoid” massive Covid-19 rises that end up overwhelming our not-so-difficult-to-overwhelm health care system:

These new bivalent boosters are the first big update in the Covid-19 mRNA vaccines since, well, ever. As I described previously for Forbes, the Pfizer-BioNTech and Moderna bivalent booster vaccines are called bivalent because they contain messenger RNA (mRNA) for not just one type of spike proteins but two of them. These two types of mRNA will help your cells code for not only the original SARS-CoV-2 spike protein but also the spike proteins found on the surfaces of the BA.4 and BA.5 Omicron subvariants.

Could getting the bivalent booster right now be a bit too early? Today, a friend borrowed words from the song “My Shot” from the musical Hamilton when wondering whether getting the bivalent booster right now would be “throwin’ away your shot.” (By the way, that song from Hamilton was not about vaccination.) Sure, your immune protection may peak four to six weeks after vaccination and then start waning afterwards. Sure, that may leave you not quite as well protected January through March as compared to November and December. Nevertheless, waning immune protection is not like one of those warrantees on your tech devices where everything starts falling apart as soon as the warrantee expires. Instead, the waning should be gradual, meaning that getting vaccinated now should still leave you with a fair amount of protection for at least the next four to six months or so, as the World Health Organization (WHO) indicates.

If you are really worried about what may happen after six months, think about where you may be by then. It will be the Springtime when the weather should be warmer and more humid again with people moving activities back outside once more. That’s all assuming that a nuclear Armageddon hasn’t yet occurred, which certainly is always possible but may not be that likely. Meanwhile, no one can say for sure what variants and subvariants may be circulating by the Spring 2023. Chances are they will be different from the BA.4 and BA.5. So the real prime usefulness of the current bivalent boosters should be over the next six months.

On top of all that, our world could be in a very different situation come April and May. The Winter of 2022-2023 could potentially see the last one or two big Covid-19 surges before the pandemic is no longer considered to be a pandemic and instead has transitioned to a seasonal virus situation. So you might as well “hold on” in the words of Wilson Phillips and get up-to-date with your Covid-19 vaccinations now for what could be the Covid-19 pandemic’s last stand.

The three possible exceptions are if you’ve just gotten a previous version of the vaccine such as the older booster, just had Covid-19, or have been told by your medical doctor to hold off on getting vaccinated for some reason. The U.S. Food and Drug Administration (FDA) has indeed stipulated that before getting this new bivalent booster you should be at least two months out of previous Covid-19 vaccination such as getting the old booster. So if you are trying to get the bivalent too close to your last booster, the pharmacist may say, “bye Felicia” or “bye” whatever your name is and ask you to come back later.

If you’ve recently had Covid-19, the CDC is recommending that you wait at least three months before getting the bivalent booster, as I covered for Forbes on October 7. That’s because it may take your immune system a little while to recover from fighting Covid-19. And you want your immune system to be ready for the vaccine and ready to generate a proper full response. As I reported in that previous Forbes article, a study has suggested that waiting six months may give your immune system the full amount of time to recover from Covid-19, but it’s still unclear whether such a wait would necessarily be better.

So what do you do if you last got Covid-19 say in mid-June? It may seem like you are currently in the gray zone, being longer than three months out but not quite past the six-month mark. The challenge is that you can’t be sure what kind of immune protection you may have gotten from your last bout of Covid-19. It could be fairly strong. Or it could be relatively weak. Therefore, if you want to make sure that you are protected for a starting-in-November surge, it may be better to just get the bivalent booster right now.

Of course, there are situations where your doctor may tell you to wait for it, wait for it, wait to get your booster. For example, you may be getting some type of treatment that may be suppressing your immune system. Or you may be one of those rare individuals who has an actual ongoing medical reason not to get the vaccine. In any case, make sure that you are getting advice from a real medical doctor first. Your medical doctor should also give a clear scientific rationale for holding off on the Covid-19 vaccine. If the words “microchip”, “5G”, or “they’re coming to get you,” enter his or her explanation, you may want to find another doctor.

As a reminder, getting the bivalent booster alone won’t mean that you are completely protected from getting Covid-19. It won’t mean that you don’t have to maintain other Covid-19 precautions such as face mask wearing while in public indoors to avoid getting infected. That would be like assuming that wearing pants alone would be enough for a date or a job interview. Your interviewer or your date may say something like, “umm, where is your shirt?” As long as the pandemic continues, which certainly won’t be forever, consider vaccination to be only one layer of protection no matter when you time your vaccinatations.

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Toronto-based infectious disease expert seeing more older patients with flu in hospital

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An infectious diseases physician in Toronto is reporting an increase in the number of older patients he is seeing with seasonal influenza.

Dr. Isaac Bogoch at Toronto General Hospital noted this year’s flu season started early and escalated quickly.

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According to the Public Health Agency of Canada, children under five are still making up the largest age bracket of flu patients in hospital. However, rates among seniors (aged 65 and up) are on the rise.

Bogoch expects the number of flu cases to keep increasing. The season usually peaks in January.

To track the number of flu cases in Durham Region this season, click here.

 

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Breakthrough Infections More Likely in Infliximab Treated IBD Patients Than Those Treated With Vedolizumab

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Patients with inflammatory bowel disease (IBD) treated with infliximab who were vaccinated against SARS-CoV-2 were more likely to have a breakthrough infection than patients treated with vedolizumab, but the benefits of the vaccine are still superior.

A team, led by Zhigang Liu, PhD, Department of Metabolism, Digestion and Reproduction, Imperial College London, determined how infliximab and vedolizumab affect vaccine-induced neutralizing antibodies against highly transmissible omicron (B.1.1.529) BA.1, and BA.4 and BA.5 (hereafter BA.4/5) SARS-CoV-2 variants.

The Treatments

Anti-TNF drugs, including infliximab, are linked to attenuated antibody responses following SARS-CoV-2 vaccination. The variants included in the analysis have the ability to evade host immunity and with emerging sublineages are currently the dominating variants causing the current waves of infection.

In the prospective, multicenter, observation, CLARITY IBD cohort study, the investigators looked at the effect of infliximab and vedolizumab on SARS-CoV-2 infections and vaccinations in patients with IBD.

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The study included patients aged 5 years or older with an IBD diagnosis that were treated with infliximab or vedolizumab for 6 weeks or longer in infusion units at 92 hospitals in the UK. Each participant had uninterrupted biological therapy since recruitment and were not previously diagnosed with a SARS-CoV-2 infection.

Outcomes

The investigators sought primary outcomes of neutralizing antibody responses against SARS-CoV-2 wild-type and omicron subvariants BA.1 and BA.4/5 following 3 doses of a SARS-CoV-2 vaccine.

The team also investigated the risk of breakthrough infections in relation to neutralizing antibody titers using Cox proportional hazard models.

There were 7224 patients with IBD recruited to the study between September 22 and December 23, 2020. Of this group, 1288 had no previous SARS-CoV-2 infections after 3 doses of the vaccine that were established on either infliximab (n = 871) or vedolizumab (n = 417). The median age of the patient population was 46.1 years.

Following 3 doses of SARS-CoV-2 vaccine, 50% neutralizing titers were significantly lower in the infliximab group compared to patients treated with vedolizumab against wild-type (geometric mean, 2062; 95% CI, 1720–2473 vs geometric mean, 3440; 95% CI, 2939–4026; P <0.0001), BA.1 (geographic mean, 107.3; 95% CI, 86.40–133.2 vs geographic mean, 648.9; 95% CI, 523.5–804.5; P <0.0001), and BA.4/5 (geographic mean, 40.63; 95% CI, 31.99–51.60] vs geographic mean, 223.0; 95% CI, 183.1–271.4; P <0.0001) variants.

Breakthrough infections more frequently occurred in patients treated with infliximab (n = 119; 13.7%; 95% CI, 11.5–16.2) than in those treated with vedolizumab (n = 29; 7.0%; 95% CI, 4.8–10.0; P = 0.00040).

The Cox proportional hazard models show time to breakthrough infection after the third vaccine dose in the infliximab group was associated with a higher hazard risk than treatment with vedolizumab (HR, 1.71; 95% CI, 1.08-2.71; P = 0.022).

There was also higher neutralizing antibody titers against BA.4/5 with a lower hazard risk in the group with a breakthrough infection and a longer time to breakthrough infection (HR, 0.87; 95% CI, 0.79-0.95; P = 0.0028).

“Our findings underline the importance of continued SARS-CoV-2 vaccination programs, including second-generation bivalent vaccines, especially in patient subgroups where vaccine immunogenicity and efficacy might be reduced, such as those on anti-TNF therapies,” the authors wrote.

The study, “Neutralizing antibody potency against SARS-CoV-2 wild-type and omicron BA.1 and BA.4/5 variants in patients with inflammatory bowel disease treated with infliximab and vedolizumab after three doses of COVID-19 vaccine (CLARITY IBD): an analysis of a prospective multicenter cohort study,” was published online in The Lancet Gastroenterology & Hepatology.

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Flu shot uptake in children ‘too low,’ P.E.I. CPHO says

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With flu cases on the rise in the province, P.E.I.’s Chief Public Health Officer is urging parents to get their young children a flu shot.

Currently, just 19 per cent of children under the age of 10 have gotten a vaccine.

“I do think that’s too low,” said Dr. Heather Morrison, the province’s chief public health officer. “On the other hand, we’ve had great uptake of our high dose influenza for those who are 65 years of age and up.”

Morrison said there are some clinics on the weekend in Charlottetown through public health nursing and appointments are available “to really help those who may not be able to come during the week.”

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By Dec. 3 there have been 155 lab-confirmed cases, according to a P.E.I. government website. The median age of cases to date is 14 years old. The site says there was “widespread flu activity” last week on P.E.I. with flu activity “above expected levels for this time of year.”

‘They are getting better now’

Without vaccines, children four and under are most at risk of being hospitalized, Morrison said. That’s exactly what happened to Island resident Shidhin Philip’s youngest son, Adam, who was less than a month old when he was hospitalized with influenza and RSV.

Shidhin Philip’s youngest child, Adam, at the QEH when he was sick with RSV and influenza at less than a month old. (Submitted by Shidhin Philip)

“We were really scared,” said Philip. “But we know we took him to the hospital at the right time, so that was a good decision.”

On Wednesday, Philip brought two of his older children to the children’s clinic in Sherwood to get their flu shot.

“They all had the flu, the sore throat, running nose, they had fever, they were throwing up. They were absent from school for two weeks,” Philip said. “They are getting better now, I don’t want to get it back again. So I took the appointment for the flu shot today.”

A man in a puffy green jacket wraps his arms around his two daughters, who stand on either side of him.
Shidhin Philip and two of his four children, Angel and Anna, outside a vaccination clinic in Charlottetown. (Steve Bruce/CBC)

But he says having vaccines available at public schools would make it easier for busy parents to get their children vaccinated.

“They can send the paper home, we can sign the consent,” he said. “Instead of making an appointment or waiting [a] long time, you know, it can finish in one day.”

Morrison says there are some logistical issues with making the vaccine available in schools, but it is something the province is potentially looking into for future years.

“It’s something that we certainly would be very open to having that conversation with education, public health, nursing, Health P.E.I,” she said. “It has been something that has been discussed over the years.”

In the meantime, she encourages parents to make an appointment and hopes strong messaging, combined with the recent spike in flu cases, will motivate parents to book their kids’ shots.

“Children are at school, and activities, we’re all busy,” she said. “But if we can get it now, get our children vaccinated, ourselves vaccinated, it will protect us in time for the holidays.”

Visit P.E.I.’s weekly influenza summary and flu vaccination clinics websites for more information.

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