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Boost Now or Best to Wait?

July 5, 2022 – A new combination vaccine for COVID-19 will likely be coming out this fall, offering more protection against the Omicron variants of COVID-19. Vaccine maker Moderna said in a recent news release that the new vaccine is expected to be a “lead candidate” as a booster shot in the fall. But as the CDC has doubled down on its recommendations for those who are eligible to get their second booster, some are questioning the timing and choice of their fourth shot.

Here are the answers to some common questions about boosters.

Should I get a second booster if I recently tested positive for COVID-19?

According to CDC recommendations, it is best to wait until your symptoms have ended before getting a second booster shot. The CDC says that some may want to consider waiting 3 months after the start of COVID-19 symptoms to receive a second booster shot, but the only requirement is that you no longer have to self-isolate.

Should I expect any different side effects from the second booster?

Hannah Newman, the director of infection prevention at Lenox Hill Hospital in New York City, says side effects from a second booster are different from person to person. “Side effects are very short-lived and can be treated with supportive medication,” she says. According to experts at Johns Hopkins Medicine, common side effects of COVID-19 vaccinations include fever, body aches, chillsoath swollen lymph nodes. But these symptoms are a sign that “your immune system is responding to the shots,” they say

Should I try to time my second booster with the expected surge of COVID-19 cases in the fall?

Newman recommends getting the second booster as soon as you can. “There is a high level of community transmission right now, so it’s better to get it as soon as you are eligible to allow time to build up antibodies.”

Amesh Adalja, MD, an assistant professor at the Bloomberg School of Public Health at Johns Hopkins University, says it takes “probably 7 days or so until you reach the peak protection for the immune system to have reacted.”

Should immunocompromised people consider getting a second booster?

The FDA has authorized second booster shots for anyone over the age of 50 and people over the age of 12 who are immunocompromised. Newman says a second booster can offer immunocompromised people more protection from COVID-19. “If they ended up having a breakthrough infection, it would ensure their symptoms would be milder, in theory,” she says.

How does the new Novavax vaccine affect COVID-19 vaccinations and boosters?

A panel of advisers to the FDA says the Novavax vaccine for COVID-19 should be granted emergency use authorization, although the agency itself has not yet agreed. The Novavax shots are protein-based vaccines, meaning that they inject the spike protein of the COVID-19 virus into your body. Protein-based vaccines have been used for decades. Common vaccines like those for hepatitis B and human papillomavirus (HPV) use this method. These are different from the mRNA-based Moderna and Pfizer vaccines, which give your body the instructions to make the spike protein so your immune system can learn to recognize it in the future.

William Schaffner, MD, a professor of preventive medicine at Vanderbilt University School of Medicine, says unvaccinated Americans may be more likely to get the Novavax shot if they are skeptical of mRNA vaccines, saying “Novavax is made from more traditional methods, so we may be able to add more people to the vaccinated cohort.”

If I have had three doses of Pfizer’s vaccine, can I switch to Moderna for the fourth?

You can get a different second booster that is different from the primary series and the first booster you received. A study sponsored by the National Institutes of Health found that using different vaccines as a first booster was safe and effective.

Looking Forward

A lot could be riding on whether a combination vaccine designed to target two coronavirus strains in one product gains FDA authorization and CDC recommendations for use as an updated booster.

In the meantime, Ashish Jha, MD, the White House COVID-19 Response Team coordinator, reassured reporters during a June 23 White House briefing that there would be enough of this combination – known as a bivalent vaccine – for high-risk Americans going into fall and winter. But he said that without new COVID-19 funding from Congress, “we will not have enough vaccines for every American who wants one.”

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