4th Covid Booster
BA.2 Wave and 4th Covid Booster; Should you get it?
We have been in a pandemic for the past 2 years and although it seems like life has gone back to semi-normal, the pandemic is still here. We are extremely fortunate in the US that we have vaccines available to help prevent the transmission of Covid and decrease the severity of disease in those that are infected. The vaccines have been a game changer for sure and we can say we are in a much better place from 2 years ago as far as increase in knowledge, understanding, and treatment of Covid-19, although we still have much left to learn. The word Pandemic is defined as “occurring over a wide geographic area (such as multiple countries or continents) and typically affecting a significant proportion of the population" by Miriam Webster Dictionary.
Currently a new strain BA.2 (sub-variant of Omicron BA.1) has gained hold and is now the most common circulating strain in the US causing more than 85% of cases. BA.2 is much more transmissible than Omicron by 30% to 60%. 1 The good news is that it doesn’t seem to be anymore severe in symptoms than Omicron. Evidence shows that re-infection with BA.2 after having been infected with Omicron is possible but less common.
We are seeing some dramatic increases in cases in parts of the US, especially in the North East. Locally we have seen an increased positivity rate to 23%, up from 4% just several weeks ago. However, we are not seeing as dramatic increase of hospitalization rates just yet. Hospitalizations typically lags behind 3-4 weeks, which could explain this. The hope is that with higher percentage of the population through vaccination and prior infection, we won’t see as dramatic a peak as we did with the Omicron wave and hopefully not as many hospitalizations or deaths either.
Most Covid restrictions have been lifted and funding for testing, vaccinations, etc have been exhausted. Currently, vaccines and Paxlovid treatment (oral pill for Covid treatment outpatient) remains to be offered free to uninsured and without any out of pocket cost to insured. Monoclonal antibody treatment, while available, is not as abundant and may require out of pocket costs.
If you have not yet been vaccinated, I highly recommend doing so. It is never too late to start. If you have any questions related to the vaccines or concerns, please do not hesitate to reach out. Especially now, with most restrictions having been lifted, vaccination is the best tool we have to help reduce infections, reduce rate of mutations, decrease incidence of long Covid, decrease hospitalizations and prevent deaths.
BREAKING NEWS: 3rd dose Booster approved for ages 5 yrs and up.
Vaccine is not yet approved for <5 yrs old.
A 4th dose Booster approved for ages 50 yrs and up; or those who are immunocompromised.
Covid Vaccine Fourth Dose; Should you get it?
Are you planning to get the fourth dose? If you're wondering what the fourth covid dose is about, here is all you need to know regarding it.
According to FDA and CDC recommendations, there are two types of covid boosters, i.e., the fourth dose. These include:
mRNA series for immunocompromised people and those over the age of 50 years who got an initial booster (3rd dose) at least 4 months ago
J&J for all those adults who received a primary J&J vaccination plus a booster at least 4 months ago, they may get a second dose of the booster using an mRNA vaccine
If you're still debating whether you should get the booster, you must compare the benefits and risks. Although the original booster prevents hospitalization and death quite effectively, the evidence does vary from time to time.
Benefit:
The fourth dose provides added immunity and protection to those individuals that had been fully vaccinated. The immunity is not as strong as that offered by the three-dose full course of the vaccine. However, the benefit has been demonstrated by a study conducted on individuals aged 60 years and above from Israel. 2 There was a reduction in infection rate by 2 times and a reduced rate of severe disease by 4 times. The prevention of using boosters can also protect against long COVID.
Risk:
Mild fever and slight muscle pain are common side effects, but the risk of severe outcomes is close to none. Some individuals may need to rest for a few days to recover, which is definitely shorter than the amount of rest you would need if you were infected with covid.
The benefits thus outweigh the risks and make the booster useful for prevention.
When to get a booster?
You can not time when to get the booster ideally. We know that cases with the new BA.2 variant is on the rise. The local positivity rate is now at 23.7% up from 4% just several weeks ago. Immunity tends to wane a bit over time and it takes about 2 weeks to build antibodies from the vaccine so getting it prior to a wave is ideal.
Therefore, it is recommended to stick to the CDC recommended schedule and get the fourth dose.
Do you need a booster if you were infected with Covid before?
We do not know the complete answer to this. We do know that having the Covid Vaccine and having had Covid provides a Hybrid Immunity that is much better than just the vaccine alone. Some call it “Super Immunity”. Every person is different and it is hard to gauge how much of an immune response the virus will illicit in each individual person. However, studies show if you have received the first booster after being infected with covid, particularly the Omicron variant, then the 4th vaccination does not provide you with too much-added immunity since you most likely already have sufficient immunity.
Which booster should you get?
When getting the fourth dose, consider mixing the vaccines. For example, if you've received Moderna, you can choose to go for Pfizer for the fourth or vice versa.
While Moderna and Pfizer are both mRNA vaccines they are not identical, they have a different impact on T-cell mechanisms and Fc-functional antibodies, which target the whole surface of the spike protein. Therefore, mixing vaccines may provide more protection.
Should you wait for an Omicron-specific booster?
At this point we do not have a Omicron specific booster and there may or may not ever be one. Our current vaccines are doing what they were intended to do which is decrease risk of severe disease and/or hospitalizations and death.
References:
Berg, S. (2022, April 22). What doctors wish patients knew about the ba.2 omicron subvariant. American Medical Association. Retrieved May 17, 2022, from https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-ba2-omicron-subvariant
Bar-On YM, Goldberg Y, Mandel M, et al. Protection by 4th dose of BNT162b2 against Omicron in Israel. medRxiv. 2022:2022.02.01.22270232. doi:10.1101/2022.02.01.22270232