The Sjögren's Foundation's goal is to keep patients informed about COVID-19 and vaccine updates when there is a new Centers for Disease Control and Prevention (CDC) recommendation.
The CDC recommends "everyone aged 5 and older should get 1 dose of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine to protect against serious illness from COVID-19" if it has been longer than 6 months since your last COVID-19 vaccine.
The CDC recommends delaying getting your updated COVID-19 vaccine if you have recently had a COVID-19 infection within the past 3 months, since reinfection is less likely within in weeks to months of prior infection. However, you may want to get your updated vaccine sooner if you are a person with
personal risk of severe disease
risk of disease in a loved one or close contact
a location with high COVID-19 hospital admission level and/or the most common COVID-19 variant currently causing illness
Throughout the pandemic and after, we asked our COVID-19 and vaccine expert, Dr. Cassandra Calabrese, to provide information and guidance on the current status of COVID, COVID vaccines, and the flu shot.
Dr. Calabrese offers us her opinion in the following Q&A:
Q: Can you share with us the current status on COVID-19 case increase and what doctors believe will occur this Fall and Winter?
A: COVID-19 infections are on the rise again but nothing like we saw last fall/winter. Fortunately, COVID-19 continues to cause less severe infection in most, which is likely reflective of protection from vaccines and prior infection, as well as less severe variants of the virus.
Q: Can you explain the different variants that are infecting people today? What is different about the new COVID vaccine?
A: On September 11, 2023, the FDA approved new COVID-19 vaccines that have been reformulated to target the Omicron subvariant, XBB. The FDA fully approved the Pfizer and Moderna mRNA vaccines for people ≥ 12 years and authorized them for emergency use in people aged 6 month to 11 years of age. The FDA isn’t calling these vaccines “boosters”, but rather a vaccine updated to “better match the currently circulating virus”. These new vaccines push last year’s bivalent boosters out, and they are no longer authorized for use in the United States.
On September 12, 2023, the CDC met to discuss recommendations for the new vaccines, and the Advisory Committee on Immunization Practices (ACIP) announced a very broad recommendation for everyone aged 6 months and up to receive a dose of the new vaccines. This is in stark contrast to guidance in other countries for this vaccine (e.g. in Europe), which focuses on specific high-risk, older populations.
The vaccines are expected to be available in the coming days.
The vaccines target a newer Omicron subvariant called XBB.1.5. Unfortunately, as SARS-CoV-2 continues to mutate, as of recent weeks, XBB.1.5 is now responsible for < 5% of new COVID-19 infections and we are on to newer variants such as EG.5 and BA.2.86, highly mutated new strains. Despite these changes, there is hope the boosters will still offer some protection against these newer variants, especially if you also have a history of COVID-19 infection. Specifically, the hope is for the vaccines to reduce severity and length of symptoms.
The new vaccines are monovalent and come in one dose option.
Q: If we got a booster this year, do we need another booster or the new vaccine in the fall?
A: In general, if you had COVID-19 infection or a prior COVID-19 vaccine dose in the past 6 months, you do not need another vaccine dose right now. My professional opinion along with many other doctors is to get the new vaccine after 6 months of prior COVID-19 infection or a prior COVID-19 vaccine or booster. The CDC recommendation suggests to consider delaying the new vaccine for 3 months after a COVID-19 infection.
Q: What if a patient had a really difficult time and a bad reaction to previous doses?
A: This question comes up a lot and it is important to differentiate a true bad reaction from vaccine reactogenicity, or the body’s normal immune response to a vaccine which can range from local redness, swelling or pain, to systemic symptoms such as fevers, chills, headaches and joint pain. Patients who experienced true adverse events or longstanding side effect from an mRNA vaccine, such as tinnitus, heart inflammation, or anything else weird or concerning, I would recommend to NOT receive another COVID-19 mRNA vaccine.
Q: Are their different makers of a vaccine and if yes, should we be seeking one over another?
A: The currently approved and recommended vaccines are from Pfizer or Moderna and are both mRNA vaccines. Novavax has also created a COVID vaccine targeting XBB, and is an adjuvanted vaccine, but has not yet been approved for use.
Q: Who should get the new vaccine?
A: As the CDC recommends and I state above, the recommendation is to get the updated vaccine if your last vaccine has been longer than 6 months and if you have not had COVID within the past 3 months.
More detailed recommendations for specific age and risk groups was not touched on in the CDC/ACIP recommendations. Personally, I believe that only those considered to be high-risk need a dose of this new vaccine. I consider patients with higher levels of immunocompromise to be high risk. “Immunocompromised” is a very broad group, and some are higher risk than others due to medications or underlying disease.
Those I consider to be “higher risk” include recipients of organ or bone marrow transplants, cancer patients actively receiving treatment, patients with immunodeficiencies, and patients with immune-mediated diseases (such as Sjögren’s) who are also receiving immunosuppressing medications such as high dose steroids, like Cellcept, rituximab, amongst others. Plaquenil is not considered to be immunosuppressing. Other risk factors include older age, which I consider to be 65 and up. If you are at higher risk, you should get the updated vaccine now.
I do not feel strongly that lower risk (< 60 yrs old, not on immunosuppression, not with multiple comorbidities, not at high risk as defined above) persons need this vaccine right now, especially if they have a history of COVID-19 infection in the past 6 months.
Q: Can you talk about research that’s been done, especially with Sjögren’s or other autoimmune patients?
A: With the new vaccines, essentially nothing – no data. We are extrapolating from data from the prior vaccines.
Q: What studies show how a vaccine may wane over time? How do we know when and if we should get a vaccine based on our own antibodies?
A: No firm recommendations were made on timing of the vaccine after infection or past vaccines (see the CDC's recommendation above). Generally, we say that if you had COVID-19 infection or a previous COVID vaccine in the past 6 months, you do not need this new vaccine quite yet.
It is not currently recommended to check COVID-19 (anti-spike) antibodies to determine if another vaccine dose is due.
Q: How should we consider masking in public at this time- with and without getting the vaccine?
A: Currently, I recommend my higher risk patients to mask in crowded spaces, such as while traveling on an airplane or at the airport.
Q: Can patients get a new flu shot and COVID vaccine at the same time? Who should get the higher dose flu shot and can that be given at the same time as the COVID vaccine?
A: Patients can receive the flu shot and COVID vaccine at the same time, whether given the standard or high-dose flu shot. The high-dose flu shot is approved for people age 65 and older. We recommend that patients get their flu shot by early October.
If you have any further questions about your medical condition, please seek advice from your physician.
Adjuvants are any substances that help the body induce an immune response and they are incorporated into some vaccines to enhance the immune response of the vaccinated individuals.
Example: The adjuvanted COVID-19 vaccine from Novavax contains saponin- an adjuvant- which stimulates an immune response and produces T lymphocytes that aid in getting rid of the antibody-marked virus and infected cells.
Definition: contains two types of antibodies
Example: Bivalent vaccines for COVID-19 contain an antibody for the spike protein of the original COVID-19 strain and an antibody for the spike protein of newer variants (ex: Omicron or BA 2.75)
Note: The spike protein is important for the virus entering a cell and causing infection.
Definition: contains one type of antibody
Example: Monovalent vaccines for COVID-19 contain an antibody for the spike protein of an ancestral COVID-19 strain (usually the original strain).
Note: The spike protein is important for the virus entering a cell and causing infection.
mRNA vaccines work by introducing a piece of mRNA that corresponds to a viral protein. For COVID-19, it is the spike protein, which is important for the virus entering the cell and causing infection. Individuals who get an mRNA vaccine are not exposed to the virus, nor can they become infected with the virus by the vaccine. Our cells will produce the spike protein and our immune system will recognize it as a foreign substance. Then, our bodies produce antibodies against the protein. If the body is infected with a virus containing the same protein, the antibodies will recognize it, attach to it, and mark it for destruction.