VACCINATION UPDATE FOR FALL 2023
Over the past few months, there have been a number of news reports concerning risks for developing various infections and strategies for infection prevention. The three major infections are Covid 19 (still), Influenza, and RSV (Respiratory Syncytial Virus). Fortunately, we now have or will shortly have protection by way of vaccinations. The following article summarizes the major topics involving each of these vaccinations.
The impact of Covid 19 since its first reported cases in early 2020 has been quite dramatic. Over 1.1 million Americans have died from Covid infections. Long Covid remains a significant issue with about 6-7% of people now having evidence of “Long Covid”. About 25 % of those experience symptoms that impact their daily activities.
Our knowledge concerning this virus has grown significantly in a relatively short period of time. There has been significant advancement in vaccine development including the introduction of the bivalent vaccine a year ago which expanded protection beyond the original alpha and delta strains (original vaccines) to include the omicron strains which has become the prevalent virus. Additionally, anti-viral therapy is now available should people become infected (Paxlovid) lessening the aggressiveness of the infection.
It is expected that the FDA will approve a new vaccine that should have one main advantage over the previous ones available thus far. The vaccine should expand coverage against all of the original strains but will also cover the Omicron strain presently most prevalent, EG.5. Initially, there will be two vaccines available similar to the past, manufactured by both Moderna and Pfizer and using mRNA technology. Shortly thereafter, it is anticipated that the Novavax vaccine will also be available using different technology (protein subunit vaccine). Additionally, these vaccines appear to yield protection against the BA.4, and BA.5 strains which are being closely monitored for their potential infectious risks.
In April 2023, the CDC simplified its COVID 19 vaccination recommendations: All individuals should receive at least one bivalent vaccine. This was followed by the recommendation that people over 65 years and those considered at higher risk for complications should receive a second vaccine if more than 4 months from the first bivalent vaccination. This would include those people on immunomodulators, those with chronic health problems such as significant lung or heart disease, etc.
Having an infection results in in natural immunity for at least 3 months and vaccination can be delayed for 3 months.
BOTTOM LINE: What does this mean for most patients: Unless you have had a recent Covid infection, if it has been more than 4 months since your last vaccine, strongly consider obtaining the new vaccine when available probably in mid September.
Once again, the pattern of influenza infections are anticipated to be similar to previous seasons. The updated vaccines for this year’s strains are now available. However, we typically don’t recommend obtaining the vaccine until the end of September and attempt to receive the vaccine by the end of October. The logic being the fact that the duration of impact for these vaccinations is about 6 months so if there is a late flu surge in March, people would remain protected on this schedule. Once again, patients over 65 years old and those immunocompromised should consider obtaining the high potency vaccine.
Although covid infections have a greater potential impact for patients, estimates of approximately 40,000 people die from complications of influenza infections and a greater number of people are sick enough to be hospitalized each season.
BOTTOM LINE: Unless there is a specific reason to avoid the influenza vaccine (major previous reactions), it is recommended for adults should obtain the flu vaccine.
RESPIRATORY SYNCYTIAL VIRUS (RSV)
Although RSV gets less publicity than the flu each season, most parents of young children are aware of RSV because it is the cause of serious respiratory infections in infants especially responsible for many hospitalizations. Additionally, once again the elderly and immunosuppressed are at risk. It is estimated that about 14,000 deaths occur in the U.S. annually and 60,000-160,000 people older than 65 are hospitalized. The RSV “season” is somewhat similar to influenza although some early cases are seen earlier in the fall, infections peak from late December to mid February.
There are now 2 RSV vaccines approved and available: Arexvy (Glaxo-Smith-Kline) and Abrysvo (Pfizer). No, we have no idea how these names were derived but do know it will take a little practice to get these names down. Fortunately, although each is slightly different from each other in mechanism of action, they both appear to be relatively equal in effectiveness with about an 85% response rate. They are closer to the older vaccines in mechanism of action and do not use mRNA technology. As with the other vaccines, these vaccines will have their greatest impact for the elderly population and those who are immunocompromised.
Why the publicity this year? With the availability of vaccinations, there is now the capability to protect susceptible populations from the complications of this infection.
BOTTOM LINE: If you fit within the population at risk of having a more serious infection (elderly, immunocompromised), it would be worth considering obtaining either RSV vaccine.
The above information should serve as reasonablele guidelines and recommendations, they may need to be modified at times based on individual circumstances. Patients are encouraged to discuss these issues further with their providers if there are any additional questions.
Timing: The CDC states that the Covid and Influenza vaccines can be administered together with full effectiveness and safety. Alternatively, most vaccines take about two weeks to reach full effectiveness. One can “time” vaccinations by administrating them at two week intervals.
Order of priority for 2023: Covid infections are surging presently and therefore it would be reasonable to get the Covid vaccine as soon as it is available. The influenza vaccine can be administered toward the end of September through October. The RSV vaccine can be administered 2 weeks after either vaccine. Because it is new, there is a hesitation at this point to recommend administering it at the same time as other vaccines until more data is available.
Patients receiving certain immunomodulating medications may occasionally alter the timing of these medications when receiving certain vaccinations. Discuss this issue with your provider if there are any questions.